The Walking Trail-Making Test is an early detection tool for mild cognitive impairment

Anaick Perrochon, Gilles Kemoun, Anaick Perrochon, Gilles Kemoun

Abstract

Background: Executive function impairment (in particular, mental flexibility) in the elderly, and in patients with mild cognitive impairment (MCI), is strongly correlated with difficulties in performing complex walking tasks. The aim of this study was to determine if the adaptation of a neuropsychological test (the Trail-Making Test), to evaluate executive functions during walking, can be an early detection tool for cognitive impairment.

Methods: Fifty subjects (15 young, 20 older, presumably healthy, and 15 MCI) were first evaluated for cognitive functions (Mini-Mental State Examination, Frontal Assessment Battery, and Trail-Making Test) and motor functions (10-meter walking test). All subjects then performed a spatial navigation, or a complex walking test (the Walking Trail-Making Test: [WTMT]), and their spatiotemporal walking variables were analyzed using cluster analysis.

Results: Following evaluation of WTMT locomotor performance, cluster analysis revealed three groups that were distinctly different in age and cognitive abiliTIES: a group of young subjects, a group of healthy older subjects, MCI subjects with amnestic impairment, and a group of MCI subjects with executive function impairment. The WTMT enabled early detection, (ie, borderline MCI) of dysexecutive impairment, with 78% sensitivity and 90% specificity.

Conclusion: The WTMT is of interest in that it can help provide early detection of dysexecutive cognitive impairment.

Keywords: detection; mild cognitive impairment; spatial navigation; trail making test; walking.

Figures

Figure 1
Figure 1
Illustration of WTMT experimental conditions. Notes: There are three different walking conditions: WTMT-N, where the subject must walk in ascending order on numbered targets 1–20; WTMT-A, where the subject must walk in ascending order on targets 1–20, avoiding distractors; and WTMT-B, where the subject must walk alternating between numbers and letters in ascending order, while avoiding distractors. Abbreviation: WTMT, Walking Trail-Making Test.
Figure 2
Figure 2
Dendrogram of spatio-temporal walking variables during WTMT. Note: The subjects are grouped in pairs by similarity of the selected variables. Abbreviations: YH, young healthy; OH, older healthy; blMCI, borderline MCI; naMCI, non-amnestic MCI – executive impairment only; aMCI, amnestic MCI; mdMCI, multiple domain amnestic MCI; WTMT, Walking Trail-Making Test.
Figure 3
Figure 3
Breakdown by circular diagram of the cognitive profiles of the subjects in each group from the cluster analysis. Abbreviations: YH, young healthy; OH, older healthy; blMCI, borderline MCI; naMCI, non-amnestic MCI – executive impairment only; aMCI, amnestic MCI; mdMCI, multiple domain amnestic MCI.

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Source: PubMed

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