Instrumented Trail-Making Task to Differentiate Persons with No Cognitive Impairment, Amnestic Mild Cognitive Impairment, and Alzheimer Disease: A Proof of Concept Study
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Bibliographic record
Abstract
<b><i>Background:</i></b> Objective and time-effective tools are needed to identify motor-cognitive impairment and facilitate early intervention. <b><i>Objective:</i></b> 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. <b><i>Methods:</i></b> 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 (iTMT<sub>fixed</sub>) or random (iTMT<sub>random</sub>) order, or numbers (1-3) and letters (A and B) positioned in random order (iTMT<sub>number-letter</sub>). 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. <b><i>Re</i></b><b><i> sults:</i></b> 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 iTMT<sub>number-letter</sub>, 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 (<i>p</i> = 0.006). Pairwise comparison suggested strong effect sizes between AD and healthy (Cohen's <i>d</i> = 1.384, <i>p</i> = 0.001) and between aMCI and AD (<i>d</i> = 0.923, <i>p</i> = 0.028). Significant correlation was observed when comparing iTMT<sub>number-letter</sub> with MoCA (<i>r</i> = -0.598, <i>p</i> = 0.001), TMT A (<i>r</i> = 0.519, <i>p</i> = 0.006), TMT B (<i>r</i> = 0.666, <i>p < </i>0.001), and DTC (<i>r</i> = 0.713, <i>p < </i>0.001). <b><i>Conclusion:</i></b> 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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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 it