Enhancing MCI Assessment: A Digital Trail Making Test with Integrated Eye and Hand Tracking

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Publicat a:Alzheimer's & Dementia vol. 21 (Dec 1, 2025)
Autor principal: Juantorena, Gustavo E
Altres autors: Berrios, Waleska, Fernández, Maria Cecilia, Ibanez, Agustin, Petroni, Agustin, Kamienkowski, Juan E
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John Wiley & Sons, Inc.
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Accés en línia:Citation/Abstract
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022 |a 1552-5260 
022 |a 1552-5279 
024 7 |a 10.1002/alz70863_110549  |2 doi 
035 |a 3285984013 
045 0 |b d20251201 
100 1 |a Juantorena, Gustavo E  |u Instituo de Ciencias de la Computacion (CONICET‐UBA), Ciudad Autonoma de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina 
245 1 |a Enhancing MCI Assessment: A Digital Trail Making Test with Integrated Eye and Hand Tracking 
260 |b John Wiley & Sons, Inc.  |c Dec 1, 2025 
513 |a Journal Article 
520 3 |a Background We extended our computerized Trail Making Test (c‐TMT) to investigate deficits in Mild Cognitive Impairment (MCI) compared to neurotypical controls. By integrating hand and eye tracking, we captured fine‐grained movement dynamics, revealing distinct trajectory alterations in MCI patients. These differences suggest potential digital biomarkers, offering a more precise assessment beyond traditional total time measurements. Methods Twenty‐nine MCI patients and 28 age‐ and education‐matched controls (with significant Mini‐Mental Test differences, p < 0.001) were enrolled at Hospital Italiano de Buenos Aires, Argentina, with informed consent. Two practice trials and 20 experimental trials (alternating TMT‐A and TMT‐B) were presented. Stimuli were displayed on a 24‐inch screen. Gaze was recorded from the right eye at 500 Hz using an EyeLink 1000 Plus. The mouse trajectory was displayed in real‐time, with feedback on the correct element selection. Results Linear Mixed Models (LMM) were applied to correct trials to estimate the main effects of subject group (MCI vs. control), trial type (TMT‐A vs. TMT‐B), and their interaction using the statsmodels library in Python. For performance metrics, LMM revealed a significant effect of subject group and trial type on the percentage of completion (PC) (SE = 0.066, p&#xa0;=&#xa0; 0.040; SE = ‐9.017, p&#xa0;=&#xa0; 1.9 × 10⁻¹⁹) and the time required to complete a trial (RT) (SE = ‐2.514, p&#xa0;=&#xa0; 0.012; SE = 7.896, p&#xa0;=&#xa0; 2.9 × 10⁻¹⁵). For eye‐tracking metrics, we found significant differences for both trial type (SE = 2.06, p&#xa0;=&#xa0; 0.002) and subject group (SE = 2.81, p&#xa0;=&#xa0; 0.023) in scanpath length (number of fixations). However, fixation duration differences were not significant (SE = 7.830, p&#xa0;=&#xa0; 0.68; SE = 12.90, p&#xa0;=&#xa0; 0.80). We also analyzed eye‐hand coordination by parsing fixations based on mouse position and time‐locking mouse and hand movements to target entry. Differences were observed by trial type but not by subject group. Conclusions Our c‐TMT version identified significant differences in scanpath length between MCI patients and controls. Hand and eye movements together allow fixation analysis to determine how increased fixations are distributed. These findings highlight the potential of this approach in Digital Neuropsychology. 
653 |a Feedback 
653 |a Time 
653 |a Eye movements 
653 |a Informed consent 
653 |a Politics 
653 |a Eye fixation 
653 |a Neuropsychology 
653 |a Cognitive impairment 
653 |a Hand movements 
653 |a Parsing 
653 |a Biological markers 
653 |a Fixation 
653 |a Coordination 
653 |a Patients 
653 |a Tracking 
653 |a Computerization 
653 |a Eye tracking 
653 |a Tests 
653 |a Hands 
653 |a Groups 
700 1 |a Berrios, Waleska  |u Churruca Visca Hospital, Buenos Aires, Argentina 
700 1 |a Fernández, Maria Cecilia  |u Hospital Italiano de Buenos Aires, Buenos Aires, Argentina 
700 1 |a Ibanez, Agustin  |u Global Brain Health Institute, University of California, San Francisco, USA 
700 1 |a Petroni, Agustin  |u University of Gothenburg, Gothenburg, Gothenburg, Sweden 
700 1 |a Kamienkowski, Juan E  |u Instituo de Ciencias de la Computacion (CONICET‐UBA), Ciudad Autonoma de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina 
773 0 |t Alzheimer's & Dementia  |g vol. 21 (Dec 1, 2025) 
786 0 |d ProQuest  |t Consumer Health Database 
856 4 1 |3 Citation/Abstract  |u https://www.proquest.com/docview/3285984013/abstract/embedded/6A8EOT78XXH2IG52?source=fedsrch 
856 4 0 |3 Full Text  |u https://www.proquest.com/docview/3285984013/fulltext/embedded/6A8EOT78XXH2IG52?source=fedsrch 
856 4 0 |3 Full Text - PDF  |u https://www.proquest.com/docview/3285984013/fulltextPDF/embedded/6A8EOT78XXH2IG52?source=fedsrch