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PSYCHOMOTOR PERFORMANCE INMEDICAL OPD PATIENTS
A H Shah, P P Mehrotra, S V Joshi, Dharmendra Sharma, J C Patel, H L Dhar
Medical Research Centre, Bombay Hospital, Mumbai - 20.
Psychomotor performance tests were undertaken in 329 patients attending medical OPD of MRC. All the patients were subjected to reaction time (visual, auditory and touch). Other tests were studied as follows. Maze (154), arithmatic ability (193), and mental status questionnaires (116). All the patients were sub-grouped into age, sex and educational levels. It was observed that as age advances-visual, auditory and touch reaction time increases but decreases with education. Sex did not make any difference. Time taken to complete maze and mental status questionnaires increases with age specially in 60+ subjects with decreased arithmatic ability. Sex does not affect the performance of arithmatic ability. Sex does not affect the performance of arithmatic ability and mental status questionnaires but higher the educational status better the performance.
INTRODUCTION
Psychomotor performance including reaction time and effect of calcium channel antagonists has been reported earlier. [1,2] Reaction time as such in adults [3,4] and in elderly [5] has also been reported. However, most of these studies were performed in small number of subjects and in particular to find the effects of diurnal variation [4] or drugs. [2,3] Currently effect of nimodipine, a calcium channel antagonist which crosses the blood brain barrier has also been reported. [6]
Present study was aimed at having detailed information about psychomotor abilities including reaction time using large number of subjects and to correlate the effect of age, sex, education and mental status to evaluate this ability to react to urgent and emergency situation, no such study has so far been reported.
MATERIAL AND METHODS
Three hundred twenty nine patients attending medical OPD of Bombay Hospital during 1996-97 were included in the study. Patients attending OPD for the first time, who were not getting any drug were selected. Subjects habituated to alcohol and sleeping pills and suffering from CNS disorders were excluded from the study. All tests were performed under similar condition including time period after taking the detail history and following tests were performed.
Reaction time
This was recorded on response analyser (model YSRT 1T2 from Yantrashilpa, Pune). The individual was asked to respond to visual stimulus, namely Red, Yellow and Green light as well as auditory sound and touch immediately after getting a signal by pressing a key. The reaction time was measured in milliseconds taking the mean of five simultaneous readings and analysed as per age, sex and educational background.
Arithmatic ability
Summation test using ten vertical columns was performed in order to judge arithmatic ability. Each column containing 5 figures (0 to 9) was to be added and time taken was noted in seconds.
Maze
Natural numbers from 1 to 20 were arranged inhaphazard manner and subjects were to join these numbers chronologically as quickly as possible and time to complete the maze noted in seconds.
Mental status questionnaire
Small general questions were framed to find out mental status of subjects by recording response time (Table 1).
Mental status questionnaire1. Age in years 2. What is the day today? 3. What is the time now? 4. Which month is this? 5. Which year is this? 6. Name of this Hospital 7. Prime Minister now? 8. Date and year of independence of India 9. Name of months back (any 6 correct sequences) 10. 20-1 counting backwards.
RESULTS
Results were analysed according to age, sex and grades of institutional qualification. Demographic data of 329 subjects included in the study has been shown in Table 2.
Demographic dataAge (years) Nos. Sex Nos. Education Nos. upto 18 36 Male 260 Illiterate 7 19 - 40 210 Primary 54 41 - 59 52 Female 69 Secondary 174 60+ 31 Collegiate 94 Total 329
Mean reaction time in response to various stimuli in different age groups has been shown in Table 3. It was found that as age advances, the visual, auditory and touch reaction time progressively increases showing stiff rise (25%) in age group of 60+ compared to 5.47% in the lower age group (60-). However, analysis of data sexwise does not show any apparent difference.
Mean reaction time (milliseconds) in relation to ageStimulus upto 18 yrs. 19-40 yrs. 41-59 yrs. 60+ Visual - Red 156.66 157.55
(+0.56%)165.23
(+5.47%)186.35
(+18.95%)- Yellow 155.33 155.18
(-0.09%)161.05 (+3.68%) 148.03
(-4.70%)- Green 157.41 154.97
(-1.55%)157.44
(+0.02%)175.09
(+11.23%)Auditory 139.97 139.97 141.04 157.0 — (+0.76%) (+12.17%) Touch 179.67 170.37 168.33 225.17 (-5.17%) (-6.31%) (+25.32%)
Table 4 shows effect of various stimuli in different groups of educational status compared to control with no institutional education. It was observed that higher the education, less is the reaction time irrespective of stimuli ranging from 11% (Touch) to 27% (yellow light) compared with illiterate.
Mean reaction time (milliseconds) in relation to educationStimulus Illiterate Primary Secondary Collegiate Visual - Red 197.71 168.22
(-14.91%)160.86
(-18.64%)155.72
(-21.24%)- Yellow 194.71 163.65
(-15.95%)158.09
(-18.39%)141.45
(-27.35%)- Green 184.85 161.18
(-12.81%)159.39
(-13.77%)150.23
(-18.73%)Auditory 174.71 150.22 141.32 135.22 (-14.01%) (-19.11%) (-22.60%) Touch 212.50 188.60 174.83 168.40 (-11.25%) (-17.72%) (-20.75%)
Table 5 shows, as age advances, time taken to complete maze and mental status questionnaire increases while arithmatic ability decreases in 60+ age group but without any significant difference in male and female.
However, it was evident that college education had some positive effect on the performance of maze test, arithmatic ability or attending to questionnaire (Table 6).
Average time taken (seconds) in relation to ageTest upto 18 yrs. 19-40 yrs. 41-59 yrs. 60+ Maze
(154)15.80 16.61
(+5.13%)19.50
(+23.42%)28.50
(+80.37%)Arithmatic-ability (193) 57.88 56.25
(-2.82%)47.0
(-18.97%)47.20
(-18.45%)Mental status Questionnaire (116) 92.75
(-5.66%)87.50
(-3.90%)89.13 113.57
(+122.45%)
Average time taken (seconds) in relation to educationTest Primary Secondary Collegiate Maze
(154)27.0 17.81
(-34.03%)17.68
(-34.52%)Arithmatic ability (193) 59.0 59.22
(+0.37%)46.98
(-20.37%)Mental status Questionnaire (116) 104.0 96.78
(-6.94%)87.00
(-16.34%)DISCUSSION
Purpose of this study was to get normal reaction time in different age groups according to sex and to see whether educational back-ground makes any difference. Although isolated evidences of reaction time in normal volunteers [1,2] and other subjects [3,4] including in elderly Indians [5] has been reported results were widely variable due to different parameters used as well as limited number of cases studied under dissimilar conditions. However, in one such study, [5] reaction time was recorded in large number of subjects of 60+ age group (285M, 65F) using a crude device and only one parameter, but the reaction time was about one and half times more than the present study. No comparable data is available for other age groups. [6] As far as adult (30-45 years) is concerned only 9 subjects were studied, [1] that too in relation to drugs using placebo control but control reaction time (though studied with electronic device) was five times higher compared to present finding (19-48 years).
Regarding maze, arithmatic ability and mental status questionnaire, there is no such comprehensive study in Indian subjects except letter cancellation and short term memory but only in 9 subjects. [1] In one recent study from USA, psychomotor performances in young and elderly [7] were compared however, only positive finding was reaction time in elderly subjects was longer similar to our results. Visual reaction time has been associated with athletic activity, [8] but no significant difference has been observed with age or race.
Present study confirms the reaction time increases as age advances but without any significant difference in relation to sex. The study also shows that both arithmatic ability and mental faculty increase with age and education.
REFERENCES
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2. Khajuria V, Kapoor B, Raina RK. Studies on psychomotor performance in healthy volunteers after diazepam propranolol and alcohol given alone or in combination. Ind J Physiol Pharmacol 1995; 39 (3) : 242-6.
3. Pathak JD, Mehrotra PP. Human reaction time after stimulants and tranquillisers. Bom Hosp Jour 1981; 23 (1) : 23-5.
4. Pathak JD, Mehrotra PP. Variation in human alertness in course of a day as evidenced by reaction time. Bom Hosp Jour April 1976; 18 (2) : 7-8.
5. Pathak JD, Joshi SV, Mehrotra PP. Reaction time in elderly Indian subjects. Jour of Indian Med Asson Nov. 1, 1978; 71 (9) : 221-3.
6. Dhar HL. Benefits and safety of calcium channel antagonists. Ind J Clin Pharmacol Therap 1998 (Press).
7. Smith GA, Brewee N (Australia). Slowness and age : speed accuracy mechanisms. Psychol Aging (United States) June 1995; 10 (2) : 238-47.
8. Classe JG, Semes LP, Daum KM, Nawakowski R, Alexander LJ, Wisniewsiki J, Beisel JA, Mann K, Rutstein R, Smith M, Bartolucci A. Association between visual reaction time and batting, fielding and earned run averages among players of southern baseball league. J Am Optom Associ Jan. 1997; 68 (1) : 43-9.
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