Screening Potential of Finger Tapping and Visual Reaction Time Tests for Sarcopenia in Geriatric Clinical Practice

Screening Potential of Finger Tapping and Visual Reaction Time Tests for Sarcopenia in Geriatric Clinical Practice | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Screening Potential of Finger Tapping and Visual Reaction Time Tests for Sarcopenia in Geriatric Clinical Practice Busragul Yilmaz, Fatma Kaplan Efe, Serap Boz, Hemrin Kavak, Busra Betul Cagır, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7700433/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Sarcopenia is a progressive skeletal muscle disorder characterized by the loss of muscle mass and strength, associated with falls, fractures, and mortality. The Finger Tapping Test (FTT) has been widely used in neurophysiological studies to evaluate motor control and function. Visual reaction time tests are computer-based tools that measure the response speed to visual stimuli and have been linked to cognitive function. This study aimed to evaluate the potential of computer-based Finger Tapping Test and visual reaction time tests in diagnosing and staging sarcopenia. Methods: Demographic characteristics, handgrip strength, muscle mass, physical performance, and Sarcopenia Questionnaire (SARC-F) scores were recorded. Participants underwent computer-based Finger Tapping Test and visual reaction time tests. Data distribution was assessed using the Shapiro–Wilk test. As data were non-normally distributed, the Kruskal–Wallis test was applied, revealing significant intergroup differences (p < 0.005). Pairwise comparisons were conducted with the Dunn–Bonferroni test. Results: Finger Tapping Test results showed a significant decline in motor performance with increasing sarcopenia severity. Visual reaction time outcomes revealed significant differences between healthy individuals and all sarcopenia groups (p < 0.001), although response patterns varied across groups. Conclusions: The prolongation of Finger Tapping Test times in severe sarcopenia indicates impaired motor performance. The Finger Tapping Test may raise early awareness as a screening tool; however, due to its sensitivity to multiple influencing factors, it should not be considered a stand-alone diagnostic method. Figures Figure 1 Introduction Sarcopenia is a serious condition that predominantly affects the elderly population, although it begins as early as the fourth decade of life. It is estimated that 10–16% of older adults worldwide are affected by sarcopenia【1】. Sarcopenia is a progressive and generalized skeletal muscle disease characterized by loss of muscle mass and strength, associated with adverse outcomes including falls, fractures, and mortality. Before 2019, sarcopenia was defined primarily as a loss of muscle mass; however, with the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP) in 2019, the focus shifted to loss of muscle strength【2】. Untreated sarcopenia causes significant personal and socioeconomic burdens. It increases the risk of falls and fractures, affects activities of daily living, contributes to cardiovascular diseases, chronic pulmonary diseases, cognitive impairment, reduced quality of life, increased dependency, and mortality【3–8】. Moreover, it increases caregiver burden, frequency of hospitalizations, and healthcare costs【9】. Materials and Methods Ethical Approval: This study was approved by the Clinical Research Ethics Committee (Date: 22.06.2022, Decision: E1-22 2391). The research was conducted in accordance with the Declaration of Helsinki. Study Population: This study was carried out with volunteer participants who applied to the geriatrics outpatient clinic of Ankara Bilkent City Hospital between July 2022 and July 2023. Participant Selection: Right-handed individuals over the age of 65 were included in the study. Before testing, participants were asked about demographic characteristics such as age, height, weight, body mass index, and education level, as well as whether they had any history of psychiatric disorders, diseases involving the muscular or nervous system, smoking or alcohol use, sleep duration the night before testing, consumption of tea or coffee on the day of testing, and whether they had engaged in exercise within the last half hour. Participants with a history of psychiatric illness, neuromuscular disease, smoking or alcohol use, consumption of more than one cup of coffee or more than two glasses of tea, or those who exercised within the last half hour were excluded【20–22】. Patients with advanced dementia, active delirium, severe visual or auditory impairment preventing cooperation with the tests, acute life-threatening diseases (acute myocardial infarction, acute stroke, sepsis), or end-stage metastatic cancer with a life expectancy of less than three months were also excluded. General Study Procedure: After collecting demographic data and applying exclusion criteria, eligible participants who signed the informed consent form were included. Handgrip strength was evaluated using a handgrip dynamometer, muscle mass was measured with bioelectrical impedance analysis (BIA), and physical performance was assessed with the 4-meter walking test. Motor function was assessed with a computer-based Finger Tapping Test (FTT), and cognitive function was assessed with four different computer-based Visual Reaction Time (VRT) tests. Since colored squares were used in the VRT, participants first underwent the Ishihara color blindness test. Data Collection: Demographic characteristics (age, sex, comorbidities), laboratory tests (hemogram, biochemistry), SARC-F scores, walking speed, handgrip strength, calf circumference, BIA results, and 4-meter walking test speed were recorded. Grouping of Participants: Sarcopenia severity was determined according to the EWGSOP2 (2019) criteria. Participants with low handgrip strength (women <22 kg, men <32 kg) were classified as probable sarcopenia. Those with low handgrip strength and low muscle mass (men <9.2 kg/m², women <7.4 kg/m²) were classified as confirmed sarcopenia. Those with low handgrip strength, low muscle mass, and low physical performance (4-m walking test ≤0.8 m/s) were classified as severe sarcopenia. Assessment of Color Blindness: The Ishihara Color Test was administered in a normally illuminated room (200–250 lux). Each plate was shown at a distance of 70 cm for 3 seconds, and participants were asked to read the numbers. Those who correctly identified all plates were classified as not color-blind, whereas those with ≥4 errors were considered color-blind【23】. Determination of Hand Dominance: Hand preference was determined using the Turkish version of the Oldfield Questionnaire. The questionnaire included questions about writing, drawing, throwing a ball or stone, brushing teeth, holding a knife without a fork, holding a fork, using a hammer, using scissors, striking a match, and opening a bottle cap. Results were scored using the Geschwind scale【9,24】. Finger Tapping Test Procedure: The TanTong FingerTap Test system was used【25】. Participants sat comfortably, approximately 50 cm from the screen, with wrist support. When ready, they were instructed to press a designated key with the index finger of the right hand as quickly and repeatedly as possible for 20 seconds【9】. Visual Reaction Time Tests Procedure: Four different VRTs were administered. In each test, ten colored squares (7×7 cm) appeared on the screen, and participants were instructed to press the designated key as quickly as possible according to the instructions: Simple Visual Reaction Time (S-VRT): A single square appeared at fixed intervals. Complex Visual Reaction Time (C-VRT): A single square appeared at variable intervals. Simple Recognition Visual Reaction Time (SR-VRT): Squares of different colors appeared at equal intervals. Participants were instructed to press one key if the square was red and another key if it was not red. Complex Recognition Visual Reaction Time (CR-VRT): Squares of different colors appeared at variable intervals. Participants were instructed to press the designated key depending on whether the square was red or not. The system used the computer’s central processor instructions “Read Time Stamp Counter–RDTSC” to achieve high temporal resolution (1/100 ms). It automatically recorded intertap intervals in the FTT, reaction times in the VRTs, and incorrect or missed responses, saving all data to the computer for further analysis【9】. Statistical Analysis: Statistical analyses were performed using IBM SPSS Statistics 22. Normality of the data distribution was assessed with the Shapiro–Wilk test, which revealed that the data were not normally distributed (p < 0.05). Accordingly, the non-parametric Kruskal–Wallis test was applied, and significant differences were found among groups for all variables (p < 0.005). Pairwise comparisons were conducted using the Dunn–Bonferroni post-hoc test. The significance level (type I error) was set at α = 0.05. Effect size (ε²) was calculated using Cohen’s (1988) formula to evaluate the impact of group differences identified by the Kruskal–Wallis test. Spearman’s rank correlation test was used to determine associations between variables, and results were reported as rho (ρ) coefficients. Finally, multiple linear regression analysis was conducted to evaluate the independent effects of FTT and sarcopenia severity on dependent variables. Results A total of 120 volunteer participants were initially enrolled in the study; however, 19 were excluded because they were unable to complete the Finger Tapping Test. Thus, 101 participants were included in the final analysis. Among them, 58 (57.4%) were female and 43 (42.5%) were male. Dynapenia was present in 84 participants (83.2%), while 17 participants (16.8%) had no dynapenia. The demographic and baseline clinical characteristics of the study population are summarized in Table 1 . Table 1. Distribution of demographic and clinical characteristics of the participants Characteristics Males (n = 43, 42.5%) Females (n = 58, 57.4%) Age, years, mean ± SD 78.14 ± 1.29 74.36 ± 0.93 Nursing home, n (%) 4 (9.3) 6 (10.3) Education - Uneducated 2 (4.6) 25 (43.1) Education - 0–5 years 19 (44.1) 24 (41.3) Education - 5–8 years 6 (13.9) 2 (3.4) Education - 8–12 years 8 (18.6) 5 (8.6) Education - >12 years 8 (18.6) 2 (3.4) Muscle mass, kg/m², mean ± SD 8.23 ± 0.17 9.93 ± 0.27 BMI, kg/m², mean ± SD 26.68 ± 0.64 29.86 ± 0.76 Smoking, n (%) 31 (72.0) 5 (8.6) Hypertension, n (%) 31 (72.0) 42 (72.4) Diabetes mellitus, n (%) 17 (39.5) 24 (41.3) Coronary artery disease, n (%) 10 (23.2) 6 (10.3) Hyperlipidemia, n (%) 16 (37.2) 13 (22.4) Dementia, n (%) 3 (7.0) 5 (8.6) Depression, n (%) 10 (23.2) 23 (39.6) Chronic obstructive pulmonary disease, n (%) 7 (16.2) 6 (10.3) Asthma, n (%) 0 1 (1.7) Osteopenia, n (%) 17 (50.0) 30 (61.2) Osteoporosis, n (%) 2 (4.6) 12 (20.6) Urinary incontinence, n (%) 15 (34.8) 37 (63.8) Falls, n (%) 13 (30.2) 18 (31.0) Weight loss, n (%) 14 (32.5) 24 (41.3) Slow gait speed, n (%) 7 (16.2) 12 (20.6) SARC-F ≥ 4, n (%) 13 (30.2) 33 (56.9) Grip strength, kg, mean ± SD (min–max) 26.2 ± 1.15 (6.5–39.6) 16.1 ± 0.64 (6.1–25.5) Non-sarcopenia, n (%) 10 (23.2) 7 (12.1) Probable sarcopenia, n (%) 16 (37.2) 31 (53.4) Confirmed sarcopenia, n (%) 10 (23.2) 8 (13.7) Severe sarcopenia, n (%) 7 (16.2) 12 (20.6) SD: standard deviation; BMI: body mass index; SARC-F: Sarcopenia Questionnaire. Analysis of the Finger Tapping Test (FTT) findings revealed significant differences among the groups according to sarcopenia severity. The mean FTT times were 258 ± 57 ms in the non-sarcopenia group (NS), 391 ± 139 ms in the probable sarcopenia group (PS), 471 ± 161 ms in the confirmed sarcopenia group (CS), and 601 ± 137 ms in the severe sarcopenia group (SS). Since the data were not normally distributed, the Kruskal–Wallis test was used to evaluate intergroup differences, and a statistically significant difference was observed (p < 0.001). Post-hoc analyses demonstrated significant differences between non-sarcopenic participants and those with probable sarcopenia (p = 0.003), confirmed sarcopenia (p < 0.001), and severe sarcopenia (p < 0.001). Additionally, a significant difference was observed between the probable and severe sarcopenia groups (p < 0.001). In contrast, no significant differences were found between the probable and confirmed sarcopenia groups (p = 0.662) or between the confirmed and severe sarcopenia groups (p = 0.292). The effect size calculated for this comparison was ε² = 0.378, which was used to assess the magnitude and strength of the statistically significant differences【26】. The variation of FTT results across groups is illustrated in Figure 1 . Table 2. S-VRT results and significance levels between groups Variable Unit NS Group PS Group CS Group SS Group Significance (p < 0.05) S-VRT (Mean ± SD, min–max) ms 515.2 ± 160.2 (310–877) 876.5 ± 330.0 (344–1925) 818.2 ± 212.7 (485–1228) 1040.0 ± 412.7 (534–2065) NS significantly different from PS, CS, SS Table notes: S-VRT: Simple Visual Reaction Time; SD: standard deviation; NS: non-sarcopenia; PS: probable sarcopenia; CS: confirmed sarcopenia; SS: severe sarcopenia. The mean ± standard deviation (min–max) values of the groups are presented in Tables 2 and 3. In the S-VRT test, the highest mean value was observed in the severe sarcopenia (SS) group. According to the results of the Dunn–Bonferroni post-hoc test, statistically significant differences were found between the non-sarcopenia group and the probable sarcopenia group (p < 0.001), the confirmed sarcopenia group (p = 0.006), and the severe sarcopenia group (p < 0.001). However, no statistically significant differences were observed between the confirmed and probable sarcopenia groups (p = 1.000), between the confirmed and severe sarcopenia groups (p = 0.974), or between the probable and severe sarcopenia groups (p = 1.000). Table 3. C-VRT results and significance levels between groups Variable Unit NS Group PS Group CS Group SS Group Significance (p < 0.05) C-VRT (Mean ± SD, min–max) ms 725.3 ± 229.6 (400–1101) 1211.5 ± 367.5 (247–2079) 1184.9 ± 306.3 (753–2037) 1541.9 ± 613.2 (806–2807) NS significantly different from PS, CS, SS SR-VRT (Mean ± SD, min–max) ms 614.7 ± 163.7 (414–895) 1153.7 ± 351.9 (335–1747) 1358.3 ± 445.0 (924–2689) 1659.1 ± 489.6 (1125–2840) NS significantly different from PS, CS, SS; PS significantly different from SS CR-VRT (Mean ± SD, min–max) ms 784.5 ± 206.1 (521–1190) 1372.6 ± 407.4 (467–2623) 1704.1 ± 524.2 (1008–3076) 1947.6 ± 511.6 (1210–3032) NS significantly different from PS, CS, SS; PS significantly different from SS Table notes: NS: non-sarcopenia; PS: probable sarcopenia; CS: confirmed sarcopenia; SS: severe sarcopenia. FTT: Finger Tapping Test; S-VRT: Simple Visual Reaction Time; C-VRT: Complex Visual Reaction Time; SR-VRT: Simple Recognition Visual Reaction Time; CR-VRT: Complex Recognition Visual Reaction Time. In the C-VRT test, healthy individuals had significantly shorter reaction times compared to all patient groups (p 0.7). In the SR-VRT test, healthy individuals were significantly different from all patient groups (p < 0.001). In the CR-VRT test, significant differences were found between healthy individuals and all patient groups (p < 0.003). When the results of the S-VRT, C-VRT, SR-VRT, and CR-VRT tests were evaluated together, statistically significant differences were observed between healthy individuals (NS) and all groups within the disease spectrum (PS, CS, SS) across all four measures (p < 0.001). However, these differences did not follow the same distribution pattern in each test, and the degree of separation between groups varied depending on the test. Previous literature has demonstrated that sarcopenia may affect not only physical but also cognitive functions【27】. Therefore, in this study, the relationship between sarcopenia severity and both motor performance, assessed by the Finger Tapping Test (FTT), and cognitive status, assessed by the Mini-Mental State Examination (MMSE), was comparatively examined. The aim was to identify which of these physical and cognitive parameters could more sensitively predict sarcopenia. The relationships between FTT, MMSE, and sarcopenia severity were analyzed using Spearman’s rank correlation test. The analysis revealed a positive and moderate-to-strong correlation between FTT and sarcopenia severity (rho = 0.627, p < 0.001). In contrast, a negative and weak-to-moderate correlation was observed between MMSE and sarcopenia severity (rho = –0.306, p = 0.002). The correlations between FTT, MMSE, and sarcopenia severity are shown in Table 4. Table 4. Correlation of FTT, MMSE, and sarcopenia severity Correlation rho Direction Strength (Interpretation) Significance (p) FTT ↔ Sarcopenia +0.627 Positive Moderate–Strong p < 0.001 MMSE ↔ Sarcopenia –0.306 Negative Weak–Moderate p = 0.002 Table notes: FTT: Finger Tapping Test; MMSE: Mini-Mental State Examination. To evaluate whether the increase in SR-VRT and CR-VRT times was attributable solely to motor slowing (FTT) or also to cognitive processes involved in the processing and response to visual stimuli, a multiple linear regression model was applied to determine the independent effects on the dependent variables. When FTT was entered alone as an independent variable, it accounted for 14.3% of the variance in SR-VRT (R² = 0.143) and 11.1% of the variance in CR-VRT (R² = 0.111), and was identified as a significant predictor (SR-VRT: p < 0.001, β = 0.378; CR-VRT: p = 0.001, β = 0.333). However, when sarcopenia severity was added to the model, the explained variance increased substantially (CR-VRT: R² = 0.419; SR-VRT: R² = 0.401), and only sarcopenia severity remained as a statistically significant predictor (CR-VRT: β = 0.715, p < 0.001; SR-VRT: β = 0.654, p < 0.001). In contrast, the effect of FTT lost its statistical significance (CR-VRT: p = 0.241; SR-VRT: p = 0.730). These results demonstrate that changes in SR-VRT and CR-VRT are primarily associated with sarcopenia severity rather than motor performance reflected by FTT, indicating that the predictive value of FTT may be indirectly mediated through sarcopenia status. The results of these regression analyses are presented in Table 5. Table 5. Predictors of reaction time tests Dependent Variable Independent Variables in the Model R² Significant Predictors Strongest Predictor (β) SR-VRT FTT 0.143 FTT (p < 0.001) β = .378 (FTT) CR-VRT FTT 0.111 FTT (p = 0.001) β = .333 (FTT) CR-VRT FTT + Sarcopenia 0.419 Sarcopenia (p < 0.001); FTT (p = 0.241) β = .715 (Sarcopenia) SR-VRT FTT + Sarcopenia 0.401 Sarcopenia (p < 0.001); FTT (p = 0.730) β = .654 (Sarcopenia) Table notes: FTT: Finger Tapping Test; SR-VRT: Simple Recognition Visual Reaction Time; CR-VRT: Complex Recognition Visual Reaction Time. Analyses were based on regression models. Discussion In this study, the significant differences observed in FTT scores across sarcopenia groups indicate that motor performance impairments increase with sarcopenia severity. Supporting this finding, the calculated effect size (ε² = 0.378) corresponds to a large effect according to the classification proposed by Cohen (1988) and Tomczak & Tomczak (2014). This result suggests that the observed differences are not only statistically significant but also clinically and practically meaningful. Similarly, studies examining the relationship between muscle strength and reaction time have shown that elderly individuals with lower muscle strength exhibit significantly prolonged reaction times. This supports the notion that FTT is a sensitive test, particularly in detecting motor slowing.(28) In the S-VRT test, the significantly shorter reaction times observed in healthy individuals compared to all patient groups (p < 0.001) demonstrate that sarcopenia-related cognitive-motor slowing becomes evident even at an early stage. On the other hand, no significant difference was observed between the confirmed and severe sarcopenia groups (p > 0.05), suggesting that the increase in reaction time may not progress linearly with disease severity and may stabilize beyond a certain threshold. In the C-VRT test, the inability to statistically distinguish between the probable, confirmed, and severe sarcopenia groups (p > 0.7) indicates that C-VRT may be sensitive in early diagnosis but limited in detecting performance differences as the disease progresses. In the SR-VRT test, although healthy individuals were significantly distinguished from all patient groups (p < 0.001), the confirmed sarcopenia group did not differ significantly from other patient groups. This may indicate that SR-VRT has the potential to capture changes between early and advanced stages. In the CR-VRT test, significant differences were found between healthy individuals and all patient groups, with the difference between the probable and severe sarcopenia groups being particularly notable (p = 0.003). This result suggests that CR-VRT may be effective in distinguishing early from advanced stages. However, confirmed sarcopenia individuals appeared to obscure this differentiation. Our findings are consistent with studies reporting prolonged reaction times in sarcopenia and suggest that reaction time measurements may be particularly sensitive in distinguishing healthy from sarcopenic individuals.(29) This study was primarily conducted to investigate the relationship between sarcopenia stages and FTT, which reflects both psychomotor performance and cognitive processes. Since previous literature has demonstrated that sarcopenia may also affect cognitive functions, the Mini-Mental State Examination (MMSE), which assesses cognitive status, was additionally evaluated.(27) Correlation analyses revealed that both FTT and MMSE scores were significantly associated with sarcopenia severity (Table 4). The moderate positive correlation between FTT and sarcopenia (rho = 0.627) suggests that psychomotor performance and related cognitive functions decrease as sarcopenia progresses. The weak-to-moderate negative correlation between MMSE and sarcopenia (rho = –0.306) indicates that cognitive impairment, albeit limited, may be associated with sarcopenia. The repeated demonstration of the sarcopenia–cognitive performance relationship in the literature explains the weak-to-moderate negative correlation observed with MMSE in our study.(30) These findings are consistent with the literature, indicating that sarcopenia affects not only physical but also cognitive aspects. Analysis of reaction times showed that FTT initially had a significant effect on CR-VRT and SR-VRT, which represent cognitive processes. This finding suggests that FTT, as a motor performance indicator, may be related to the response time to visual stimuli. However, with the inclusion of sarcopenia severity in the model, the effect of FTT lost its significance, and sarcopenia severity emerged as the strongest predictor in both tests. This indicates that the prolongation of these reaction times is primarily due to more complex physiological and cognitive slowing associated with sarcopenia. Therefore, changes in reaction times can be associated not only with motor slowing but also with cognitive processes slowed by sarcopenia. Summary of Findings The significant prolongation of FTT duration in the severe sarcopenia group demonstrates deterioration in motor performance. This test may raise early awareness for screening purposes; however, due to its susceptibility to multiple influencing factors, it should not be considered a specific diagnostic tool on its own. While S-VRT is a test that does not require central processing and evaluates basic motor response, C-VRT measures alertness without central processing. In contrast, SR-VRT requires central processing and assesses sustained attention, while CR-VRT simultaneously evaluates both alertness and sustained attention. In our study, participants in the severe sarcopenia group demonstrated significantly slower performance in C-VRT, SR-VRT, and CR-VRT compared to both healthy individuals and the probable sarcopenia group. This suggests that as sarcopenia severity increases, impairments occur not only in physical but also in cognitive functions. This indicates that with the progression of sarcopenia, mental processes—particularly executive functions related to attention and alertness—are also affected. Strengths and Limitations The strengths of this study include the use of computer-based objective measurements to simultaneously evaluate both motor and cognitive processes, and the detailed examination of the relationship between FTT, VRT tests, and sarcopenia stages. However, the study’s single-center design, the relatively limited sample size, and the use of only MMSE for cognitive evaluation are important limitations. The inclusion of participants from a single geographical region may also limit the generalizability of the findings. Clinical Implications and Future Research Our findings suggest that FTT and computer-based VRT tests may be useful in identifying sarcopenia-related motor and cognitive slowing. These tests have potential as practical tools for early screening in clinical practice, as they are easy to administer, provide rapid results, and are cost-effective. However, they are not sufficient on their own for staging or definitive diagnosis. Future studies with larger sample sizes, multicenter designs, and more comprehensive cognitive test batteries are needed to increase the generalizability of these results and contribute to clinical applications. Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution Author ContributionsBY, KS, LA, RTD, and HSO contributed to the conceptualization of the study. Methodology was developed by BY, LA, EK, KS, GA, RTD, and HSO. Formal analysis was performed by LA and BE. Investigation was carried out by BY, SB, KS, LA, EK and FKE. Resources were provided by BY, FKE, SB, BBC, HK, ED, and RE. Data curation was conducted by BY and FKE. The original draft was prepared by BY, LA, KS, and FKE. Review and editing of the manuscript were performed by LA. Visualization was conducted by BY. Supervision was provided by KS, LA, RTD, HSO, and GA. Project administration was undertaken by BY, KS and LA. All authors read and approved the final manuscript. References Yuan S, Larsson SC. Epidemiology of sarcopenia: Prevalence, risk factors, and consequences. Metabolism. 2023;144:155533. 10.1016/j.metabol.2023.155533 . Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. 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Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. Chen LK, Arai H, Assantachai P, Akishita M, Chew STH, Dumlao LC, et al. Roles of nutrition in muscle health of community-dwelling older adults: evidence-based expert consensus from Asian Working Group for Sarcopenia. J Cachexia Sarcopenia Muscle. 2022;13(3):1653–72. 10.1002/jcsm.12981 . Jiménez-García JD, Martínez-Amat A, Hita-Contreras F, Fábrega-Cuadros R, Álvarez-Salvago F, Aibar-Almazán A. Muscle strength and physical performance are associated with reaction time performance in older people. Int J Environ Res Public Health. 2021;18(11):5893. 10.3390/ijerph18115893 . Pereira da Silva Alves II, Santos Bueno GA, Brito Elmescany R, Aparecida Borges L, Pinto DK, et al. Motor reaction time, sarcopenia and functional skills in elderly women: A cross-sectional study. J Nutr Health Aging. 2023;27(10):878–84. 10.1007/s12603-023-1983-0 . Chen X, Cao M, Liu M, Liu S, Zhao Z, Chen H. Association between sarcopenia and cognitive impairment in older people: A meta-analysis. Eur Geriatr Med. 2022;13(4):771–7. 10.1007/s41999-022-00661-1 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 01 Oct, 2025 Editor assigned by journal 27 Sep, 2025 Submission checks completed at journal 27 Sep, 2025 First submitted to journal 24 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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08:14:37","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101671,"visible":true,"origin":"","legend":"","description":"","filename":"d1890f79b01147a58c22e16c8b41878f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7700433/v1/51bab9913a781d75862a506b.xml"},{"id":92574947,"identity":"c1065a13-b413-411f-bd61-1a3ef205a5d2","added_by":"auto","created_at":"2025-10-01 08:14:37","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119071,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7700433/v1/922103428eb86a9dc5fa3d49.html"},{"id":92574939,"identity":"c67a570b-ebb0-4c9c-aaeb-13c147529d5c","added_by":"auto","created_at":"2025-10-01 08:14:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":73898,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMean Finger Tapping Test (FTT) times according to sarcopenia severity\u003c/strong\u003e\u003cbr\u003e\nMean FTT times are shown for non-sarcopenia (NS), probable sarcopenia (PS), confirmed sarcopenia (CS), and severe sarcopenia (SS) groups. Error bars represent standard deviation.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7700433/v1/95c2da7507c3e7e4086b71d6.png"},{"id":92576764,"identity":"9be073c5-8ef6-480b-971d-d97a66be907b","added_by":"auto","created_at":"2025-10-01 08:30:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":883081,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7700433/v1/12a3e810-ca30-4c11-8a0a-afef66b67347.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Screening Potential of Finger Tapping and Visual Reaction Time Tests for Sarcopenia in Geriatric Clinical Practice","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSarcopenia is a serious condition that predominantly affects the elderly population, although it begins as early as the fourth decade of life. It is estimated that 10\u0026ndash;16% of older adults worldwide are affected by sarcopenia【1】. Sarcopenia is a progressive and generalized skeletal muscle disease characterized by loss of muscle mass and strength, associated with adverse outcomes including falls, fractures, and mortality. Before 2019, sarcopenia was defined primarily as a loss of muscle mass; however, with the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP) in 2019, the focus shifted to loss of muscle strength【2】. Untreated sarcopenia causes significant personal and socioeconomic burdens. It increases the risk of falls and fractures, affects activities of daily living, contributes to cardiovascular diseases, chronic pulmonary diseases, cognitive impairment, reduced quality of life, increased dependency, and mortality【3\u0026ndash;8】. Moreover, it increases caregiver burden, frequency of hospitalizations, and healthcare costs【9】.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThis study was approved by the Clinical Research Ethics Committee (Date: 22.06.2022, Decision: E1-22 2391). The research was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThis study was carried out with volunteer participants who applied to the geriatrics outpatient clinic of Ankara Bilkent City Hospital between July 2022 and July 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant Selection:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eRight-handed individuals over the age of 65 were included in the study. Before testing, participants were asked about demographic characteristics such as age, height, weight, body mass index, and education level, as well as whether they had any history of psychiatric disorders, diseases involving the muscular or nervous system, smoking or alcohol use, sleep duration the night before testing, consumption of tea or coffee on the day of testing, and whether they had engaged in exercise within the last half hour. Participants with a history of psychiatric illness, neuromuscular disease, smoking or alcohol use, consumption of more than one cup of coffee or more than two glasses of tea, or those who exercised within the last half hour were excluded【20–22】. Patients with advanced dementia, active delirium, severe visual or auditory impairment preventing cooperation with the tests, acute life-threatening diseases (acute myocardial infarction, acute stroke, sepsis), or end-stage metastatic cancer with a life expectancy of less than three months were also excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral Study Procedure:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAfter collecting demographic data and applying exclusion criteria, eligible participants who signed the informed consent form were included. Handgrip strength was evaluated using a handgrip dynamometer, muscle mass was measured with bioelectrical impedance analysis (BIA), and physical performance was assessed with the 4-meter walking test. Motor function was assessed with a computer-based Finger Tapping Test (FTT), and cognitive function was assessed with four different computer-based Visual Reaction Time (VRT) tests. Since colored squares were used in the VRT, participants first underwent the Ishihara color blindness test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eDemographic characteristics (age, sex, comorbidities), laboratory tests (hemogram, biochemistry), SARC-F scores, walking speed, handgrip strength, calf circumference, BIA results, and 4-meter walking test speed were recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrouping of Participants:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eSarcopenia severity was determined according to the EWGSOP2 (2019) criteria. Participants with low handgrip strength (women \u0026lt;22 kg, men \u0026lt;32 kg) were classified as probable sarcopenia. Those with low handgrip strength and low muscle mass (men \u0026lt;9.2 kg/m², women \u0026lt;7.4 kg/m²) were classified as confirmed sarcopenia. Those with low handgrip strength, low muscle mass, and low physical performance (4-m walking test ≤0.8 m/s) were classified as severe sarcopenia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of Color Blindness:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe Ishihara Color Test was administered in a normally illuminated room (200–250 lux). Each plate was shown at a distance of 70 cm for 3 seconds, and participants were asked to read the numbers. Those who correctly identified all plates were classified as not color-blind, whereas those with ≥4 errors were considered color-blind【23】.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDetermination of Hand Dominance:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eHand preference was determined using the Turkish version of the Oldfield Questionnaire. The questionnaire included questions about writing, drawing, throwing a ball or stone, brushing teeth, holding a knife without a fork, holding a fork, using a hammer, using scissors, striking a match, and opening a bottle cap. Results were scored using the Geschwind scale【9,24】.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinger Tapping Test Procedure:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe TanTong FingerTap Test system was used【25】. Participants sat comfortably, approximately 50 cm from the screen, with wrist support. When ready, they were instructed to press a designated key with the index finger of the right hand as quickly and repeatedly as possible for 20 seconds【9】.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisual Reaction Time Tests Procedure:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eFour different VRTs were administered. In each test, ten colored squares (7×7 cm) appeared on the screen, and participants were instructed to press the designated key as quickly as possible according to the instructions:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eSimple Visual Reaction Time (S-VRT):\u003c/strong\u003e A single square appeared at fixed intervals.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eComplex Visual Reaction Time (C-VRT):\u003c/strong\u003e A single square appeared at variable intervals.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSimple Recognition Visual Reaction Time (SR-VRT):\u003c/strong\u003e Squares of different colors appeared at equal intervals. Participants were instructed to press one key if the square was red and another key if it was not red.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eComplex Recognition Visual Reaction Time (CR-VRT):\u003c/strong\u003e Squares of different colors appeared at variable intervals. Participants were instructed to press the designated key depending on whether the square was red or not.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe system used the computer’s central processor instructions “Read Time Stamp Counter–RDTSC” to achieve high temporal resolution (1/100 ms). It automatically recorded intertap intervals in the FTT, reaction times in the VRTs, and incorrect or missed responses, saving all data to the computer for further analysis【9】.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics 22. Normality of the data distribution was assessed with the Shapiro–Wilk test, which revealed that the data were not normally distributed (p \u0026lt; 0.05). Accordingly, the non-parametric Kruskal–Wallis test was applied, and significant differences were found among groups for all variables (p \u0026lt; 0.005). Pairwise comparisons were conducted using the Dunn–Bonferroni post-hoc test. The significance level (type I error) was set at α = 0.05. Effect size (ε²) was calculated using Cohen’s (1988) formula to evaluate the impact of group differences identified by the Kruskal–Wallis test. Spearman’s rank correlation test was used to determine associations between variables, and results were reported as rho (ρ) coefficients. Finally, multiple linear regression analysis was conducted to evaluate the independent effects of FTT and sarcopenia severity on dependent variables.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 120 volunteer participants were initially enrolled in the study; however, 19 were excluded because they were unable to complete the Finger Tapping Test. Thus, 101 participants were included in the final analysis. Among them, 58 (57.4%) were female and 43 (42.5%) were male. Dynapenia was present in 84 participants (83.2%), while 17 participants (16.8%) had no dynapenia.\u003c/p\u003e\n\u003cp\u003eThe demographic and baseline clinical characteristics of the study population are summarized in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eTable 1. Distribution of demographic and clinical characteristics of the participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMales (n = 43, 42.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemales (n = 58, 57.4%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge, years, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e78.14 \u0026plusmn; 1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74.36 \u0026plusmn; 0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNursing home, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation - Uneducated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation - 0\u0026ndash;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation - 5\u0026ndash;8 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation - 8\u0026ndash;12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation - \u0026gt;12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMuscle mass, kg/m\u0026sup2;, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.23 \u0026plusmn; 0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.93 \u0026plusmn; 0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI, kg/m\u0026sup2;, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.68 \u0026plusmn; 0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.86 \u0026plusmn; 0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSmoking, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31 (72.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHypertension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31 (72.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42 (72.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCoronary artery disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHyperlipidemia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDementia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDepression, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (39.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChronic obstructive pulmonary disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAsthma, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOsteopenia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOsteoporosis, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrinary incontinence, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37 (63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFalls, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 (31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWeight loss, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSlow gait speed, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSARC-F \u0026ge; 4, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGrip strength, kg, mean \u0026plusmn; SD (min\u0026ndash;max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.2 \u0026plusmn; 1.15 (6.5\u0026ndash;39.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.1 \u0026plusmn; 0.64 (6.1\u0026ndash;25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon-sarcopenia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProbable sarcopenia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConfirmed sarcopenia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSevere sarcopenia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: standard deviation; BMI: body mass index; SARC-F: Sarcopenia Questionnaire.\u003c/p\u003e\n\u003cp\u003eAnalysis of the Finger Tapping Test (FTT) findings revealed significant differences among the groups according to sarcopenia severity. The mean FTT times were 258 \u0026plusmn; 57 ms in the non-sarcopenia group (NS), 391 \u0026plusmn; 139 ms in the probable sarcopenia group (PS), 471 \u0026plusmn; 161 ms in the confirmed sarcopenia group (CS), and 601 \u0026plusmn; 137 ms in the severe sarcopenia group (SS). Since the data were not normally distributed, the Kruskal\u0026ndash;Wallis test was used to evaluate intergroup differences, and a statistically significant difference was observed (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003ePost-hoc analyses demonstrated significant differences between non-sarcopenic participants and those with probable sarcopenia (p = 0.003), confirmed sarcopenia (p \u0026lt; 0.001), and severe sarcopenia (p \u0026lt; 0.001). Additionally, a significant difference was observed between the probable and severe sarcopenia groups (p \u0026lt; 0.001). In contrast, no significant differences were found between the probable and confirmed sarcopenia groups (p = 0.662) or between the confirmed and severe sarcopenia groups (p = 0.292).\u003c/p\u003e\n\u003cp\u003eThe effect size calculated for this comparison was \u0026epsilon;\u0026sup2; = 0.378, which was used to assess the magnitude and strength of the statistically significant differences【26】. The variation of FTT results across groups is illustrated in \u003cstrong\u003eFigure 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eTable 2. \u0026nbsp;S-VRT results and significance levels between groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSignificance (p \u0026lt; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS-VRT (Mean \u0026plusmn; SD, min\u0026ndash;max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e515.2 \u0026plusmn; 160.2 (310\u0026ndash;877)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e876.5 \u0026plusmn; 330.0 (344\u0026ndash;1925)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e818.2 \u0026plusmn; 212.7 (485\u0026ndash;1228)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1040.0 \u0026plusmn; 412.7 (534\u0026ndash;2065)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNS significantly different from PS, CS, SS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable notes: S-VRT: Simple Visual Reaction Time; SD: standard deviation; NS: non-sarcopenia; PS: probable sarcopenia; CS: confirmed sarcopenia; SS: severe sarcopenia.\u003c/p\u003e\n\u003cp\u003eThe mean \u0026plusmn; standard deviation (min\u0026ndash;max) values of the groups are presented in Tables 2 and 3. In the S-VRT test, the highest mean value was observed in the severe sarcopenia (SS) group. According to the results of the Dunn\u0026ndash;Bonferroni post-hoc test, statistically significant differences were found between the non-sarcopenia group and the probable sarcopenia group (p \u0026lt; 0.001), the confirmed sarcopenia group (p = 0.006), and the severe sarcopenia group (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eHowever, no statistically significant differences were observed between the confirmed and probable sarcopenia groups (p = 1.000), between the confirmed and severe sarcopenia groups (p = 0.974), or between the probable and severe sarcopenia groups (p = 1.000).\u003c/p\u003e\n\u003cp\u003eTable 3. C-VRT results and significance levels between groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSignificance (p \u0026lt; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eC-VRT (Mean \u0026plusmn; SD, min\u0026ndash;max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e725.3 \u0026plusmn; 229.6 (400\u0026ndash;1101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1211.5 \u0026plusmn; 367.5 (247\u0026ndash;2079)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1184.9 \u0026plusmn; 306.3 (753\u0026ndash;2037)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1541.9 \u0026plusmn; 613.2 (806\u0026ndash;2807)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNS significantly different from PS, CS, SS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSR-VRT (Mean \u0026plusmn; SD, min\u0026ndash;max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e614.7 \u0026plusmn; 163.7 (414\u0026ndash;895)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1153.7 \u0026plusmn; 351.9 (335\u0026ndash;1747)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1358.3 \u0026plusmn; 445.0 (924\u0026ndash;2689)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1659.1 \u0026plusmn; 489.6 (1125\u0026ndash;2840)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNS significantly different from PS, CS, SS; PS significantly different from SS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCR-VRT (Mean \u0026plusmn; SD, min\u0026ndash;max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e784.5 \u0026plusmn; 206.1 (521\u0026ndash;1190)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1372.6 \u0026plusmn; 407.4 (467\u0026ndash;2623)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1704.1 \u0026plusmn; 524.2 (1008\u0026ndash;3076)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1947.6 \u0026plusmn; 511.6 (1210\u0026ndash;3032)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNS significantly different from PS, CS, SS; PS significantly different from SS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable notes: NS: non-sarcopenia; PS: probable sarcopenia; CS: confirmed sarcopenia; SS: severe sarcopenia. FTT: Finger Tapping Test; S-VRT: Simple Visual Reaction Time; C-VRT: Complex Visual Reaction Time; SR-VRT: Simple Recognition Visual Reaction Time; CR-VRT: Complex Recognition Visual Reaction Time.\u003c/p\u003e\n\u003cp\u003eIn the C-VRT test, healthy individuals had significantly shorter reaction times compared to all patient groups (p \u0026lt; 0.001). However, probable sarcopenia, confirmed sarcopenia, and severe sarcopenia groups could not be statistically distinguished from each other (p \u0026gt; 0.7). In the SR-VRT test, healthy individuals were significantly different from all patient groups (p \u0026lt; 0.001). In the CR-VRT test, significant differences were found between healthy individuals and all patient groups (p \u0026lt; 0.003).\u003c/p\u003e\n\u003cp\u003eWhen the results of the S-VRT, C-VRT, SR-VRT, and CR-VRT tests were evaluated together, statistically significant differences were observed between healthy individuals (NS) and all groups within the disease spectrum (PS, CS, SS) across all four measures (p \u0026lt; 0.001). However, these differences did not follow the same distribution pattern in each test, and the degree of separation between groups varied depending on the test.\u003c/p\u003e\n\u003cp\u003ePrevious literature has demonstrated that sarcopenia may affect not only physical but also cognitive functions【27】. Therefore, in this study, the relationship between sarcopenia severity and both motor performance, assessed by the Finger Tapping Test (FTT), and cognitive status, assessed by the Mini-Mental State Examination (MMSE), was comparatively examined. The aim was to identify which of these physical and cognitive parameters could more sensitively predict sarcopenia.\u003c/p\u003e\n\u003cp\u003eThe relationships between FTT, MMSE, and sarcopenia severity were analyzed using Spearman\u0026rsquo;s rank correlation test. The analysis revealed a positive and moderate-to-strong correlation between FTT and sarcopenia severity (rho = 0.627, p \u0026lt; 0.001). In contrast, a negative and weak-to-moderate correlation was observed between MMSE and sarcopenia severity (rho = \u0026ndash;0.306, p = 0.002).\u003c/p\u003e\n\u003cp\u003eThe correlations between FTT, MMSE, and sarcopenia severity are shown in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4. Correlation of FTT, MMSE, and sarcopenia severity\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCorrelation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003erho\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDirection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrength (Interpretation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSignificance (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFTT \u0026harr; Sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eModerate\u0026ndash;Strong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ep \u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMMSE \u0026harr; Sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWeak\u0026ndash;Moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ep = 0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable notes: FTT: Finger Tapping Test; MMSE: Mini-Mental State Examination.\u003c/p\u003e\n\u003cp\u003eTo evaluate whether the increase in SR-VRT and CR-VRT times was attributable solely to motor slowing (FTT) or also to cognitive processes involved in the processing and response to visual stimuli, a multiple linear regression model was applied to determine the independent effects on the dependent variables. When FTT was entered alone as an independent variable, it accounted for 14.3% of the variance in SR-VRT (R\u0026sup2; = 0.143) and 11.1% of the variance in CR-VRT (R\u0026sup2; = 0.111), and was identified as a significant predictor (SR-VRT: p \u0026lt; 0.001, \u0026beta; = 0.378; CR-VRT: p = 0.001, \u0026beta; = 0.333).\u003c/p\u003e\n\u003cp\u003eHowever, when sarcopenia severity was added to the model, the explained variance increased substantially (CR-VRT: R\u0026sup2; = 0.419; SR-VRT: R\u0026sup2; = 0.401), and only sarcopenia severity remained as a statistically significant predictor (CR-VRT: \u0026beta; = 0.715, p \u0026lt; 0.001; SR-VRT: \u0026beta; = 0.654, p \u0026lt; 0.001). In contrast, the effect of FTT lost its statistical significance (CR-VRT: p = 0.241; SR-VRT: p = 0.730).\u003c/p\u003e\n\u003cp\u003eThese results demonstrate that changes in SR-VRT and CR-VRT are primarily associated with sarcopenia severity rather than motor performance reflected by FTT, indicating that the predictive value of FTT may be indirectly mediated through sarcopenia status. The results of these regression analyses are presented in Table 5.\u003c/p\u003e\n\u003cp\u003eTable 5. Predictors of reaction time tests\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDependent Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIndependent Variables in the Model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSignificant Predictors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongest Predictor (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSR-VRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFTT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFTT (p \u0026lt; 0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026beta; = .378 (FTT)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCR-VRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFTT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFTT (p = 0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026beta; = .333 (FTT)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCR-VRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFTT + Sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSarcopenia (p \u0026lt; 0.001); FTT (p = 0.241)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026beta; = .715 (Sarcopenia)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSR-VRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFTT + Sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSarcopenia (p \u0026lt; 0.001); FTT (p = 0.730)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026beta; = .654 (Sarcopenia)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable notes: FTT: Finger Tapping Test; SR-VRT: Simple Recognition Visual Reaction Time; CR-VRT: Complex Recognition Visual Reaction Time. Analyses were based on regression models.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the significant differences observed in FTT scores across sarcopenia groups indicate that motor performance impairments increase with sarcopenia severity. Supporting this finding, the calculated effect size (ε² = 0.378) corresponds to a large effect according to the classification proposed by Cohen (1988) and Tomczak \u0026amp; Tomczak (2014). This result suggests that the observed differences are not only statistically significant but also clinically and practically meaningful. Similarly, studies examining the relationship between muscle strength and reaction time have shown that elderly individuals with lower muscle strength exhibit significantly prolonged reaction times. This supports the notion that FTT is a sensitive test, particularly in detecting motor slowing.(28)\u003c/p\u003e\n\u003cp\u003eIn the S-VRT test, the significantly shorter reaction times observed in healthy individuals compared to all patient groups (p \u0026lt; 0.001) demonstrate that sarcopenia-related cognitive-motor slowing becomes evident even at an early stage. On the other hand, no significant difference was observed between the confirmed and severe sarcopenia groups (p \u0026gt; 0.05), suggesting that the increase in reaction time may not progress linearly with disease severity and may stabilize beyond a certain threshold.\u003c/p\u003e\n\u003cp\u003eIn the C-VRT test, the inability to statistically distinguish between the probable, confirmed, and severe sarcopenia groups (p \u0026gt; 0.7) indicates that C-VRT may be sensitive in early diagnosis but limited in detecting performance differences as the disease progresses.\u003c/p\u003e\n\u003cp\u003eIn the SR-VRT test, although healthy individuals were significantly distinguished from all patient groups (p \u0026lt; 0.001), the confirmed sarcopenia group did not differ significantly from other patient groups. This may indicate that SR-VRT has the potential to capture changes between early and advanced stages.\u003c/p\u003e\n\u003cp\u003eIn the CR-VRT test, significant differences were found between healthy individuals and all patient groups, with the difference between the probable and severe sarcopenia groups being particularly notable (p = 0.003). This result suggests that CR-VRT may be effective in distinguishing early from advanced stages. However, confirmed sarcopenia individuals appeared to obscure this differentiation. Our findings are consistent with studies reporting prolonged reaction times in sarcopenia and suggest that reaction time measurements may be particularly sensitive in distinguishing healthy from sarcopenic individuals.(29)\u003c/p\u003e\n\u003cp\u003eThis study was primarily conducted to investigate the relationship between sarcopenia stages and FTT, which reflects both psychomotor performance and cognitive processes. Since previous literature has demonstrated that sarcopenia may also affect cognitive functions, the Mini-Mental State Examination (MMSE), which assesses cognitive status, was additionally evaluated.(27) Correlation analyses revealed that both FTT and MMSE scores were significantly associated with sarcopenia severity (Table 4). The moderate positive correlation between FTT and sarcopenia (rho = 0.627) suggests that psychomotor performance and related cognitive functions decrease as sarcopenia progresses. The weak-to-moderate negative correlation between MMSE and sarcopenia (rho = –0.306) indicates that cognitive impairment, albeit limited, may be associated with sarcopenia. The repeated demonstration of the sarcopenia–cognitive performance relationship in the literature explains the weak-to-moderate negative correlation observed with MMSE in our study.(30) These findings are consistent with the literature, indicating that sarcopenia affects not only physical but also cognitive aspects.\u003c/p\u003e\n\u003cp\u003eAnalysis of reaction times showed that FTT initially had a significant effect on CR-VRT and SR-VRT, which represent cognitive processes. This finding suggests that FTT, as a motor performance indicator, may be related to the response time to visual stimuli. However, with the inclusion of sarcopenia severity in the model, the effect of FTT lost its significance, and sarcopenia severity emerged as the strongest predictor in both tests. This indicates that the prolongation of these reaction times is primarily due to more complex physiological and cognitive slowing associated with sarcopenia. Therefore, changes in reaction times can be associated not only with motor slowing but also with cognitive processes slowed by sarcopenia.\u003c/p\u003e"},{"header":"Summary of Findings","content":"\u003cp\u003eThe significant prolongation of FTT duration in the severe sarcopenia group demonstrates deterioration in motor performance. This test may raise early awareness for screening purposes; however, due to its susceptibility to multiple influencing factors, it should not be considered a specific diagnostic tool on its own.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;While S-VRT is a test that does not require central processing and evaluates basic motor response, C-VRT measures alertness without central processing. In contrast, SR-VRT requires central processing and assesses sustained attention, while CR-VRT simultaneously evaluates both alertness and sustained attention. In our study, participants in the severe sarcopenia group demonstrated significantly slower performance in C-VRT, SR-VRT, and CR-VRT compared to both healthy individuals and the probable sarcopenia group. This suggests that as sarcopenia severity increases, impairments occur not only in physical but also in cognitive functions. This indicates that with the progression of sarcopenia, mental processes—particularly executive functions related to attention and alertness—are also affected.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Strengths and Limitations","content":"\u003cp\u003eThe strengths of this study include the use of computer-based objective measurements to simultaneously evaluate both motor and cognitive processes, and the detailed examination of the relationship between FTT, VRT tests, and sarcopenia stages. However, the study’s single-center design, the relatively limited sample size, and the use of only MMSE for cognitive evaluation are important limitations. The inclusion of participants from a single geographical region may also limit the generalizability of the findings.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Clinical Implications and Future Research","content":"\u003cp\u003eOur findings suggest that FTT and computer-based VRT tests may be useful in identifying sarcopenia-related motor and cognitive slowing. These tests have potential as practical tools for early screening in clinical practice, as they are easy to administer, provide rapid results, and are cost-effective. However, they are not sufficient on their own for staging or definitive diagnosis. Future studies with larger sample sizes, multicenter designs, and more comprehensive cognitive test batteries are needed to increase the generalizability of these results and contribute to clinical applications.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor ContributionsBY, KS, LA, RTD, and HSO contributed to the conceptualization of the study. Methodology was developed by BY, LA, EK, KS, GA, RTD, and HSO. Formal analysis was performed by LA and BE. Investigation was carried out by BY, SB, KS, LA, EK and FKE. Resources were provided by BY, FKE, SB, BBC, HK, ED, and RE. Data curation was conducted by BY and FKE. The original draft was prepared by BY, LA, KS, and FKE. Review and editing of the manuscript were performed by LA. Visualization was conducted by BY. Supervision was provided by KS, LA, RTD, HSO, and GA. Project administration was undertaken by BY, KS and LA. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYuan S, Larsson SC. Epidemiology of sarcopenia: Prevalence, risk factors, and consequences. Metabolism. 2023;144:155533. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.metabol.2023.155533\u003c/span\u003e\u003cspan address=\"10.1016/j.metabol.2023.155533\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruy\u0026egrave;re O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. 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Association between sarcopenia and cognitive impairment in older people: A meta-analysis. Eur Geriatr Med. 2022;13(4):771\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s41999-022-00661-1\u003c/span\u003e\u003cspan address=\"10.1007/s41999-022-00661-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7700433/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7700433/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nSarcopenia is a progressive skeletal muscle disorder characterized by the loss of muscle mass and strength, associated with falls, fractures, and mortality. The Finger Tapping Test (FTT) has been widely used in neurophysiological studies to evaluate motor control and function. Visual reaction time tests are computer-based tools that measure the response speed to visual stimuli and have been linked to cognitive function. This study aimed to evaluate the potential of computer-based Finger Tapping Test and visual reaction time tests in diagnosing and staging sarcopenia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nDemographic characteristics, handgrip strength, muscle mass, physical performance, and Sarcopenia Questionnaire (SARC-F) scores were recorded. Participants underwent computer-based Finger Tapping Test and visual reaction time tests. Data distribution was assessed using the Shapiro–Wilk test. As data were non-normally distributed, the Kruskal–Wallis test was applied, revealing significant intergroup differences (p \u0026lt; 0.005). Pairwise comparisons were conducted with the Dunn–Bonferroni test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nFinger Tapping Test results showed a significant decline in motor performance with increasing sarcopenia severity. Visual reaction time outcomes revealed significant differences between healthy individuals and all sarcopenia groups (p \u0026lt; 0.001), although response patterns varied across groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003cbr\u003e\nThe prolongation of Finger Tapping Test times in severe sarcopenia indicates impaired motor performance. The Finger Tapping Test may raise early awareness as a screening tool; however, due to its sensitivity to multiple influencing factors, it should not be considered a stand-alone diagnostic method.\u003c/p\u003e","manuscriptTitle":"Screening Potential of Finger Tapping and Visual Reaction Time Tests for Sarcopenia in Geriatric Clinical Practice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 08:14:32","doi":"10.21203/rs.3.rs-7700433/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-01T09:25:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-27T06:35:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-27T06:34:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-09-24T06:57:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7015baa8-b71e-4186-a3f3-0697c0cd27be","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T07:53:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 08:14:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7700433","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7700433","identity":"rs-7700433","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}