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PubMed1984

The Trail Making Test and Canter Background Interference Procedure in screening for organicity in chronic schizophrenia: a preliminary report.

For 10 male organic chronic schizophrenics scores on the Trail Making Test and Canter Background Interference Procedure were compared. These patients had severe hyponatremia, a condition that results in brain damage. The hit rate for correctly classifying the oranicity was 100% on the basis of sequence binding on Trial Making B and 50% on Canter's procedure. The findings suggested that the Trial Making Test may prove useful in discriminating organic from nonorganic schizophrenics. Implications for research were discussed.

Chronic Disease↗
PubMed2003

Clinical utility of the trail making test ratio score.

It has been suggested that a ratio score of part B to part A of the Trail Making Test (TMT) may have clinical utility as a measure of cognitive efficiency and/or dissimulation. We investigated the clinical utility of the TMT B/A ratio score in the evaluation of patients with traumatic brain injury. Part B of the TMT demonstrated a statistically significant difference between groups with mild (n = 59) versus moderate-severe (n = 41) injuries. However, the B/A ratio score did not demonstrate sensitivity to injury severity and also failed to discriminate reliably individuals who had independent psychometric indicators of possible dissimulation from those who did not. We conclude that in individuals with traumatic brain injury, the B/A ratio score does not appear to enhance the clinical utility of the TMT and that interpretation of performance on this test should instead involve comparing subtest completion times to established normative data.

Adult↗
PubMed2003

Trait characteristic of impaired visuomotor integration during Trail-Making Test B performance in schizophrenia.

Using concurrent recording of eye and hand movements during the performance of the Trail-Making Test B (TMT-B), Wölwer and Gaebel have recently reported impaired visuomotor integration in patients with acute schizophrenia, which mainly accounted for patients' poor test performance. In order to replicate these exploratory findings in an independent sample of patients and to further investigate their stability during different stages of the illness, the performance process during a computerized TMT-B was assessed in 22 remitted outpatients with schizophrenia, 12 unaffected first-degree relatives and 26 healthy controls. As an estimate of longitudinal stability, a partial sample of 12 patients and 19 controls was reassessed after a period of 3 months. Remitted schizophrenia patients showed exactly the same strategic problems during the performance process of TMT-B as previously found in acute patients. Compared with healthy controls, patients more often sequenced searching ('planning') and connecting targets instead of time-sparing parallel execution, and their planning periods contained more and longer planning fixations (i.e. fixations outside the cursor area), which was related to longer performance time. Unaffected relatives mostly scored between patients and healthy controls without statistically significant differences to either group. Thus, the abnormalities in the process of TMT-B performance proved to be reliable and stable trait characteristics in schizophrenia.

Adult↗
PubMed1998

The role of speed of processing, inhibitory mechanisms, and presentation order in trail-making test performance.

The roles of speed of processing, inhibition, and presentation order in the Trail Making Test (TMT) performance were examined. One-hundred ten undergraduates performed the TMT (1/2 received order Part A-Part B, 1/2 received order Part B-Part A) and also completed computerized tests of inhibitory functioning and speed of processing. Neither speed of processing nor inhibitory functioning affected TMT performance. However, order of presentation significantly affected TMT performance. Presentation order is an important variable to consider in TMT performance.

Adult↗
PubMed2002

Derived trail making test indices in a sample of alcohol abusers: demographic effects.

Derived indices on the Trail Making test (TMT), a test often used for screening cognitive impairments, were examined in a sample of alcohol abusers in drug abuse treatment programs. A mixed race sample of 1000 subjects was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. Data were analyzed to determine the effects of demographic variables on derived indices created by adding, subtracting, multiplying, and dividing parts A and B of the TMT in this large treatment sample of alcohol abusers. The variables of age, ethnicity, and education were statistically significant for the total (A + B), interaction (A x B/100), and difference score (B-A) derived indices of the TMT. The ratio score (B/A) was only significant for education.

Adult↗
PubMed2000

Comparison of time and error rates on the trail making test among patients with head injuries, experimental malingerers, patients with suspect effort on testing, and normal controls.

Clinical utility of completion time and performance errors was investigated for the Trail Making Test (TMT; Reitan, 1958). Archival neuropsychological files for patients with mild and moderate/severe head injuries, as well as patients with suspect effort on neuropsychological testing, were examined and compared to controls and experimental malingerers. Time-to-completion scores differentiated the participants who were malingering and who gave suspect effort from those patients with head injuries. There were no differences in error rates among the head-injury groups or controls for either the TMT-A or TMT-B. Errors were also not uncommon among normal controls; 12% and 35% of the controls made at least one error on TMT-A and TMT-B, respectively. However, error rates for both the suspect-effort and malingering groups were inflated on TMT-B as compared to the head-injured and control groups. Results suggest that performance errors on the TMT lack diagnostic utility for persons with head injuries, and time-to-completion is still the best indicator of neuropathology. However, performance errors, in conjunction with inflated time scores on the TMT, may be useful in the assessment of malingering.

Analysis of Variance↗
PubMed2001

Sex, ethnicity, age and education effects on the Trail Making test in a sample of cocaine abusers.

Sex, ethnicity, age and education effects on the Trail Making test (TMT), a test often used to for screen for cognitive impairment, were examined in a sample of cocaine abusers in drug abuse treatment programs. A mixed race sample of 5116 males and 2614 females was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. The number of cocaine/crack abuser scores available for analysis was 4306. Data were analyzed to determine the effects of sex, ethnicity, age and education variables on the two parts of the TMT in this large treatment sample of cocaine abusers. The variables of sex age, ethnicity and education were statistically significant for both parts A and B of the TMT. In addition, R-Square values for overall models were quite weak (A = .08, B = .11) suggesting that sex, ethnicity, age and education effects on the TMT, while clearly present, account for relatively little overall variance in terms of cocaine users TMT performance. These results are consistent with earlier research using a more heterogenous drug abuse treatment sample.

Adolescent↗
PubMed2003

Psychometric properties of the Mid-Range Expanded Trail Making Test. An examination of learning-disabled and non-learning-disabled children.

By systematically varying the stimuli within the Mid-Range Trail Making Test (MTMT), it may eventually be possible to isolate the cognitive demands of this test. Toward this end, the Mid-Range Expanded TMT (METMT) was developed by adding five new forms to the original forms A and B. To insure its appropriateness for clinical and experimental use, the current study sought to quantify the psychometric properties of this new test. The results indicate that the METMT is reliable and has adequate construct, criterion, and factoral validity. The results also cross-validated the findings of Davis et al. [J. Clin. Psychol. 45 (1989) 423.], suggesting that brief neuropsychological evaluations can effectively differentiate normal learners from learning-disabled children. The present study suggests that the MTMT is robust to alterations of its stimulus dimensions. Preliminary METMT normative data are presented.

Adolescent↗
PubMed1989

Analysis of errors on the Trail Making Test.

This study was designed to determine whether the number and/or types of errors on the Trail Making Test differentiated head-injured and normal control subjects. Errors on Part B were categorized into two types of shifting errors (from number to letter and from letter to number) and two types of sequencing errors (number and letter). Subjects consisted of 133 head-injured patients and 145 normal controls. Analysis showed that the frequency of errors on Parts A and B did not differ significantly between the groups nor did the percentage of subjects making errors. Total shifting and sequencing errors also did not differentiate between the two groups. Although head-injured subjects were more likely than controls to err in shifting from letters to numbers, this finding was of no apparent clinical usefulness. The discriminative value of time scores was confirmed.

Brain Damage, Chronic↗
PubMed2003

Demographic effects on the Trail Making Test in a drug abuse treatment sample.

Appreciation of the importance of screening for cognitive impairment among substance abusing populations has increased in recent years. In this article, demographic effects on the Trail Making Test (TMT), a test often used for screening for cognitive impairment, are examined in a sample of patients in drug abuse treatment programs. A sample of 5,619 males and 2,902 females was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic cohort study that collected data from 1991 to 1993 in 96 programs in 11 cities in the US. Data were analyzed to determine the effects of demographic variables on the two parts of the TMT in this large sample of patients. Consistent with previous research, demographic variables such as age, gender, education level, and ethnicity were statistically significantly related to both TMT Parts A and B. More importantly, however, the percentage of variance accounted for was quite small. These results suggest that, while clearly present, demographic effects on the TMT are weak.

Adolescent↗
PubMed2002

Variability of trail making test, symbol digit test and line trait test in normal people. A normative study taking into account age-dependent decline and sociobiological variables.

BACKGROUND AND AIMS: The influence of sociobiological variables and aging on the variability of the Trail Making Tests (TMT), the Symbol Digit Substituting Test (SDT), and the Line Trait Test (LTT) in the general healthy populations are not well known. Even less is known about the reliability at re-testing. This study aimed at determining the reference range of these tests, taking into account sociobiological variables and age, and the re-testing effect. METHODS: We studied 300 healthy subjects from 20 to 80 years of age. The sample was derived by the pooling of two samples stratified by age and sex: a randomized sample of 161 subjects collected from the city registers of Padova, and a convenience sample of 139 subjects collected in 20 towns (mainly rural) of Northern Italy. After normalization, data were assayed for the influence of age, education, job, and gender. RESULTS: Age was found to be a significant independent predictor for all the tests, education for all but the LTT, job only for the TMT-B and a geometrical version of the same test (TMT-G) which was proved to be highly correlated with the TMT-B (r=0.80, p<0.01). Job and the interaction age x education level influenced the difference TMT-B minus TMT-A. From the predicting equations, the normative data and the formulas to obtain Z scores for each test were derived. Reliability was lowest for LTT errors (CV=67%), highest for the SDT (13%), whereas the TMT obtained intermediate values (22-33%, depending on the test). CONCLUSIONS: This study provides the most reliable normative data range for the TMT, SDT and LTT to date because it considers important demographic variables such as age, education and job.

Adult↗
PubMed2003

Intermanual difference in the Japanese Trail Making Test and its mirror version: intra-subject comparison of the task-completion time, cognitive time, and motor time.

PURPOSE: To investigate intermanual differences in the performance of the Japanese Trail Making Test (JTMT) using an intra-subject comparison, and to investigate how the cognitive and motor times spent in performing the task were related with the total completion time. METHODS: All subjects performed both parts A and B of the following three tasks: JTMT with the right hand (R); JTMT with the left hand (L); and a mirror version of the JTMT with the left hand (M). The order in which these three tasks were performed (RLM, RML, LRM, LMR, MRL, and MLR) was randomly determined. An interval of 4 weeks was scheduled between each examination. In addition to the completion time, we measured 'motor time', a sum of the times for drawing lines to connect the targets, and 'cognitive time', a time obtained by subtracting the motor time from the completion time. RESULTS: The task-completion time was more strongly correlated with the cognitive time than with the motor time. The order of the task performance did not influence the task-completion time. A learning effect was found only between the first and second examinations of part A. The cognitive time for the second and third performances of part A were significantly shorter than that for the first task, whereas the motor time remained unchanged. No intermanual differences in the performance were found in any comparisons. CONCLUSIONS: The non-dominant hand can be used as an alternative hand in the JTMT, and it can be expected to perform comparably to the dominant hand. These findings are consistent with the finding previously obtained by inter-subject comparison. The lack of any significant intermanual difference can be explained by that the total completion time is less influenced by the motor time than by the cognitive time.

Adult↗
PubMed2004

The Trail Making Test as an initial screening procedure for neuropsychological impairment in older children.

This study was designed to explore the possibility of using a brief neuropsychological test for broad-band initial screening of children with academic problems who might have neuropsychological deficits that should be more completely evaluated. Part B of the Trail Making Test was selected as the instrument for investigation. Three groups of children, aged 9-14 years, were composed for this study to represent (1) children with diagnosed brain damage or disease, (2) children who were medically normal but who were of serious concern to parents and teachers because of inadequate academic progress, and (3) a normal control group. The Brain-Damaged group required more than three times the number of seconds needed by the controls to complete the test, and the group with academic difficulties required more than twice the time of the controls. Using the limits set by the distributions of the Brain-Damaged and control groups, it was possible to identify a cutoff point that may be used for preliminary identification of children with academic difficulties who might benefit from further neuropsychological evaluation. The results of this study stand in need of cross-validation and, obviously, much additional outcome research is necessary to evaluate the efficacy and validity of the findings for screening purposes.

Adolescent↗