The development and examination of a new walking executive function test for people over 50 years of age

Abstract

A reduction in executive function (EF) performance is a major factor associated with the loss of functional independence among older adults. Computer-based tests are commonly used to evaluate EF; however, these mouse or keyboard tests are upper limb dominant while most activities of daily living (ADL, e.g. crossing a street) are lower limb dominant. The purpose of this study was to examine the utility of a newly developed walking EF test called the Walking Response and Inhibition Test (WRIT). The WRIT was validated by comparing its results a number of established computer-based tests and to an ADL-related test known to require EF, the Timed “Up & Go” Test (TUG). Fifty healthy adults, ranging in age from 50 to 86years (mean±SD, 65.5±9.6y) were evaluated using the WRIT, three computer-based EF tests, the TUG, a verbal memory test and an agility test. All computer-based EF tests were positively correlated to the WRIT (p<0.05); however, regression analyses revealed that the WRIT explained 37.5% of the variance in the TUG, while a composite of traditional computer-based tests explained 10.5%. As indicated by Lin's Concordance reliability (pc=0.82) between testing days was high and was supported by a Cronbach's alpha of 0.90. Bland–Altman analyses also demonstrated good agreement between the testing days with a small mean difference 3.48 (−3.71, 10.67). These results support the validity and reliability of the WRIT, and indicate that when assessing EF as it relates to functionality, the WRIT test may be a more appropriate measure than existing computer-based mouse and keyboard tests.