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PubMed1978

The Trail Making Test and Bender Background Interference Procedure as screening devices.

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.

Adult↗
PubMed2003

Limitations of the Oral Trail Making Test in a mixed sample of older individuals.

The utility of the Oral Trail Making Test (OTMT), a motor and visual-free alternative to the traditional Trail Making Test, was examined in 86 older (> or =60 years old) medical inpatients and 30 healthy controls. The OTMT-Part B evidenced a moderate correlation with the MMSE, and individuals with medical conditions that affect cognition displayed a high failure rate (more than five errors or 300+s). Moderate education effects were present for the OTMT-Part B. Thus, the current study suggests caution when employing this test and the above noted cutoffs with older medical patients or those with lower levels of education.

Aged↗
PubMed1998

Trail Making Test: issues in normative data selection.

The Trail Making Test (TMT) is one of the most frequently administered neuropsychological instruments, having been used in the evaluation of cognitive dysfunction for over 50 years. Despite the measure's extensive clinical use and proliferation of research, no comprehensive review of the adult TMT normative literature is available. This report examines the available TMT normative reports and provides a summary of the sample characteristics. Significant variability between studies precludes the use of metanorms. Clinically, these findings indicate that biased results may be obtained if the most appropriate normative data set is not used and underscore the importance of identifying the normative comparison group that approximates the relevant patient characteristics. To assist the clinician, selected normative reports (based on certain exclusionary parameters) have been compiled for three nonclinical comparison groups: (a) an adolescent and young adult group (ages 15-24), (b) an adult group (ages 20-54), and (c) an older adult group (ages 55-85). Results are discussed in terms of the influence of moderator variables on TMT performance and other factors, such as procedural differences in administration, that may account for the significant variability between normative samples.

Journal Article↗
PubMed1977

Assessment of cognitive recovery in alcoholics by use of the trail-making test.

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.

Adult↗
PubMed1996

Trail making test: normative values from 287 normal adult controls.

The Trail Making Test (TMT), which explores visual-conceptual and visual-motor tracking, is a frequently used neuropsychological test because of its ease of administration and sensitivity to brain damage. In this paper, norms are provided for the time scores derived from parts A and B, and for the (B-A) difference. The data were collected from 287 adult Italian subjects stratified by gender, schooling and age (from 20 to 79 years). The test scores were affected by age, education and general intelligence (as expressed by Raven's Coloured Progressive Matrices). Only for part A did females have longer time scores than males. Test-retest reliability was high for each score.

Adolescent↗
PubMed2001

Demographic effects on the Trail Making Test in narcotic/other opiate abusers.

Demographic effects on the Trail Making Test (TMT), a test often used to screen for cognitive impairments, were examined in a sample of narcotic/other opiate abusers in drug abuse treatment programs. A sample was drawn from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991 through 1993 in 96 programs within 11 cities in the United States. The number of narcotic/other opiate abusers' scores available for analysis was 191. Data were analyzed to determine the effects of sex, ethnicity, age, and education on the two parts of the TMT in this sample of narcotic/other opiate abusers. The variables of age and education level were statistically significantly related to TMT parts A and B, and ethnicity was statistically significant for part B of the TMT. R-square values for overall models were moderate (A = .34, B = .24), suggesting that demographic effects on the TMT are moderate.

Adult↗
PubMed2002

Normative data on trail making test for neurologically normal, Chinese-speaking adults.

This study presents normative data on the Trail Making Test Part A and the Chinese version of the Trail Making Test Part B (C-Trails B). The ages of the 110 participants ranged from 21 to 75 (M = 48, SD = 14.7) and years of education from 1 to 20 (M = 12, SD = 5). No gender effects were found on the test scores; however, age and education were significantly associated with scores on both Trails A (p < .01) and C-Trails B (p < .01). Results also suggest a high correlation (Pearson r = .69) between C-Trails B and the Digit Symbol-Coding subtest of the Wechsler Adult Intelligence Scale-Third Edition. In light of our earlier study, this finding provides further evidence that C-Trails B may be equivalent to the standard Trails B. Findings also demonstrate a need for norms adjusted for both age and education for adults whose primary language is Chinese.

Adult↗
PubMed2001

The symbol trail making test: test development and utility as a measure of cognitive impairment.

Although the Trail Making Test (TMT) has proven to be an exceptional clinical tool, its applications have been limited by the instrument's use of the Arabic numeral system and Latin alphabet. Clearly an instrument not limited by a specific alphabet or numerical system could fill this void. This study presents the development and validation of an alternative to the TMT that offers modestly similar psychometric properties and can be used with populations that have no familiarity with the Arabic numerical system or a specific alphabet. The Symbol Trail Making Test (STMT), which employs symbols that are not language or numerically based was administered to a normative sample of 210 participants, including 54 individuals whose first language was not English, for the purpose of collecting normative data. Reliability, assessed through an alternate form administration, and convergent validity, assessed through correlation with the TMT in a nonpatient sample, was deemed acceptable. Significant discriminant validity was obtained comparing non-brain-injured patients to brain-injured patients, particularly on time measures. An analysis of variance found no significant difference between native English speakers and individuals speaking English as a second language on performance on the STMT. This preliminary study provides evidence that the STMT is a clinically useful instrument for discriminating brain-injured from non-brain-injured participants without employing a specific culture-bound symbol system.

Adult↗
PubMed2005

An fMRI study of the Trail Making Test.

This study investigated the cerebral correlates of the Trail Making Test (TMT), used commonly as a measure of frontal lobe function. Such work sheds additional light on the known shortcomings of the TMT as a localizing instrument, as indicated, for example, by studies of patients with focal brain lesions. Functional magnetic resonance imaging (fMRI) was used to record brain activity while participants performed the TMT using a custom-built, fiber-optic fMRI-compatible writing device, the "virtual stylus". Unlike in a previous fMRI study that used a verbal adaptation of the TMT, the virtual stylus enabled a closer depiction of the brain regions engaged by the actual paper-and-pencil task. Twelve, right-handed healthy young adults participated. In Part A of the task, participants were required to link in ascending order numbers (1-2-3 ...) that were randomly distributed on a computer screen. In Part B, participants were required to link alternately between numbers and letters (1-A-2-B ...). Although behavioral performance was somewhat less than typically obtained with the TMT due to use of the virtual stylus, distinct left-sided dorsolateral and medial frontal activity was revealed when comparing Part B versus Part A. These findings agree with existing literature showing sensitivity of the TMT to frontal regions in the left hemisphere. However, other activity was also observed (left middle and superior temporal gyrus) reinforcing that the brain-behavior correlations for the TMT are multifaceted and not restricted to the frontal lobe.

Adult↗
PubMed1994

The Trail Making Test A and B: a technical note on structural nonequivalence.

The major structural aspect of the Trail Making Test, length of drawn lines needed to complete the tests, was measured and compared for the adult and school-aged child versions. Trail Making B is a markedly longer test than Trail Making A, 32% for adults and 27% for school-aged children. The interpretive assumptions that Trail Making B differs from Trail Making A only in terms of the cognitive skills needed to complete the test and the implicit interpretive bias toward minimizing the motor component of the tests were challenged in this technical note.

Adult↗
PubMed2006

Trail making test errors and executive function in schizophrenia and depression.

The Trail Making Test (TMT) frequently is used as a measure of executive cognitive function. However, traditional use of test completion time as the primary outcome score does not give the more detailed information on cognitive processes that analysis of test-taking errors may provide. The present study compared TMT performance of three groups: patients with schizophrenia, patients with major depression, and healthy control participants (n = 30 for each group). Three operationally defined error types were examined: (a) tracking, (b) perseverative, and (c) proximity. Although both patient groups were slower than the healthy control group, only the schizophrenia group made significantly more errors, particularly tracking errors, suggesting a greater degree of cognitive disorganization. Within-group analysis of a larger group of schizophrenia patients (n = 84) revealed that TMT time was most strongly associated with the Withdrawal-Retardation factor of the Brief Psychiatric Rating scale. In contrast, TMT errors were most strongly associated with the Conceptual Disorganization factor. Comparisons of TMT scores and other cognitive tests showed moderate to high associations with tests of working memory, psychomotor speed, and executive function. Stepwise regression analysis revealed an independent association between Digit Cancellation and Part B Time, indicating a unique contribution of visuomotor scanning to performance. In contrast, Part B errors were uniquely associated with the Verbal Series Attention Test and the Token Test, tests of mental tracking and executive-mediated working memory, respectively. These findings demonstrate the utility of TMT error analysis in revealing cognitive deficits not traditionally captured using completion time as the sole outcome variable.

Adult↗
PubMed2003

Anxiety and trail making test scores in a sample of cocaine abusers.

Anxiety effects on the Trail Making test (TMT), a test often used for screening for cognitive impairments, were examined in a sample of cocaine abusers in drug abuse treatment programs. A mixed race sample of 4306 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 anxiety on the TMT scores A and B, and also derived indices created by adding, subtracting, multiplying, and dividing parts A and B of the TMT in this large treatment sample of cocaine abusers. The variables of sex, age, ethnicity, and education were included in analyses to control for demographic effects. The ratio derived score was the least sensitive TMT score to the effects of anxiety, but all TMT R-squares were quite small.

Adolescent↗
PubMed2002

The trail making test, part B: cognitive flexibility or ability to maintain set?

The Trail Making Test (TMT) is a well-established test sensitive to impairment in multiple cognitive domains. There has been ambiguity about which cognitive demands are placed on the patient by TMT Part B over and above those required to perform TMT Part A. In particular, cognitive flexibility and ability to maintain a complex response set have been 2 competing hypotheses. This study preliminarily examined which of these 2 abilities primarily contributes to Part B performance. A total of 121 clinically referred Veterans Affairs patients were administered the TMT, as well as other tests of executive and other cognitive functions. Regression analyses were used to examine which tests predicted Part B performance above and beyond Part A performance. The results provide preliminary support for TMT Part B performance being more sensitive to cognitiveflexibility (operationalized as Wisconsin Card Sorting Test [WCST], percent perseverative errors) than ability to maintain set (operationalized as WCST, failure to maintain set).

Adult↗