The utility of the Oral Trail Making Test in telehealth assessments with cognitively impaired older adults

Abstract

Background: Due to the recent COVID-19 pandemic, many clinicians have transitioned to telehealth-based cognitive assessments as a practical alternative to in-person evaluations. Meta-analysis has shown that verbally-mediated measures of cognition are the most easily adapted to telehealth administration, while measures that include visual or motor components are more variably impacted. The Oral Trail Making Test (O-TMT) is one verbal measure of executive function that removes motor and visual demands. However, there is a dearth of research related to the use of the O-TMT in cognitively impaired older adults to evaluate executive function. Therefore, this project aimed to examine the relationship between O-TMT scores with other neuropsychological measures in individuals with cognitive impairment. Method: Forty-one participants enrolled in the Emory Cognitive Empowerment Program underwent telehealth-based neuropsychological assessment that included the O-TMT. The O-TMT is comprised of two parts. Part A requires individuals to count out loud from 1 to 25 and is primarily a measure of processing speed and simple attention. Part B requires individuals to alternate saying numbers and letters (1-A, 2-B, etc.) and is a measure of mental flexibility. Time to completion as well as total errors are captured during administration. Participants also completed the Montreal Cognitive Assessment (MoCA) as a measure of global cognitive function, a measure of practical reasoning (Test of Practical Judgement), and a self-report measure of cognitive change (Everyday Cognition). Correlational analyses were completed to examine the relationship between O-TMT scores and global cognitive function, practical judgment, and subjective cognitive status. Results: The sample consisted of older adults (M age = 72.84, SD age = 8.20) who were well-educated (M years = 16.07, SD years = 2.22). O-TMT Part B Time to Completion was moderately correlated with total MoCA score (r = -0.36, p = 0.03), such that slower performance was associated with poorer overall cognitive function. The O-TMT was not significantly correlated with practical judgment or subjective cognitive status. Conclusion: Results of the current study indicate poorer performance on the O-TMT part B is associated with poorer overall cognitive function on the MoCA. Future research should examine the sensitivity and specificity of the O-TMT part B for individuals who are cognitively impaired.

Enhancing COVID Rehabilitation with Technology (ECORT): protocol for an open-label, single-site randomized controlled trial evaluating the effectiveness of electronic case management for individuals with persistent COVID-19 symptoms

“…and is a measure of mental flexibility. Time to completion as well as total errors are recorded [34,35]. The use of time and error rate led to slightly improved classification rates for cognitive impairments compared to either alone [36].…”

Enhancing COVID Rehabilitation with Technology (ECORT): Protocol for an open-label, single site randomized controlled trial evaluating the effectiveness of electronic case management for individuals with persistent COVID-19 symptoms.

“…and is a measure of mental exibility. Time to completion as well as total errors are recorded (34,35). The use of time and error rate led to slightly improved classi cation rates for cognitive impairments compared to either alone.…”