![]() ![]() Type 2 diabetes mellitus (T2DM) is closely linked to cognitive decline and alterations in brain structure and function. Further research is required to confirm results in the long term using a larger and more diverse sample. Stepping exergames may be useful for assessing the cognitive and motor status of older adults, potentially allowing assessments to be more frequent, affordable, and enjoyable. The preliminary visual analysis revealed that the group with cognitive impairment required more time to advance to the next difficulty level, also presenting slower reaction times and stepping speeds when compared to the healthy control group. Stepping and gameplay metrics had moderate-to-strong correlations with cognitive and mobility performance indicators: faster, longer, and higher steps were associated with better mobility scores better cognitive games’ scores and reaction times, and longer and faster steps were associated with better cognitive performance. The differences between the two groups were visually inspected, considering their within-game progression over the training period. Based on MoCA scores, patients were then stratified into two groups: cognitively impaired and healthy controls. Parameters measured on the first gameplay were correlated against standard cognitive and mobility assessments, including the Montreal Cognitive Assessment (MoCA), gait speed, and the Short Physical Performance Battery. Stepping parameters included length, height, speed, and duration, measured by inertial sensors placed on the shoes while interacting with the exergames. Game parameters included games’ scores and reaction times. Stepping and gameplay metrics were recorded in a longitudinal study involving 13 older adults with mobility limitations. In this study, we investigated the potential of stepping and gameplay metrics to assess the motor-cognitive status of older adults. Stepping exergames designed to stimulate physical and cognitive skills can provide important information concerning individuals’ performance. The MoCA has proved to be an appropriate measure for cognitive screening taking into account different cognitive domains, which will enable clinicians and researchers to use this test and its six latent dimensions to achieve a better understanding of the individuals' cognitive profile. The present findings corroborate the six-dimensional structure of the MoCA and provide good evidence of the construct related validity. This study contributes to overcome an important gap in the construct related validity of this instrument. An overall psychometric adequacy of the items, and a good reliability were also found. The results allowed us to establish the factorial, convergent, and discriminant validity of this six-dimensional structure. Although all tested models showed a good fit, the six-factor model based on the conceptual model proposed by the MoCA's authors showed a significantly better fit. In a Portuguese sample of 830 participants, several models were tested using Confirmatory Factor Analysis. The present study aims to assess the construct related validity of the MoCA through the establishment of the factorial, convergent, and discriminant related validities, and the reliability of data. The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment.
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