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The improvement in Trail Making Test performance of men alcoholics over a period of 3 weeks suggests that long-term recovery from brain dysfunctioning is a common occurrence in alcoholics.
The Trail Making Test and Bender Background Interference Procedure were evaluated with 598 Ss against both external neurologic criteria and against psychological opinion derived from a more complete evaluation. For Trails, highly significant differences in mean scores were seen when preselected neurologic patients and patients without neurologic stigmata were compared. Similarly, the distribution of classification of these patients by Bender is significantly different from chance. Application of these measures in a screening paradigm, however, yielded large numbers of false negatives against both neurological and psychological criteria. It was not possible to establish an optimal cutting score to justify application of these measures as screening devices, either alone or in concert.
Cognitive recovery among male alcoholics and controls was investigated with the Trail-Making Test as an index of cognitive impairment. The test was administered twice to all Ss with an interval of approximately 1 year between testings. A reported measures analysis of variance showed that the controls performed significantly better than the alcoholics at both administrations, although the alcoholics did improve between the pre-and posttests. Reported drinking episodes that occurred between the pre-and posttests appeared to have no effect on cognitive recovery in the alcoholic group when relapsed and abstinent subgroups were compared.
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This study is a reinvestigation of the effectiveness of the Trail Making Test in discriminating between brain-damaged (n = 51) and pseudoneurologic (n = 72) subjects. All subjects were hospitalized male veterans at the Allen Park Veterans Administration Hospital. An analysis of covariance showed that the pseudoneurologic subjects performed at a significantly higher level than the brain-damaged subjects. Further analysis with two different cut-off scores exhibited unequal discriminatory power throughout the whole range of Trail Making Test scores. These results suggested diagnosing only when the scores were 9 or lower and 13 or higher. This use of extreme scores resulted in an over-all hit rate of 87% in the study. Comparisons with five major subgroupings of the pseudoneurologic subjects yielded only one significant difference: more accurate discrimination with the 12 cut-off score between 10 general-medical and peripheral nerve-damaged subjects (100% correct) and 18 psychotic subjects (39% accuracy).
100 workers' compensation claimants with no known history of brain injury and no claim for neuropsychological impairment were administered a generally accepted neuropsychological screening instrument, the Trail Making Test, to consider the possibility that the presence of litigation may be reflected in neuropsychological test scores. On Trails A and B, respectively, 40% and 36% of subjects scored in the impaired range. Clinicians are urged to interpret the results of the Trail Making Test cautiously when a patient is in litigation. Suggestions for research are offered.
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Subjects between the ages of 18 and 30 were divided in groups based on their Satz-Mogel Wechsler Adult Intelligence Scale-Revised Full Scale IQs: (a) Borderline (70 to 79); (b) Low Average (80 to 89); (c) Average (90 to 109); (d) High Average (110 to 119); (e) Superior (120 to 129). Each subject was administered the Trail Making Test (Forms A and B) and the written version of the Symbol Digit Modalities Test. A significant effect for IQ emerged. The low ability subjects were, in the main, significantly different from the higher ability subjects. No gender differences were found.
Several testing procedures borrowed from Reitan's extensive investigations of impairment in brain function were employed in the present study (Tactual Performance Test, Trail Making Test, Seashore Rhythm Test, Speech Sounds Perception Test, Finger Oscillation Test). These tests were administer to three groups of Ss matched for age, education, and sex distribution. All Ss were 40 years of age or older. The groups were: hospitalized psychiatric patients suspected by their psychiatrists of some degree of organic impairment; hospitalized psychiatric patients not suspected of any organic impairment; and nonhospitalized, apparently normally functioning control Ss. Four months after the beginning of the study, the psychiatrists reevaluated and reclassified the patient Ss and formed new groups of those suspected and not suspected of organic impairment. A comparison of group means that used the original S groups showed that three of nine test scores were nondiscriminating, while the remaining six discriminated the control Ss from the patients, but not the two patient groups from each other. A similar comparison that used the revised patient groups formed from the psychiatrists' re-evaluations after an additional 4 months of observation yielded four test scores that discriminated successfully between the two patient groups: Tactual Performance Test, total time; Trail Making Test, Part A and Part B; and Finger Oscillation Test, right hand. These four test scores predicted the later classification of the patients more accurately than did the psychiatrists' own original evaluations, which would be in keeping with the general function of diagnostic testing, i.e., to provide initial information about patients beyond that which can be obtained from initial psychiatric examination.
BACKGROUND/OBJECTIVE: Virtual reality (VR) exergaming enhances several cognitive domains through multisensory engagement. Acute cognitive benefits of VR are established, but evidence for direct comparisons with non-immersive controls is limited. This study aimed to determine whether VR exercise provides additional cognitive and cognitive-motor benefits beyond a matched non-immersive active stick-fight video (SFV) intervention, and whether effects persist after training. METHODS: In this randomized quasi-experimental study, N = 55 healthy adults (VR: n = 30; SFV: n = 25; 25.5 ± 7.1 years; 41.8% female) completed an 8-week program (2 × 30 min/week), of VR or SFV matched in movement patterns, frequency, intensity and duration. Measurements included reaction time (RT), Stroop Test (versions 1-3), Letter Cancellation Test (LCT), Trail Making Test (TMT), Trail Walking Test (TWT) and Fitts task (difficulty level 1-4). Data were analyzed using mixed-design ANOVAs. RESULTS: Improvements were observed in Stroop reading (F(1,53) = 14.84, p < .001, η2 = 0.219), Stroop inhibition (F(1,53) = 10.99, p = .002, η2 = 0.172), and LCT (F(1,53) = 4.57, p = .037, η2 = 0.079). A time × group interaction was found for TMT (F(1,53) = 6.55, p = .031, η2 = 0.110), indicating greater changes following VR training. Both groups improved cognitive-motor performance (TWT: F(1,25) = 55.32, p < .001, η2 = 0.689; Fitts3: F(1,53) = 44.97, p < .001, η2 = 0.459), with greater gains for VR in Fitts3 (p = .006). CONCLUSION(S): Eight weeks of VR and SFV enhanced cognitive and cognitive-motor performance. VR provided domain-specific advantages in executive function, but these effects were not uniformly persistent. SFV sustained more improvements in real-world-relevant cognitive-motor tasks.
A neuropsychological screening battery including the Mini-Mental State Examination and four other brief cognitive tests (Russell's Adaptation of the Visual Reproduction Test, Trail Making Test, Verbal Fluency Tests on letters and category, and the Buschke Selective Reminding Test) was administered to a randomly selected population sample of 403 subjects aged 68 to 77 years to evaluate the effect of education, age, and sex on test scores. The difference in neuropsychological screening tests between various education groups (3 years or less, 4 to 6 years, 7 years or more) was statistically highly significant, even after the adjustment for the effect of age. The subscores and total scores were lowest in the minimal education group on every neuropsychological test. Education correlated more strongly than age with all neuropsychological test scores and subscores. The effect of sex on test results was seen only in some subscores of brief neuropsychological tests but not in a single item of the Mini-Mental State Examination. On the basis of our results, the effects of education, age, and sex have to be evaluated before using brief neuropsychological tests in population-based dementia screening.
In a pilot study, a neuropsychological minibattery of tests consisting of Trail-Making Test A (TMA), Trail-Making Test B (TMB), and the Visual Reproduction subtest (VR) of the Wechsler Memory Scale was administered to patients with common psychiatric diagnoses in a psychiatric emergency room (ER). Patients with adjustment disorders were not distinguishable from normal controls, while patients with affective disorders and schizophrenia were more impaired than both of these samples. It is suggested that this or a similar minibattery of tests can be of use as an adjunct screening device for differential diagnosis of adjustment disorder versus more serious psychopathology in psychiatric ERs.
Traumatic closed head injury results in a variety of cognitive and behavioral deficits that may be difficult to assess fully. Adequately evaluating driving safety is a common and important problem for health care professionals. The purpose of this study was to examine the relationship between standardized measures of cognitive function and measures of driving performance in patients with closed head injuries and in their age-matched relative or friend cohorts. Thirteen patients were evaluated. They had each sustained a closed head injury (followed by more than 1 h of coma) 3 to 6 months before testing. Their scores were analyzed along with those of seven cohorts. Assessments of cognitive function and behind-the-wheel driving performance were conducted by examiners blinded to subjects' group membership and medical condition. There was a significant relationship (r = 0.44) between the sum of rated scores of the Tactual Performance Test and Trail Making Test and the global pass/fail ratings of the behind-the-wheel driving test, but it was not related to the driving performance score. The difference between the verbal and performance IQs, and the difference between the block design and other performance tests of the Wechsler Adult Intelligence Scale-Revised were also not significantly related to driving performance. These results suggest that tests of cognitive function alone are not adequate to predict driving performance, and should be used along with standardized driving performance evaluations before recommendations are made.
OBJECTIVE: To evaluate the clinical efficacy of dual transcranial direct current stimulation (tDCS) in patients with post-stroke cognitive impairment (PSCI) and to explore the effects on the hierarchical organization of functional brain networks, ranging from regional synchronization to inter-regional connectivity and global network topology. METHODS: In this randomized, double-blind, sham-controlled trial, 74 PSCI patients received conventional therapy alongside either active dual-tDCS (n = 38) or sham stimulation (n = 36). Active tDCS targeted the dorsolateral prefrontal cortex (DLPFC) via anodal-left/cathodal-right nodes (2.0 mA, 20 min/day, 20 sessions). The primary outcome was the Montreal Cognitive Assessment (MoCA). Secondary outcomes included the Mini-Mental Status Examination (MMSE), Stroop Test (ST), Trail Making Test (TMT), Wechsler Memory Scale (WMS), and Barthel Index (BI). A subgroup of 36 participants (18 per group) underwent resting-state functional magnetic resonance imaging (rs-fMRI) to analyze regional homogeneity (ReHo), functional connectivity (FC), and network topology. Partial correlations assessed the association between neuroimaging alterations and clinical improvements. RESULTS: The tDCS group showed significantly greater improvements in MoCA scores (tDCS: 5.74 ± 2.76 vs. sham: 2.69 ± 2.69; t = 4.799, p < 0.001) as well as in attention and memory domains compared to the sham group. The rs-fMRI changes included increased ReHo in the right middle temporal gyrus (MTG) and the left inferior frontal gyrus (IFG), and reduced FC between the right MTG-left superior frontal gyrus and left IFG-cerebellum (p < 0.05, FWE-corrected). Additionally, small-worldness and global efficiency increased (p < 0.05) with these alterations correlating with clinical recovery. Adverse events were rare and self-limiting. CONCLUSION: Dual-tDCS over bilateral DLPFC safely improves cognitive recovery in PSCI. These clinical gains are associated with rs-fMRI alterations, specifically in regional synchronization, inter-regional connectivity, and global topology, which suggest a potential biomarker for monitoring tDCS efficacy, offering a rationale for precision neuromodulation in stroke rehabilitation.
The present study investigated the influence of perceptual field orientation, as measured by the Group Embedded Figures Test (GEFT), on cognitive functioning among alcoholics and nonalcoholics. The subjects were classified as field dependent, intermediate, or field independent based upon their GEFT scores. Cognitive function was assessed by the Wechsler-Bellevue Intelligence Scale as well as the Category Test. Tactual Performance Test, and Trail Making Tests of the Halstead-Reitan Neuropsychological Test Battery. Three primary findings emerged. First, the alcoholics appeared to be significantly impaired on measures of abstraction, problem solving, and adaptive abilities relative to nonalcoholics. Second, a direct relationship was found between GEFT scores and level of cognitive function within both alcoholic and nonalcoholic samples, with field-dependent subjects evidencing the most impaired performance. Third, the level of perceptual field orientation accounted for a large portion of the variance between the alcoholic and nonalcoholic samples, with field-independent alcoholics performing at a level comparable to or greater than other nonalcoholic subroups on a number of the cognitive variables. These results provide validational support for the GEFT and indicate that field orientation may be a relevant variable in the assessment of cognitive function in both alcoholics and nonalcoholics.
BACKGROUND: Uncontrolled studies report that methylphenidate effectively treats depression in patients with acquired immunodeficiency syndrome (AIDS). Other studies report that methylphenidate improves cognition in patients with dementia stemming from human immunodeficiency virus (HIV). We performed a double-blind, placebo-controlled n-of-1 trial to learn whether methylphenidate was an effective treatment for depression in an outpatient with mild HIV dementia. METHOD: The patient received either placebo or drug in a double-blinded fashion in increasing doses in each of three 2-week phases (A = placebo, B = methylphenidate, C = placebo). Blinded outcomes of depression and cognition were measured initially and twice in each phase. Depression was measured using the Hamilton Rating Scale for Depression (HAM-D) and a mood self-assessment scale. Cognition was measured using the digit span (forward and backward subtest of the Wechsler Adult Intelligence Scale-Revised, Trail-Making Tests A and B, and the Symbol Digit Modalities Test (SDMT). RESULTS: HAM-D scores improved during the methylphenidate phase (initial = 33; A = 23, 25; B = 15, 10; C = 28, 27), as did the subjective mood assessment ratings. Digit span backward scores improved with the drug (initial = 4; A = 4, 3; B = 6, 8; C = 5, 4), as did Trail-Making Test B scores (initial = 125 seconds; A = 133, 103 seconds; B = 86, 82 seconds; C = 88, 96 seconds). Digit span forward, SDMT, and Trail-Making Test A, however, showed no drug-related trend. CONCLUSION: We conclude that methylphenidate was beneficial in the treatment of depression in this patient with AIDS.
Screening hospital patients for cognitive impairment is often required for effective treatment planning. Awareness of cognitive deficit is particularly important in working with patients who have drinking problems because of the relationship between alcohol consumption and cognitive impairment. Trail-Making Test is examined as an economic, quick, and accurate indicator of cognitive impairment in non-neurological sample of patients in a Veterans Administration Hospital. Results show that performance discriminates between normal and deficient cognitive function as assessed by established IQ and neuropsychological tests--the Wechsler Bellevue Intelligence Scale and the Halstead Reitan Battery. Nonsignificant correlations with personality variables suggest discriminant validity for the Trail-Making Test as an indicator of cognitive impairment.
Evaluated differences in performance between adult males and females with respect to Halstead's Neuropsychological Battery, additional tests employed by Reitan (Trail Making Test, Aphasia Screening Test, Perceptual Examination, dynamometer), and other neuropsychological measures (Seashore Tonal Memory Test, Logical Memory and Visual Reproduction portions of the Wechsler Memory Scale). In evaluating differences, 47 matched pairs of non-neurologic males and females were employed, as well as 47 pairs of neurologic patients. A small number of statistically significant differences were found, all of which favored males. Some of these differences occurred with respect to tasks that have very strong motor components, and these differences were shown to be related to hand size. Others pertained to tasks that have strong visual-spatial components. In general, the differences were less prominent with the neurologic than the non-neurologic samples. The question was raised as to possible over-representation of male-superior components in these tests.