Trail Making for electronic touchscreen self‐administration (eTrails) as used in the remote iPACES neuro‐exergaming trial for Mild Cognitive Impairment (MCI): An initial validation report

Abstract

AbstractBackgroundTo enable brief and integrated serial assessment across a national sample, we developed an electronic version of the Trail Making test (eTrails) for remote self‐administration on digital devices. eTrails, a digital, web‐based assessment, mimicking the traditional paper version of Trails B (see demo: https://bit.ly/33DCPGP), in which participants draw a line from a number to a letter in alternating, ascending order, was integrated into the iPACES app. Herein we report on initial validation of eTrails, as compared with the paper Trail Making Test.MethodThis initial validation report examined digital trail making data (n = 34 sessions) serially collected from ten MCI and caregiver participants in the iPACES v3 clinical trial (mean age = 70.2, mean years of education = 16.9). Included in analyses were eTrails data for traditional metrics (i.e., overall completion time) and novel digital biomarkers extracted from event‐level data (e.g., # of lifts and pause time). After a baseline tele‐neuropsychological evaluation in which paper Trail Making was administered (Forms A&B), at predetermined study intervals (typically weekly), participants were automatically prompted to complete the eTrails on their iPACES tablet. In the eTrails, participants were presented with one of four randomly selected alternate forms of trail making stimuli (i.e., different spatial configurations of Form B).ResultOverall completion time from eTrails was moderately correlated with both forms of paper‐based trail making completed at baseline (correlation with Paper Trails A: r = .37, p = .030; correlation with Paper Trails B: r = .41, p = .017). Novel digital biomarkers (i.e., # lifts, pause time) were moderately correlated (r’s = 0.59‐0.6, p’s < .001) with the traditional scoring of the eTrails (i.e., assessment completion time in seconds), and though non‐significant, weakly correlated with completion time of paper Trails A (r = 0.20, p = 0.25).ConclusionThese preliminary data provide initial evidence of validity, that eTrails as a serial assessment of subtle cognitive decline can serve as a remote self‐administered digital test for serial assessment of executive function and will be further evaluated in our ongoing iPACES study. Future research may explore the sensitivity of novel digital biomarkers extractable from event‐level data.