Differences in the Effects of Computerized and Paper-based Versions of the Stroop Color-Word Test on Brain Activation and Functional Connectivity: A Study Based on fNIRS

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Objective Using functional near-infrared spectroscopy (fNIRS), this study systematically compared cortical hemodynamic activation patterns and functional connectivity (FC) during computerized and paper-based versions of the Stroop Color-Word Test (SCWT) to elucidate the neural mechanisms by which different assessment modalities mediate cognitive processing, and to provide a neuroimaging basis for the individualized selection of cognitive assessment tools in patients with neurological impairments including aphasia, dysarthria, and upper-limb motor dysfunction. Methods Eighty-five healthy adults (mean age: 44.90 ± 16.39 years) were enrolled. fNIRS was used to record changes in oxyhemoglobin (HbO) concentration in bilateral prefrontal cortex (PFC), premotor cortex (PMC), sensorimotor cortex (SMC), and Broca's area during congruent and incongruent tasks of both SCWT versions. Regional activation levels were quantified using a general linear model (GLM), and inter-regional FC matrices were constructed via Pearson correlation analysis. Multiple comparisons were corrected using the Benjamini-Hochberg false discovery rate method ( P FDR < 0.05 considered statistically significant). Results Behavioral data: Moderate-to-high positive correlations were observed between the two versions across all behavioral indices (r = 0.611–0.826, all P < 0.05), confirming the good criterion validity of the computerized SCWT. In terms of task completion efficiency, the computerized version yielded significantly lower total trials completed and correct responses per unit time than the paper-based version under both congruent and incongruent task conditions (all P < 0.05). Regarding error rates, the computerized version produced significantly fewer errors under congruent conditions ( P < 0.001), while no significant difference was observed between versions under incongruent conditions ( P = 0.178). Cortical activation: Under congruent conditions, the paper-based version elicited significantly greater activation in the left prefrontal cortex (LPFC) than the computerized version ( P FDR < 0.05). Under incongruent conditions, the paper-based version showed significantly stronger activation in the right Broca's area (R-Broca) ( P FDR < 0.05). The computerized version demonstrated significantly greater left sensorimotor cortex (LSMC) activation than the paper-based version under both task conditions (both P FDR < 0.05). Functional connectivity: Under congruent conditions, the computerized version exhibited significantly stronger FC than the paper-based version across the RSMC-RPFC, RSMC-RPMC, RSMC-LSMC, RPFC-LPFC, and RPFC-RPMC pairs (all P FDR < 0.05). Under incongruent conditions, the computerized version showed enhanced RPFC-LPFC and RPFC-RSMC connectivity, while the paper-based version demonstrated significantly stronger LPMC–L-Broca's area FC (all P FDR < 0.05). Conclusion The computerized and paper-based versions of the Stroop task were behaviorally equivalent, but exhibited dissociable neural mechanisms: the paper-based version relied more on prefrontal and Broca's area language pathways, whereas the computerized version enhanced sensorimotor–prefrontal coordinated processing. Computerization of the Stroop task did not compromise the core measurement of interference control; rather, it reshaped neural resource allocation strategies, providing neuroimaging evidence for the individualized selection of clinical assessment tools.