Large-scale Visuomotor Reaction Time Self-Testing Reveals Subtle Motor Changes in Older Adults with Subjective Cognitive Impairment

Abstract Introduction Affordable tools for early Alzheimer’s disease (AD) detection could support drug development and early intervention. Subtle motor changes may indicate preclinical AD, but hand response selection and initiation speeds are understudied. This study assessed whether unsupervised, online visuomotor reaction time (RT) tests relate to subjective cognitive impairment (SCI), a validated high risk state for future conversion to AD Methods A total of 910 participants (age 66.3±7.5, 70.8% female) completed assessments of simple and choice visuomotor RT tests at home as part of the online TAS Test protocol; they also completed the Cambridge Neuropsychological Test Automated Battery (CANTAB) episodic memory and executive function tests. Among them, 142 participants reported SCI. Results On the TAS Test visuomotor tests, SCI was associated with 8.4% [1.4%, 15.4%] longer RT ( ( p = .008; adjusted for task complexity), greater odds of time-out failure (OR = 1.35 [1.01, 1.81]; p = .037), and greater variance in RT (log-variance (SCI – comparison) = .094 [.028, .159]; p < .001). There were no significant differences between the SCI and comparison groups on any of the CANTAB tests. After adjusting for SCI status, none of the CANTAB tests were significantly associated with RT. Discussion SCI was associated with longer and more variable visuomotor RT, and greater odds of time-out failure, while not being associated with tests of memory and executive function. Cognitive test scores did not explain a significant amount of variance in visuomotor RT. Taken together, these results support a hypothesis that people with SCI may be experiencing earlier visuomotor deficits that are distinct from (or precede) decline in episodic memory and executive function. Visuomotor tasks that record RT may be more sensitive to preclinical manifestations of cognitive decline than more traditional tests of cognitive function.