Performance of the digital trail making test in older adults with white matter lesions

BackgroundStudies have reported that digital assessment technology coupled with the traditional Trail Making Test (TMT) can capture additional information about a new cognitive domain.ObjectivesThe goal of the current study is to demonstrate the performance of the digital Trail Making Test (dTMT) in...

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Main Authors: Xinjun Shan, Le Tian, Hongyi Zhao, Xiuli Zhao, Fangyuan Wei
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Human Neuroscience
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Online Access:https://www.frontiersin.org/articles/10.3389/fnhum.2025.1572971/full
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author Xinjun Shan
Le Tian
Hongyi Zhao
Hongyi Zhao
Xiuli Zhao
Fangyuan Wei
author_facet Xinjun Shan
Le Tian
Hongyi Zhao
Hongyi Zhao
Xiuli Zhao
Fangyuan Wei
author_sort Xinjun Shan
collection DOAJ
description BackgroundStudies have reported that digital assessment technology coupled with the traditional Trail Making Test (TMT) can capture additional information about a new cognitive domain.ObjectivesThe goal of the current study is to demonstrate the performance of the digital Trail Making Test (dTMT) in older people with white matter lesions (WML).MethodsIn this single-center, observational study, 18 elderly patients with WML admitted to our hospital from June 2021 to June 2022 served as the WML group, and 18 participants matched for age, gender, and educational level who were undergoing physical examination in our hospital during the same period served as the control group. The participants completed the dTMT Part A (dTMTA) and dTMT Part B (dTMTB) to obtain the outcomes, such as dTMT completion time, number of errors, time inside each circle, total pathway deviation of each step, and velocity of drawing of each step. The severity of WML was scored using the Fazekas scale. Multiple neuropsychological assessments were carried out to assess cognitive function. The Purdue Pegboard Test (PPT) was used to display the unimanual dexterity (dominant hand task) and fine motor control (assembly task). The relationships between dTMT variables and cognition and motion in elderly patients with WML were analyzed using linear regression analysis.ResultsThe WML group required significantly more time to complete the dTMTA (19.78 ± 1.92 s vs. 18.17 ± 1.72 s, p = 0.012) and dTMTB (38.83 ± 4.33 vs. 34.00 ± 2.99, p < 0.001). For dTMTA, larger pathway deviation (43.76 ± 4.50 vs. 39.81 ± 4.66, p = 0.014) and lower velocity (17.05 ± 4.72 vs. 20.50 ± 4.00, p = 0.024) were found in the WML group. For dTMTB, longer time in the circle (30.02 ± 7.19 vs. 16.22 ± 4.70, p < 0.001), larger pathway deviation (47.00 ± 4.40 vs. 41.96 ± 6.44, p = 0.010), and lower velocity (11.48 ± 2.75 vs. 14.18 ± 3.86, p = 0.021) were exhibited in aged individuals with WML. Linear regression analysis showed that the time spent inside each circle showed a positive correlation with the Mini-Mental State Evaluation (MMSE) (p = 0.015, standardized β = 0.454) and PPT unimanual task (p = 0.024, standardized β = 0.420) for dTMTA; and the total time to completion was negatively correlated with the PPT assembly task (p = 0.001, standardized β = −0.583).ConclusionOlder adults with WML showed abnormalities while solving the dTMT. dTMT might be a potential indicator for cognitive and fine motor deficits in patients with WML.
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spelling doaj-art-e6e76691159340798ed1e19237233bf82025-08-20T03:55:54ZengFrontiers Media S.A.Frontiers in Human Neuroscience1662-51612025-07-011910.3389/fnhum.2025.15729711572971Performance of the digital trail making test in older adults with white matter lesionsXinjun Shan0Le Tian1Hongyi Zhao2Hongyi Zhao3Xiuli Zhao4Fangyuan Wei5Department of Emergency, Baoding No. 1 Hospital, Baoding, ChinaDepartment of Neurology, Mental Health Institute of Inner Mongolia Autonomous Region, The Third Hospital of Inner Mongolia Autonomous Region, Hohhot, ChinaDepartment of Neurology, NO 984 Hospital of PLA, Beijing, ChinaDepartment of Neurology, The Seventh Medical Center of PLA General Hospital, Beijing, ChinaDepartment of Neurology, NO 984 Hospital of PLA, Beijing, ChinaDepartment of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, ChinaBackgroundStudies have reported that digital assessment technology coupled with the traditional Trail Making Test (TMT) can capture additional information about a new cognitive domain.ObjectivesThe goal of the current study is to demonstrate the performance of the digital Trail Making Test (dTMT) in older people with white matter lesions (WML).MethodsIn this single-center, observational study, 18 elderly patients with WML admitted to our hospital from June 2021 to June 2022 served as the WML group, and 18 participants matched for age, gender, and educational level who were undergoing physical examination in our hospital during the same period served as the control group. The participants completed the dTMT Part A (dTMTA) and dTMT Part B (dTMTB) to obtain the outcomes, such as dTMT completion time, number of errors, time inside each circle, total pathway deviation of each step, and velocity of drawing of each step. The severity of WML was scored using the Fazekas scale. Multiple neuropsychological assessments were carried out to assess cognitive function. The Purdue Pegboard Test (PPT) was used to display the unimanual dexterity (dominant hand task) and fine motor control (assembly task). The relationships between dTMT variables and cognition and motion in elderly patients with WML were analyzed using linear regression analysis.ResultsThe WML group required significantly more time to complete the dTMTA (19.78 ± 1.92 s vs. 18.17 ± 1.72 s, p = 0.012) and dTMTB (38.83 ± 4.33 vs. 34.00 ± 2.99, p < 0.001). For dTMTA, larger pathway deviation (43.76 ± 4.50 vs. 39.81 ± 4.66, p = 0.014) and lower velocity (17.05 ± 4.72 vs. 20.50 ± 4.00, p = 0.024) were found in the WML group. For dTMTB, longer time in the circle (30.02 ± 7.19 vs. 16.22 ± 4.70, p < 0.001), larger pathway deviation (47.00 ± 4.40 vs. 41.96 ± 6.44, p = 0.010), and lower velocity (11.48 ± 2.75 vs. 14.18 ± 3.86, p = 0.021) were exhibited in aged individuals with WML. Linear regression analysis showed that the time spent inside each circle showed a positive correlation with the Mini-Mental State Evaluation (MMSE) (p = 0.015, standardized β = 0.454) and PPT unimanual task (p = 0.024, standardized β = 0.420) for dTMTA; and the total time to completion was negatively correlated with the PPT assembly task (p = 0.001, standardized β = −0.583).ConclusionOlder adults with WML showed abnormalities while solving the dTMT. dTMT might be a potential indicator for cognitive and fine motor deficits in patients with WML.https://www.frontiersin.org/articles/10.3389/fnhum.2025.1572971/fullcognitive dysfunctionfine motor controlwhite matter lesionstrail making testsmall vessel disease
spellingShingle Xinjun Shan
Le Tian
Hongyi Zhao
Hongyi Zhao
Xiuli Zhao
Fangyuan Wei
Performance of the digital trail making test in older adults with white matter lesions
Frontiers in Human Neuroscience
cognitive dysfunction
fine motor control
white matter lesions
trail making test
small vessel disease
title Performance of the digital trail making test in older adults with white matter lesions
title_full Performance of the digital trail making test in older adults with white matter lesions
title_fullStr Performance of the digital trail making test in older adults with white matter lesions
title_full_unstemmed Performance of the digital trail making test in older adults with white matter lesions
title_short Performance of the digital trail making test in older adults with white matter lesions
title_sort performance of the digital trail making test in older adults with white matter lesions
topic cognitive dysfunction
fine motor control
white matter lesions
trail making test
small vessel disease
url https://www.frontiersin.org/articles/10.3389/fnhum.2025.1572971/full
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