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At least 19 recordsLinked to original sources
PubMed2003

The cerebral correlates of set-shifting: an fMRI study of the trail making test.

The trail making test (TMT) pertains to a family of tests that tap the ability to alternate between cognitive categories. However, the value of the TMT as a localizing instrument remains elusive. Here we report the results of a functional magnetic resonance imaging (fMRI) study of a verbal adaptation of the TMT (vTMT). The vTMT takes advantage of the set-shifting properties of the TMT and, at the same time, minimizes the visuospatial and visuomotor components of the written TMT. Whole brain BOLD fMRI was performed during the alternating execution of vTMTA and vTMTB in seven normal adults with more than 12 years of formal education. Brain activation related to the set-shifting component of vTMTB was investigated by comparing performance on vTMTB with vTMTA, a simple counting task. There was a marked asymmetry of activation in favor of the left hemisphere, most notably in dorsolateral prefrontal cortex (BA 6 lateral, 44 and 46) and supplementary motor area/cingulate sulcus (BA 6 medial and 32). The intraparietal sulcus (BA 7 and 39) was bilaterally activated. These findings are in line with clinico-anatomic and functional neuroimaging data that point to a critical role of the dorsolateral and medial prefrontal cortices as well as the intraparietal sulci in the regulation of cognitive flexibility, intention, and the covert execution of saccades/anti-saccades. Many commonly used neuropsychological paradigms, such as the Stroop, Wisconsin Card Sorting, and go - no go tasks, share some patterns of cerebral activation with the TMT.

Adult↗
PubMed2004

Frontal lobe damage and tests of executive processing: a meta-analysis of the category test, stroop test, and trail-making test.

The Category Test, Trails B, and the interference task of the Stroop Test are among the most commonly administered measures of frontal lobe functioning and are thought to tap different cognitive functions mediated by these brain regions. Two meta-analyses were conducted on these tests to determine their sensitivity to frontal and lateralized frontal brain damage. Study 1 compared participants with frontal lobe damage to those with damage to posterior brain regions, whereas Study 2 compared participants with left and right frontal lobe damage. For each study, effect sizes based on performance differences between the above groups were calculated for the Category Test, Trail-Making Test Parts A and B, and the Stroop Test, including Word, Color, and Color-Word subtests. In Study 1 significant differences between groups were found for Trails A and all Stroop tasks, but in Study 2 the only difference between left and right frontal participants was on the Stroop Color-Word task. Potential reasons why Trails A and the Stroop Test are sensitive to frontal lobe damage are discussed, such as novelty and processing speed, as are clinical implications of these findings. The challenges of research on assessment of frontal lobe functioning are discussed and new developments in this area are highlighted.

Adult↗
PubMed2000

Equivalence of the Color Trails Test and Trail Making Test in nonnative English-speakers.

The Color Trails Test (CTT) has been described as a culture-fair test of visual attention, graphomotor sequencing, and effortful executive processing abilities relative to the Trail Making Test (TMT). In this study, the equivalence of the TMT and the CTT among a group of 64 bilingual Turkish university students was examined. No difference in performance on the CTT-1 and TMT Part A was found, suggesting functionally equivalent performance across both tasks. In contrast, the statistically significant differences in performance on CTT-2 and TMT Part B, as well as the interference indices for both tests, were interpreted as providing evidence for task nonequivalence of the CTT-2 and TMT Part B. Results have implications for both psychometric test development and clinical cultural neuropsychology.

Journal Article↗
PubMed2000

Effects of aging on efficiency of task switching in a variant of the trail making test.

The Trail Making Test (TMT; R. M. Reitan, 1958, 1992) is extensively used in research in neuropsychology and in aging, in part because it has been postulated to reflect executive processes, such as planning and switching. However, neurocognitive and individual-difference-based analyses of this test are complicated because of different spatial arrangements of targets, the use of letters only in Version B, and potential order effects when Version A is administered prior to Version B. The present article examines a variant of a TMT (called the Connections Test) that attempts to remedy these deficiencies. A structural equation model suggested that there were no direct effects of age on either the nonalternating or alternating versions of the Connections Test (analogous to TMT Versions A and B, respectively); rather, all age-related effects were mediated through effects on perceptual speed. Moreover, although the nonalternating and alternating versions were strongly related to one another, only the latter had significant independent relations with measures of higher order cognition.

Adolescent↗
PubMed1981

Age effects on Trail Making Test performance.

The Trail Making Test, used in differentiating brain-damaged from non-brain-damaged individuals, was administered to 150 non-brain-damaged subjects classified into five age decades to determine the effects of age on performance. Between-group comparisons as well as correlational data indicated that older subjects performed significantly more poorly than younger subjects. Significant small negative correlations of performance with education and intelligence suggested that lower intelligence and education also may adversely affect performance. Some implications of these findings for clinical neuropsychology are discussed.

Adult↗
PubMed1994

Analysis of an Oral Paradigm for the Trail Making Test

Performance on the Trail Making Test is dependent upon multiple factors (e.g., motor speed, visual search, symbolic set shifting, capacity to sustain effort), many of which are difficult to assess differentially using the test's traditional administration, or with certain clinical populations (e.g., blind or grossly motor-impaired individuals). The present study investigated a motor-free, vision-free, oral version of the Trail Making Test in two groups of younger adults and one group of elderly adults. The results demonstrated that although there were age-associated differences in raw performance times, the comparability of oral and written performances, as assessed by oral-to-written ratios, was consistent across age groups. These results suggest that the oral version of the Trail Making Test yields results consistent with an individual's written performance in normal subjects, regardless of age. Findings are discussed with regard to the potential clinical application of this measure as an alternative for specific populations, and as a useful way of interpreting written Trail Making performances.

Journal Article↗
PubMed2004

[Normative data on tests for frontal lobe functions: Trail Making Test, Verbal fluency, Wisconsin Card Sorting Test (Keio version)].

Trail Making Test (TMT Part A, B), Verbal fluency test (phonemic, semantic) and Wisconsin Card Sorting Test (Keio version : KWCST) are useful to evaluate frontal lobe functions and are commonly used in clinical settings. However, few normative data for aged Japanese have been reported. We collected normative data on these tests in elderly population, and examined the effects of age and education on the performance of these tests. Seventy-six healthy adults, aged 45 to 74 years, participated in this study. Subjects were classified into three groups by age (45-54, 55-64, 65-74). Fifty-five subjects repeated the same tests after 6 months to examine the test-retest reliability. Performance of the TMT Part A was correlated with age (r= 0.530) and that of Part B was correlated with age (r=0.500) and education (r=-0.340). Performance on both phonemic and semantic fluency was correlated with education (phonemic: r=0.357, semantic: r=0.279). Number of Categories Achieved (CA) of KWCST was correlated with education (r=0.376). The test-retest reliability of all these tests except for semantic verbal fluency and difficulty maintaining set (DMS) of KWCST was good enough for longitudinal studies.

Aged↗
PubMed2005

Age differences in timed accurate stepping with increasing cognitive and visual demand: a walking trail making test.

BACKGROUND: Impaired vision, cognition, and divided attention performance predict falls. Requiring both visual and cognitive input, the ability to step accurately is necessary to safely traverse challenging terrain conditions such as uneven or slippery surfaces. We compared healthy young and older adults in the time taken to step accurately under conditions of increasing cognitive and visual demand. METHODS: Healthy Young (n = 42, mean age 21) and Older (n = 37, mean age 70) participants were required to step accurately on an instrumented walkway under conditions of increasing visual and cognitive demand. Based on the paper-and-pencil neuropsychological test, the Trail Making Test (P-TMT) A and B, participants stepped on instrumented targets with increasing sequential numbers (Walking Trail Making Test A [W-TMT A]) and increasing sequential numbers and letters (Walking Trail Making Test B [W-TMT B]), under conditions of Low as well as Normal lighting. RESULTS: W-TMT performance time increased with increased age (Older vs Young), decreased light (Low vs Normal), and increased cognitive demand (Trails B vs Trails A). W-TMT performance time was disproportionately increased in Low light and in the Older group under the highest cognitive demand (W-TMT B) conditions. Paired W-TMT A-B differences were three times higher in the Older group than in the Young group. In the Older group, the correlation between W-TMT results and P-TMT B was particularly strong (p <.001). CONCLUSIONS: The time to perform a stepping accuracy task, such as may be required to avoid environmental hazards, increases under reduced lighting and with increased cognitive demand, the latter disproportionately so in older adults.

Adolescent↗
PubMed1995

Construct validity in the Trail Making Test: what makes Part B harder?

The Trail Making Test (TMT) is primarily a test of motor speed and visual attention. In Trail Making, Part A, the subject's task is to quickly draw lines on a page connecting 25 consecutive numbers. In Part B, the subject must draw the lines alternating between numbers and letters. To determine what makes Part B harder than Part A, variations of the standard Trail Making Test were assessed. Forty college students (20 male, 20 female) were given four forms of the Trail Making Test. The results show that Trail Making, Part B with just numbers took longer to complete than the standard Part A with numbers. Part B is 56 cm longer and has more visually interfering stimuli than Part A. These results indicate that Part B is more difficult than Part A not only because it is a more difficult cognitive task, but also because of its increased demands in motor speed and visual search.

Adolescent↗
PubMed1999

Clinical utility of the Trail Making Test practice time.

The Trail Making Test (TMT) is one of the most frequently used measures in clinical neuropsychology. Data obtained from the TMT practice times were analyzed to determine their utility in predicting success and failure on the full version of the test and to allow establishment of criteria by which to judge administration or discontinuation of the full test. Results indicated that TMT practice times were useful in predicting successful completion of Part A and B of the TMT. Tables are provided which describe the classification accuracy of various TMT practice times. These tables allow clinicians to select a practice-time cutoff and then use the cutoff as a heuristic to assist in the decision to administer the remainder of that particular part of the TMT or discontinue the test. A 20-s cutoff resulted in optimal prediction of successful completion (< 180 s) of TMT Part A. A cutoff of 30 s optimally predicted successful completion (< 300 s) of TMT Part B.

Adult↗
PubMed2002

Demographic characteristics and normative observations for derived-trail making test indices.

OBJECTIVE: The Trail Making Test (TMT) is a psychomotor task that is used routinely in clinical evaluations and consists of two parts: TMT-A and TMT-B. The purpose of the present study was to examine the relations of two derived-TMT indices with age, education, and gender and to establish normative data. BACKGROUND: Prior research has suggested that these derived indices provide purer measures of the executive skills required to complete TMT-B. It has also been suggested that these scores can be effectively used to detect cognitive impairment, and that they are relatively free from the impact of age. METHOD: Difference scores (B minus sign A) and ratio scores (B:A) were computed from the TMT performance of 285 adults who have no history of substance abuse or psychiatric or neurologic disorder and who are not currently being treated with any type of psychotropic medication. RESULTS: Subjects ranged in age from 18 to 90 years and in education level from 6 to 20 years. For the entire sample, (B minus sign A) scores ranged from 6 to 248 seconds (M, 62.15; SD, 49.44), and (B:A) scores ranged from 1.23 to 9.54 (M, 2.81; SD, 1.13). Significant correlations were noted with age and (B minus sign A) and (B:A) scores, accounting for 28% and 6% of the variance, respectively. Subjects were assigned to one of eight age groups, which were formed by decade. Univariate analyses of variance were significant for (B minus sign A) (p < 0.0001) and (B:A) (p < 0.0004) scores. Post hoc analyses indicated that the two oldest age groups had significantly larger (B minus sign A) scores than the younger age groups. However, post hoc analyses with (B:A) scores indicated that only the 70-79-year-old age group significantly differed from the three youngest age groups. No other age groups significantly differed from another on this measure. CONCLUSIONS: Normative data are presented for clinical use, and recommendations are made for future research. In addition, the current results suggest that normal aging has a significant impact on cognitive flexibility and indicate that previous suggestions for impairment cut-off scores based on the (B:A) ratio may result in erroneous classification of healthy older adults.

Adult↗
PubMed2005

Mayo's Older African Americans Normative Studies: norms for Boston Naming Test, Controlled Oral Word Association, Category Fluency, Animal Naming, Token Test, WRAT-3 Reading, Trail Making Test, Stroop Test, and Judgment of Line Orientation.

Normative data for older African Americans are presented for several clinical neuropsychological measures, including Boston Naming Test, Controlled Oral Word Association, Category Fluency, Token Test, WRAT-3 Reading, Trail Making Test, Stroop Color and Word Test, and Judgment of Line Orientation. Age-adjusted norms were derived from a sample of 309 cognitively normal, community-dwelling individuals, aged 56 through 94, participating in Mayo's Older African Americans Normative Studies (MOAANS). Years of education were modelled on age-scaled scores to derive regression Equations that may be applied for further demographic correction. These data should enhance interpretation of individual test performances and facilitate analysis of neuropsychological profile patterns in older African American patients who present for dementia evaluations.

Black or African American↗
PubMed1998

Intermanual and alternate-form equivalence on the trail making tests.

Intermanual discrepancies in performance and alternate-form equivalence on the Trail Making Test were examined among 40 left- and 40 right-hand-preferred normal adults (N = 80). The findings indicate that administration of the Trail Making Tests to the nonpreferred hand does not result in a clinically meaningful difference in score. Neither hand preference nor task complexity (numeric or numeric/lexical) significantly affected the magnitude of the intermanual discrepancy. Mixed-model analyses of variance revealed an interaction (p < .001) indicating that the alternate form for the numeric/lexical Trial Making Test (Trail Making Test, Part D; TMT-D) is slightly more difficult than is the original form Trail Making Test, Part B (TMT-B). Therefore, individuals exposed first to TMT-D performed relatively better in the second trial, whereas individuals exposed first to TMT-B first produced equivalent scores when presented the more difficult form (TMT-D) on the second trial. Thus, although TMT-D is not an equivalent form to TMT-B, it may serve as an excellent alternate form at retest.

Adolescent↗
PubMed1982

Trail Making Test and visual search.

The performance in the Trail Making Test (Form A) was correlated with a variety of verbal and nonverbal tests in 5 groups of patients: Broca's aphasics (N = 18), Wernicke's aphasics (N = 19) and nonaphasic patients with right hemisphere (N = 20), left hemisphere (N = 17) or diffuse (N = 18) lesions. Correlations with the Trail Making Test were found for two tests, both requiring visual search. The "Objects Finding Test" in which the target varies from item to item showed high correlations for all groups of patients. The "Hidden Patterns Test", in which the target is kept constant, correlated only on the groups of nonaphasic patients. It is concluded (1) that visual search, as tested here, is not restricted to lateralized cortical functions, and (2) that the performance in the Trail Making Test depends largely upon processes involved in visual search of varying targets.

Adult↗
PubMed1995

Trail Making Test norms for psychiatric patients.

The Trail Making Test was administered to a sample of 661 inpatients in a publicly supported psychiatric hospital. The patients' mean IQ of 83.7 (SD = 13.0) was in the low end of the low average range. Multiple regression analysis of the scores showed significant IQ and age components of Trail Making Test scores; however, education and gender differences in performance were not significant once IQ and age were factored into the regression equation. Ability-based norms using time in seconds to completion as the score and IQ as a moderator variable are presented. Such norms allow more appropriate evaluation of the differential cognitive functioning of this population than previously published norms. Normal standard score conversions from raw scores, the intercept, regression weights for IQ and age, and standard error of the regression for both the Trails tasks are provided for individuals desiring to write a program to provide scores corrected for IQ and age.

Adult↗
PubMed1989

An analysis of the significance of performance errors on the Trail Making Test in polysubstance users.

The Trail Making Test performance of a group of polysubstance users was evaluated in order to analyze the stability of performance errors between two administrations. Two categories of errors were identified: sequential (Part A) and sequential and/or perseverative (Part B). The general findings revealed statistically significant test-retest effects. The utility of performance errors as indicators of stable CNS dysfunction is discussed in view of these findings.

Journal Article↗