Instrumented Trail-Making Task to Differentiate Persons with No Cognitive Impairment, Amnestic Mild Cognitive Impairment, and Alzheimer Disease: A Proof of Concept Study
Bibliographic record
Abstract
BACKGROUND: Objective and time-effective tools are needed to identify motor-cognitive impairment and facilitate early intervention. OBJECTIVE: We examined the feasibility, accuracy, and reliability of an instrumented trail-making task (iTMT) using a wearable sensor to identify motor-cognitive impairment among older adults. METHODS: Thirty subjects (age = 82.2 + 6.1 years, body mass index = 25.7 + 4.8, female = 43.3%) in 3 age-matched groups, 11 healthy, 10 with amnestic mild cognitive impairment (aMCI), and 9 with Alzheimer disease (AD), were recruited. Subjects completed iTMT, using a wearable sensor attached to the leg, which translates the motion of the ankle into a human-machine interface. iTMT tests included reaching to 5 indexed circles on a computer screen by moving the ankle-joint while standing. iTMT was quantified by the time required to reach all circles in the correct sequence. Three iTMT tests were designed, including numbers (1-5) positioned in a fixed (iTMTfixed) or random (iTMTrandom) order, or numbers (1-3) and letters (A and B) positioned in random order (iTMTnumber-letter). Each test was repeated twice to examine test-retest reliability. In addition, the conventional trail-making task (TMT A and B), Montreal Cognitive Assessment (MoCA), and dual-task cost (DTC: gait-speed difference between walking alone and walking while counting backward) were used as references. Re sults: Good-to-excellent reliability was achieved for all iTMT tests (intraclass correlation [ICC] = 0.742-0.836). Between-group difference was more pronounced, when using iTMTnumber-letter, with average completion time of 26.3 ± 12.4, 37.8 ± 14.1, and 61.8 ± 34.1 s, respectively, for healthy, aMCI, and AD groups (p = 0.006). Pairwise comparison suggested strong effect sizes between AD and healthy (Cohen's d = 1.384, p = 0.001) and between aMCI and AD (d = 0.923, p = 0.028). Significant correlation was observed when comparing iTMTnumber-letter with MoCA (r = -0.598, p = 0.001), TMT A (r = 0.519, p = 0.006), TMT B (r = 0.666, p < 0.001), and DTC (r = 0.713, p < 0.001). CONCLUSION: This study demonstrated proof of concept of a simple, safe, and practical iTMT system with promising results to identify cognitive and dual-task ability impairment among older adults, including those with aMCI and AD. Future studies need to confirm these observations in larger samples, as well as iTMT's ability to track motor-cognitive decline over time.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".