ReacStick: Evaluating Executive Function Independent From Level of Education.

Abstract

Neuropsychological tests of executive function often rely on reading, writing, and/or calculation, introducing educational bias. ReacStick uses a rapid go/no-go paradigm (within a 390 millisecond window) to assess attention, processing speed, inhibition, and working memory without requiring proficiency in reading, writing, or calculation. Secondary analyses using cross-sectional data examined the impact of years of education on Trails B, a gold-standard measure of executive function, and ReacStick parameters in healthy older adults ( n = 139) and adults with hepatic cirrhosis ( n = 118). Fewer years of education correlated with longer Trails B completion times ( r = -0.214; P < 0.001) and accounted for 5.3% of Trails B variance when controlling for age, gender, and clinical group (cirrhosis vs. older) as covariates. In contrast, years of education showed no significant relationship with ReacStick accuracy parameters (on, off, and all accuracy). Similar results were obtained when years of education was dichotomized (≤12 vs. >12 years). ReacStick offers a quantifiable test of executive function with limited education bias, supporting its use in diverse population, including those with limited educational attainment or nonnative English speakers.