Effects of age and individual experiences on tactile perception over the life span in women

Acta Psychologica 190 (2018) 135–141

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Effects of age and individual experiences on tactile perception over the life span in women

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Ben Goddea, , Patrick Brunsb,c, Volker Wendeld, Mireille Trautmanna,e a

Department of Psychology and Methods, Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany Biological Psychology and Neuropsychology, University of Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany c Department of Cognitive, Linguistic & Psychological Sciences, Brown University, 190 Thayer Street, Providence, RI 02912, USA d BASF Personal Care and Nutrition GmbH, Henkelstraße 67, 40589 Duesseldorf-Holthausen, Germany e Blicklabor, Schwarzwaldstraße 13, 79117 Freiburg, Germany b

A R T I C LE I N FO

A B S T R A C T

Keywords: Tactile sensitivity Tactile discrimination Aging Lifespan development

Tactile perception results from the interplay of peripheral and central mechanisms for detection and sensation of objects and the discrimination and evaluation of their size, shapes, and surface characteristics. For different tasks, we investigated this interaction between more bottom-up stimulus-driven and rather top-down attentionrelated and cognitive processes in tactile perception. Moreover, we were interested in effects of age and tactile experiences on this interaction. 299 right-handed women participated in our study and were divided into five age groups: 18–25 years (N = 77), 30–45 years (N = 76), 50–65 years (N = 62), 66–75 years (N = 63) and older than 75 years (N = 21). They filled a questionnaire on tactile experiences and rated their skin as either very dry, dry, normal, or oily. Further they performed three tactile tests with the left and right index fingers. Sensitivity for touch stimuli was assessed with von Frey filaments. A sand paper test was used to examine texture discrimination performance. Spatial discrimination was investigated with a tactile Landolt ring test. Multivariate ANOVA confirmed a linear decline in tactile perceptual skills with age (F(3, 279) = 76.740; p < .000; pEta2 = 0.452), starting in early adulthood. Largest age effects were found for the Landolt ring test and smallest age effects for the Sand paper test, indicating different aging slopes. Tactile experiences had a positive effect on tactile performance (F (3,279) = 4.450; p = .005; pEta2 = 0.046) and univariate ANOVA confirmed this effect for the sand paper and the Landolt ring test, but not for the von Frey test. Using structural equation modelling, we confirmed two dimensions of tactile performance; one related to more peripheral or early sensory cortical (bottom-up) processes (i.e., sensitivity) and one more associated with cognitive or evaluative (top-down) processes (i.e., perception). Interestingly, the top-down processes were stronger influenced by age than bottom-up ones, suggesting that age-related deficits in tactile performance are mainly caused by a decline of central perceptive-evaluative capacities rather than by reduced sensitivity.

1. Introduction Tactile perception results from an interplay between bottom-up or stimulus-driven processes and top-down attentional or cognitive processes (Lacey & Sathian, 2008). First of all, the ability to sense a stimulus on the skin is determined by the absolute touch detection threshold (Nevid, 2003). Secondly, spatial and temporal features of tactile stimuli need to be discriminated to identify textures, patterns, forms, or objects (Greenspan & Bolanowski, 1996; Hollins, 2002). Thus, complementary peripheral (Johnson, 2002; Johnson & Hsiao, 1992; Johnson, Yoshioka, & Vega-Bermudez, 2000) and central (Godde,

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Diamond, & Braun, 2010; Harris, Arabzadeh, Fairhall, Benito, & Diamond, 2006; Hsiao, 2010) mechanisms are involved in tactile stimulus detection and discrimination. It is well-known that tactile perceptual skills decline with increasing age (Dinse, Tegenthoff, Heinisch, & Kalisch, 2010; Wickremaratchi & Llewelyn, 2005). This decline is associated with changes at all stages of somatosensory processing from periphery to cortex. For example, these changes include altered skin conformance (Bowden & McNulty, 2013), reduced receptor density (Kurth et al., 2000) and nerve conduction velocity (Dorfman & Bosley, 1979), loss of white and grey matter in the brain (Salat et al., 2005), and alterations in the activity and specificity

Corresponding author at: Department of Psychology and Methods, Jacobs University Bremen gGmbH, Campus Ring 1, 28759 Bremen, Germany. E-mail address: [email protected] (B. Godde).

https://doi.org/10.1016/j.actpsy.2018.08.004 Received 21 February 2018; Received in revised form 29 May 2018; Accepted 9 August 2018 0001-6918/ © 2018 Elsevier B.V. All rights reserved.

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investigated with a tactile Landolt ring test. Both texture and spatial discrimination are assumed to rely significantly on sensory cortical and cognitive processes (Dinse, 2006; Reuter et al., 2013). Herewith we intended to provide evidence for different tactile tasks to be dependent on different associations with separate peripheral, rather sensory and central, rather perceptual mechanisms. Furthermore, we expected the relative contribution of those mechanisms to tactile perception to change with age (Kalisch, Kattenstroth, Kowalewski, Tegenthoff, & Dinse, 2012).

of cortical neurons (Godde, Berkefeld, David-Jürgens, & Dinse, 2002; Kalisch, Ragert, Schwenkreis, Dinse, & Tegenthoff, 2009; Lenz et al., 2013). The associated functional decline is expressed by an increase in tactile thresholds (Dinse, 2006; Stevens, 1992; Tremblay, Wong, Sanderson, & Cote, 2003), as well as by reduced accuracy in tactile discrimination tasks (Deshpande, Metter, Ling, Conwit, & Ferrucci, 2008; Master, Larue, & Tremblay, 2010). While most studies only compared young adults with older adults (usually older than 65 years of age), Stevens and Patterson (1995) revealed that tactile spatial acuity in different dimensions, such as length, location, orientation, and discontinuity, starts declining early in life with a rate of about 1% per annum between ages 20 and 80. More recent studies confirmed that the described age-related decline in tactile perception can be observed already during middle adulthood, that is, between 30 and 60 years of age (Kaneko, Asai, & Kanda, 2005; Reuter, Voelcker-Rehage, Vieluf, & Godde, 2012; Reuter, Voelcker-Rehage, Vieluf, Winneke, & Godde, 2013; Voelcker-Rehage, Reuter, Vieluf, & Godde, 2013). It has been well established that individual tactile sensitivity and perception at all ages strongly depend on accumulating effects of use or disuse (Bowden & McNulty, 2013; Dinse et al., 2010). Particularly, extensive daily tactile stimulation as in musicians or blind Braille readers (Elbert, Pantev, Wienbruch, Rockstroh, & Taub, 1995; Legge, Madison, Vaughn, Cheong, & Miller, 2008; Ragert, Schmidt, Altenmüller, & Dinse, 2004) or in professionals such as surgeons, opticians, or fine mechanics (Reuter, Voelcker-Rehage, Vieluf, Winneke, & Godde, 2014), may attenuate or even prevent age-related decline. Consequently, the magnitude of age-related changes in tactile and haptic abilities varies greatly between persons (Craig, Rhodes, Busey, Kewley-Port, & Humes, 2010). Interestingly, in contrast to motor functions including manual dexterity tasks, tactile acuity does not seem to differ between the left and right hand in young adults (e.g., Sathian and Zangaladze, 1996; Van Boven et al., 2010; Vega-Bermudez and Johnson, 2001). However, for older adults (over 65 years), but not younger adults (< 56 years), Dinse et al. (2006) reported better performance with left than right index finger in a two-point discrimination task. It has been revealed that intrahemispheric and interhemispheric inhibition is altered in older adults (Brodoehl, Klingner, Stieglitz, & Witte, 2013; Gröschel et al., 2012), but if and how these changes might be related to changed laterality in tactile perceptual tasks remains open. Moreover, due to a lack of studies in this age group, it is currently unknown when and how changes in tactile laterality develop in middleaged adults. With the present study, we investigated how different tactile abilities are affected by age and tactile experiences over the adult life span, from young adulthood to old age. Specifically, our aim was to replicate that age-related changes already occur early in life around age 30 with a nearly linear decline in tactile perception from young to older adulthood (Dinse et al., 2010; Reuter et al., 2012). Individual experiences, specifically the use of the hand on the job or during leisure time, should influence such age effects, particularly in older adults (Reuter et al., 2012, 2014). We further expected the development of a left-hand dominance in tactile discrimination with older age as revealed earlier (Dinse et al., 2006). Going beyond what has been demonstrated before, we particularly focused on tactile tasks that we assumed to differently involve peripheral or early sensory cortical (bottom-up) and more cognitive or evaluative (top-down) processes. Herewith, sensing of tactile stimuli in the periphery would rely mostly on skin and receptor characteristics such as shape and density, while the evaluation and classification, i.e., perception of tactile information would be more associated with central (mostly cortical) processes and mechanisms such as cortical neuronal tuning properties, lateral inhibition, or attention and working memory. Peripheral sensitivity was tested as touch detection threshold with von Frey filaments, a sand paper test was used to examine texture discrimination performance, and spatial discrimination was

2. Methods 2.1. Participants This study was performed within the framework of a larger project on the effect of age and tactile sensitivity on the perception and evaluation of cosmetic creams (Trautmann et al., 2016). For this study, 299 women in five age groups, 18–25 years (N = 77, MEAN = 21.2, SD = 2.2), 30–45 years (N = 76, MEAN = 39.6, SD = 4.10), 50–65 years (N = 62, MEAN = 57.3, SD = 4.91), 66–75 years (N = 63, MEAN = 69.6, SD = 2.73) and older than 75 years (N = 21, MEAN = 78.5, SD = 4.11) were recruited from a data base of the three research institutes Sensory and Marketing (SAM, Hamburg, Germany), proDERM (Schenefeld, Germany) and Institut für Sensorikforschung und Innovationsberatung (ISI, Göttingen, Germany). They gave their informed consent to participate in the study and received monetary compensation for participating in the study. The study was conducted in accordance with the ethical standards of Jacobs University Bremen and the Declaration of Helsinki on experiments with human participants. All participants reported to be right-handed. 2.2. Tactile tests Three tactile tests were performed in one session lasting about 1 h. The tests were performed with the right and left index finger. Touch detection threshold (TDT) was evaluated by applying 12 von-Frey Filaments (Marstocknervtest, Schriesheim, Germany) with descending thickness, which represented the filament's force from 0.125 to 512 mN in a logarithmic scale. Participants were blindfolded and could not see if a stimulus was applied or not. Three trials per filament were done with variable time intervals and participants simply responded verbally (‘yes’) when they felt a filament touched upon their finger. Two-down, one-up procedure was used and stopped after six points of return (Leek, 2001). Threshold was defined as the mean of the forces at the six points of return. The log-transformed threshold values from the von Frey test were used for further analysis (variable FREY; cf. Mills et al., 2012). Touch perception was assessed in two different tests. Firstly, a sandpaper test (Lederman & Klatzky, 1987; Heller, 1989) was used to examine the ability to discriminate the texture of surfaces. During this test, the participants were asked to identify the finer sandpaper within pairs of sandpapers differing in grit values. Grit values between P80 and P400 were used that were logarithmically ascending to follow the Fechner-Weber-Law of perception (Barker, 1930). The test consisted of eight pairs of sandpapers: P80 and P100, P100 and P120, P120 and P150, P150 and P180, P180 and P220, P220 and P240, P240 and P320, P320 and P400 (Heller, 1989). Each pair was presented once to both index fingers. To avoid predictability for the second hand, we presented one out of three different boards in randomized order with randomized localisations of the sandpapers. The variable SAND was calculated as the sum score of correct trials. Secondly, the tactile Landolt ring test (Bruns et al., 2014; Legge et al., 2008) was applied to identify the individual spatial tactile discrimination threshold. The Landolt rings were embossed on plastic material and had an elevation of 0.4 mm (Bruns et al., 2014). One Landolt ring chart included eleven rows with four to eight rings decreasing in size from row to row. Those rings corresponded to the 136

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Further, using AMOS 24 (Arbuckle, 2014) we applied structural equation modelling (SEM) to analyze which capacities underlie tactile perception and how their influence on tactile perception changes with age and experience. SEM allows the inclusion of latent variables that have not been measured but are approximated by observable variables (Borsboom, Mellenbergh, & Van Heerden, 2003). Besides confirming associations or causal relationships, models obtained from SEM can be tested against other models to decide which one better fits the data. We started from the assumption that tactile perception, as measured by the performance in the tactile tests, separately for the left and the right hand, depends on age, skin type, and experience. We also assumed that age could also influence the skin type. We compared two different models. In the first model, we assumed only one latent variable ‘TACTILE’. In the second model, we assumed two latent variables: SENSITIVITY as a more stimulus-driven and bottom-up process and PERCEPTION as a more cognitive or top-down process.

Landolt C printed in Windows TrueType Sloan font with the gap oriented at the top, bottom, left or right. The orientation of the gap had to be detected by moving the fingertip over the respective ring. The size of the gap ranged from 5.0 mm (first row) to 0.5 mm (last row) and decreased on a logarithmic scale between rows. In each row (i.e., for each gap size), the size of the C was adjusted such that the outer diameter of the C was always five times as large as the gap (ratio 5:1). Participants started with the easiest row and had to achieve > 75% correct trials in one row to continue into the next, more difficult row. The procedure ended with the first row in which < 75% correct trials were achieved. The individual perception threshold (variable LAND) was calculated in millimeters (mm) by interpolating from the observed data the Landolt ring spacing that would have given a 75% correct response level as follows:

L 75 = Llow + ((0.75–plow )/(p high –plow )) ∗ (Lhigh − Llow). with L = Landolt spacing. p = probability of correct response. high refers to the Landolt ring spacing or probability of correct response on the lowest Landolt ring spacing on which the participants responded correctly better than 75% of the time. low refers to the Landolt ring spacing or probability of correct response on the highest Landolt ring spacing on which the participants responded correctly < 75% of the time. L75 = The hypothetical Landolt ring spacing on which the participants would have scored 75% had it been present (Van Boven, 1994).

3. Results Multivariate ANOVA was performed with z-transformed performance measures for LAND (Landolt ring test), FREY (von Frey filaments), and SAND (sandpaper test) as dependent variables (lower values indicate better performance), HAND as repeated measure, and AGE and EXPERIENCE as covariates. As we assumed that the skin characteristics from very dry to oily could have an influence on tactile sensitivity, the variable SKIN was also included as covariate. Analyses revealed main effects for AGE (F (3, 279) = 76.740; p < .000; pEta2 = 0.452) and EXPERIENCE (F (3,279) = 4.450; p = .005; pEta2 = 0.046) as well as an AGE ∗ HAND interaction effect (F (3,279) = 4.738; p = .003; pEta2 = 0.048). No other significant main or interaction effects were revealed. Univariate analyses confirmed the effect of AGE for all three tests, but with different effect sizes. The strongest age-related decline was found for LAND (F (1,281) = 182.87; p < .001; pEta2 = 0.394) followed by FREY (F (1,281) = 67.32; p < .001; pEta2 = 0.193). The smallest effect was found for SAND (F (1,281) = 17.54; p < .001; pEta2 = 0.059). Fig. 1a–f illustrates the linear relationship between AGE and performance in the three different tests separately for the left and right hand. We also tested if a quadratic fit would explain more variance in the data. This was not the case for any of the tests. EXPERIENCE had small positive effects on LAND (F (1,281) = 9.96; p = .002; pEta2 = 0.034) and SAND (F (1,281) = 4.84; p = .029; pEta2 = 0.017) but not on FREY (F (1,281) = 0.448; p = .504; pEta2 = 0.002; cf. Fig. 2a–f). Finally, the AGE ∗ HAND interaction effect was significant for the von Frey test only (F (1,281) = 13.73; p < .001; pEta2 = 0.047). To further investigate potential hand preferences in tactile performance and its interaction with age, we calculated a laterality index L as the difference between the z-transformed thresholds for the left and right hands:

2.3. Tactile experiences questionnaire Tactile experiences of the participants and regular use of their hands was assessed with a tactile experiences questionnaire. This questionnaire consisted of 3 subscales: manual activities on the job were assessed with a five-point Likert scale from ‘very seldom’ to ‘very often’ including seven items such as ‘discrimination of surfaces by touch’ or ‘use of precision instruments’ (‘Job requirements’ sub scale from Trautmann, Voelcker-Rehage, & Godde, 2011). In addition, manual activities at home and leisure time were assessed by a five-point Likert scale from ‘never’ to ‘daily’ with the eight items ‘playing an instrument’, ‘needle works’, ‘handicraft works’, ‘painting and drawing’, ‘making pottery’, ‘baking and cooking’, ‘garden work’ and, ‘writing by hand’. Finally, it was asked on a four-item scale if participants worked on a computer ‘several hours a day’, ‘1–2 h a day’, ‘1–2 times a week’, or ‘less often’. Scores for each subscale were aggregated and z-transformed over the whole sample. Z-transformed scores then were added up to form a final score that was included as variable EXPERIENCE into the analysis. 2.4. Skin characteristics Skin characteristics were assessed by subjective evaluation and included as variable SKIN in the analysis. Participants were asked to rate the skin of their hands and arms on a four-item scale as either ‘oily’, ‘normal’, ‘dry’, or ‘very dry’ (Trautmann et al., 2016).

L = Zleft − Zright; where negative values of L indicate better performance with the left hand and positive values of L indicate better performance with the right hand. Multivariate ANOVA with Laterality indices for LAND, FREY, and SAND as dependent variables and AGE, SKIN, and EXPERIENCE as covariates revealed a significant effect of AGE (F (3,279) = 4.738; p = .003; pEta2 = 0.048). Univariate analysis confirmed an increasing left laterality with increasing age for the von Frey test only (Age: F (1,281) = 13.730; p = .000; pEta2 = 0.047; cf. Fig. 3). In the next step, we applied SEM to analyze which capacities underlie tactile performance and how their contribution changes with age and experience. For power reasons (i.e., to optimize degrees of freedom in the SEM), we excluded the variable SAND from this analysis. Same analysis with SAND included revealed similar associations but with less or missing significance (not shown here). It was revealed that the

2.5. Pre-processing and statistical analysis Statistical analyses were done with SPSS for Windows version 24.0 (SPSS Inc.). Scores from all three tactile tests were z-transformed. Scores from the sand paper test were inverted to have lower values indicating a better performance thus being in line with the scales of the other two tests. After data cleaning and restructuring, analysis of variance and regression analyses were applied. A Greenhouse-Geisser nonsphericity correction was used when applicable. Bonferroni corrected post-hoc comparisons were performed. Only the results reaching a level of significance of p = .05 are reported. 137

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Fig. 1. Scatter plots show the relationship between AGE and performance in the three tests for the left and right hand (z-transformed values; lower values: lower thresholds and better performance). a and b: Landolt ring test (left and right hand, respectively); c and d: von Frey test; e and f: Sand paper test. ⁎Significant effects of AGE as revealed by ANOVA.

second model with two latent variables better fitted the data with high reliability (Chi2 = 4.347, df = 9, RMSEA = 0.000) than the model with only one latent variable (Chi2 = 106.858, df = 13, RMSEA = 0.110). Thus, two latent variables can be proposed: SENSITIVITY, that is potentially more stimulus-driven and reflecting bottom-up processing, and PERCEPTION, that is potentially involving more cognitive and topdown processing. Perception was significantly determined by LAND,

whereas Sensitivity was determined by FREY and partly LAND (cf. Fig. 4 for beta estimates and statistics). AGE significantly affected both SENSITIVITY and PERCEPTION. Furthermore, there were significant effects of AGE on SKIN and of EXPERIENCE on PERCEPTION but not on SENSITIVITY. In a follow-up, we tested if the model was supported for two different age groups: above and below 50 years of age (Fig. 5). We chose to

Fig. 2. Scatter plots show the relationship between EXPERIENCE and performance in the three tests for the left and right hand (z-transformed values; lower values: lower thresholds and better performance). a and b: Landolt ring test (left and right hand, respectively); c and d: von Frey test; e and f: Sand paper test. ⁎Significant effects of EXPERIENCE as revealed by ANOVA. 138

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Fig. 3. Laterality in tactile performance for LAND (a), FREY (b) and SAND (c); negative values indicate left-hand dominance in performance. ⁎Significant effects of AGE as revealed by ANOVA.

of the whole sample were replicated. However, model fit was lower and the effect of LAND on SENSITIVITY was no longer significant (Chi2 = 15.152, df = 9, RMSEA = 0.066). Model fit was better for the older group (Chi2 = 12.244, df = 9, RMSEA = 0.051), but in the older group, different from the younger group, age neither influenced SENSITIVITY nor SKIN. Moreover, SENSITIVITY mostly depended on performance with the right hand in the von Frey test, although the estimated regression weights were not significant. 4. Discussion We examined how different tactile abilities and their underlying peripheral and central processes are affected by age over the adult life span, from young adulthood to old age. We confirmed a linear decline in tactile perceptual skills with age, starting in early adulthood, for all three tests (Dinse et al., 2010; Reuter et al., 2012; Stevens & Patterson, 1995). However, different tactile abilities seemed to decline with different slopes as indicated by largest age effects for the Landolt ring test, followed by the von Frey test and smallest age effects for the Sand paper test. The reasons for only weak age-effects in the Sand paper test remain open. While we did not see any indicators for ceiling or ground effects, experiences not assessed with our instruments might play a major role. Further it was a rather difficult task for the participants and even young participants revealed a high inter-individual variability as found for older adults in the other two tests. Using structural equation modelling, we confirmed two dimensions

Fig. 4. Structural equation model with 2 latent variables. Standardized regression weights; significant estimates marked by *. LAND_L/R and FREY_L/R: performance measures for the Landolt ring and the von Frey test for the right and left hand, respectively; Perception, Sensitivity: latent variables.

split participants into only two age groups because otherwise the number of samples would not have been sufficient to have enough power for the SEM. In the young group (< 50 years of age), the results

Fig. 5. Structural equation models with 2 latent variables – separated by Age (below and above 50 years). Standardized regression weights; significant estimates marked by *. LAND_L/R and FREY_L/R: performance measures for the Landolt ring and the von Frey test for the right and left hand, respectively; Perception, Sensitivity: latent variables. 139

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of tactile input, than one might expect. What is more, aging of more central perceptual mechanisms in particular can be attenuated by use and tactile experiences on the job and during leisure time.

of tactile performance; one related to more peripheral or early sensory cortical (bottom-up) processes (i.e., sensitivity) and one more associated with cognitive or evaluative (top-down) processes (i.e., perception). Within the whole sample, age negatively influenced both PERCEPTION and SENSITIVITY. Interestingly, as suggested by Dinse et al., 2006), PERCEPTION was stronger influenced by age than SENSITIVITY, suggesting that age-related deficits in tactile performance are mainly caused by a decline of perceptive-evaluative capacities rather than by reduced sensitivity to tactile stimuli. This finding is in accordance with earlier findings by Vega-Bermudez and Johnson (2004) that skin conformance though changing with age does not explain age-related deficits in spatial acuity. It remains open which central mechanisms underlie age-related changes in tactile perception. One might speculate that it is particularly inhibitory mechanisms in the somatosensory cortex that are altered by age (cf. Lenz et al., 2012). Also changes in working memory or attentional control with aging might play a role. It seems that these central mechanisms much more than receptor density or afferent processing integrity determine tactile perception in older adulthood given a minimum amount of tactile information reaches the cortex through the periphery. This assumption is supported by the finding that in the older age group the age effect was significant only for PERCEPTION but not for SENSITIVITY. For the younger group, however, both effects of age were significant indicating that both peripheral and central changes determine decline in tactile abilities in young to middle-aged adulthood. Our interpretation also fits with current findings that training interventions like tactile coactivation or transcranial direct current stimulation, that have been shown to alter the somatosensory cortical representation of tactile stimuli (Gundlach, Müller, Nierhaus, Villringer, & Sehm, 2016; Ragert, Vandermeeren, Camus, & Cohen, 2008) and intracortical functional connectivity (Freyer, Reinacher, Nolte, Dinse, & Ritter, 2012), lead to improvements in tactile acuity as measured with grating orientation discrimination or two-point discrimination tasks, but not sensitivity as measured with the von Frey test (Dinse et al., 2006; Kalisch et al., 2012; Kowalewski, Kattenstroth, Kalisch, & Dinse, 2012). Previous studies reported that tactile experiences, such as regular manual activities or training and tactile stimulation in the job or during leisure time might attenuate age-related decline in tactile perception (Bowden & McNulty, 2013; Dinse et al., 2010; Legge et al., 2008; Ragert et al., 2004; Reuter et al., 2014). We found only weak such effects of experience on the Landolt ring and the Sandpaper test, but not on the von Frey test. SEM analysis, however, confirmed a significant influence of experience on the latent factor ‘PERCEPTION’, but not ‘SENSITIVITY’. In other words, cognitive-perceptual processes seem to profit from tactile experiences more than purely stimulus-driven sensory processes. For the Landolt ring test and the von Frey filament test, but not the Sandpaper test, we found that participants on average performed better with the left hand. Based on a stronger age effect for the right hand, this preference for the left hand was increased with increasing age for the von Frey test. Such left-hand dominance with increasing age has been shown previously for a 2-point discrimination task (Dinse et al., 2006). Again, the SEM analysis supported this interpretation. Though not significant, regression weights for prediction of the latent factor ‘SENSITIVITY’ were very much biased to the right hand in the older group, but not in the young group.

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