Pen pressure variability during a cognitive drawing task and its association with cognitive function in older adults: A pilot study

Abstract

Background: This pilot study aimed to investigate whether pen pressure parameters recorded during the cognitive drawing task (TMT-A) reflect motor performance under cognitive load and ascertain their association with cognitive function in older adults. Methods: We enrolled 21 participants (mean age, 80.4±4.8 years) who were divided into two groups based on the Japanese version of the Mini-Mental State Examination (MMSE-J): the decline group (MMSE-J score ≤ 23, n=16) and maintenance group (MMSE-J score ≥ 24, n=5). Pen pressure data were collected during the digital TMT-A using an iPad and Apple Pencil. The average pressure and coefficient of variation (CV) of pen pressure were analyzed. The relationship between pen pressure parameters and MMSE-J scores was examined using Spearman’s correlation. Receiver operating characteristic (ROC) analysis was performed to assess the screening ability of pen pressure parameters. Results: The average pen pressure (p = 0.032) was significantly lower, while the CV was higher (p = 0.010) in the decline group compared with the maintenance group. The CV of pen pressure was negatively correlated with the MMSE- J scores (rs = -0.535, p = 0.012), while the average pen pressure showed a weaker, non-significant correlation (rs = 0.423, p = 0.056). ROC analysis revealed that the pen pressure CV possessed strong discriminative ability (area under the curve, 0.888). Conclusion: Pen pressure fluctuations during digital TMT tasks are associated with cognitive function and may serve as a more precise and accessible screening method for cognitive decline. Further research with larger sample populations is needed to confirm these findings and explore practical applications in dementia prevention.