[Trail walking test for assessment of motor cognitive interference in older adults. Development and evaluation of the psychometric properties of the procedure]

Abstract

Background: Activities of daily living (ADL), such as walking, often involve the added complexity of walking while doing other activities (i.e. dual task walking). A complex walking task may require a greater motor and mental capacity, resulting in decrements in gait performance not seen for simple walking tasks.

Aim: The purpose of this study was to determine if the trail walking test (TWT), the mobile adaptation of the trail making test (TMT), could be a reliable and valid early detection tool to discriminate between non-fallers and fallers.

Material and methods: This study examined dual task costs of a cognitive and a sensorimotor task (walking) in 94 older adults aged 50-81 years (average age M = 67.4 years, SD ± 7.34). Based on the idea of the paper and pencil TMT, participants walked along a fixed pathway (TWT-1), stepped on targets with increasing sequential numbers (i.e. 1, 2, 3, TWT-2), and increasing sequential numbers and letters (i.e. 1, A, 2, B, 3, C, TWT-3). The dual task costs were calculated for each task. Additionally, the following tests were conducted: TMT, block tapping test (BTT), timed up and go (TUG) test, 30s chair rising test, 10 m walking time test with and without head turns, German physical activity questionnaire (German PAQ-50 +) and the activities-specific balance confidence (ABC-D) scale.

Results: The TWT performance times as well as errors increased with increasing age. Reliability coefficients were high (interclass correlation ICC > 0.90). Correlations between the different TWT conditions and potential falls-related predictors were moderate to high (r = -0.430 to 0.699). Of the participants 34 % reported falling in the past year. The stepwise logistic regression analysis revealed that the dual task costs for the numbers and letters (odds ratio OR 1.162, 95 % confidence interval CI 1.058-1.277, p = 0.002), the ABC-D (OR 0.767, 95 % CI 0.651-0.904, p = 0.002) and exercise (OR 1.027, 95 % CI 1.008-1.046, p = 0.006) were significantly related to falls and 91.6 % of cases were correctly classified.

Conclusion: The results indicate that high-level cognitive processes interfere with automatic processes such as walking. The TWT which converts a relevant fall risk-associated standard neuropsychological test (TMT) with increasing cognitive load into a mobility task, was shown to be a feasible, reliable and valid tool for older adults to discriminate between non-fallers and fallers.

Keywords: Accidental falls; Dual-task costs; Gait; Trail making test; Visuo-spatial working memory.