Digital trail making test-black and white: Normal vs MCI

Abstract

Objective

Trail Making Test-Black and White (TMT-B&W) was developed to assess the cognition of patients with mild cognitive impairment (MCI), dementia, and Alzheimer’s disease. Collection and analysis of test results have been limited due to scoring time and efforts required from both administrators and patients during and after taking the test. To increase efficiency and reducing scoring time, a computer version touchscreen-based digital trail making test-black and white (dTMT-B&W) was developed on Android and it was administered on MCI versus cognitively normal controls (NC) participants. The current study examines the sensitivity of newly developed computer version dTMT-B&W on NC and MCI subjects.

Method

dTMT-B&W was developed using MIT app inventor software, a web-based integrated development environment (IDE) with the Android development tools that are used to build fully functional applications for smartphones and tablets. A total of 44 participants were included, comprised of 22 NC and 22 MCI. The dTMT-TMT-B&W was administered to all NC and MCI subjects.

Result

dTMT-B&W was designed to be as consistent with the pen-paper TMT-B&W (ppTMT-B&W) where the application is a standalone installation. dTMT-B&W is divided into two parts (Part-A and Part-B), in which the subject attempts to connect black and white numbered circles sequentially as quickly as possible, while still maintaining accuracy. Similarly, the paper-based TMT-B&W requires the subject to connect black and white numbered circles in ascending order, except on a sheet of paper rather than a tablet. dTMT-B&W successfully distinguished NC from MCI subjects.

Conclusion

dTMT-B&W is an Android application that was successfully developed to be as consistent as possible with the original pen-paper TMT-B&W to establish equal concurrent validity, with some improved features embedded into the design and dTMT-B&W revealed a significant correlation with frontal executive function and this can help in early diagnosing subjects with MCI among NC subjects.

Keywords:

• Design
• mild cognitive impairment
• mobile application
• Trail Making Test

Acknowledgments

We would like to thank the Department of Neurology at Seoul National University Bundang Hospital for providing the tools to make this application successful.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The research was funded by the Gachon University Research Fund of 2019 [GCU-2019-0815] and the National Research Foundation of Korea (NRF) Grants awarded by the Korean government [MES, No. NRF-2020R1A2B5B01002463].