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PubMed2005

Demographic influences on baseline and derived scores from the trail making test in healthy older Australian adults.

Normative data from 363 community-dwelling older adults (60-89 years) is presented in relation to performance on the Trail Making Test. Age and years of education were identified as significantly impacting on performance. Therefore, data are presented for four separate age groups (60-69; 70-74; 75-79; 80-89) and two different lengths of education. In addition to data for Trails A and B, information is provided for the difference and ration scores, which are increasingly used by clinicians to interpret executive function.

Age Distribution↗
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↗
PubMed2005

Interpreting the trail making test following traumatic brain injury: comparison of traditional time scores and derived indices.

The purpose of this study was to examine the clinical application of traditional time scores and various derived indices from the Trail Making Test (TMT) in a sample of 571 patients with acute traumatic brain injury (TBI). Participants were classified into four injury severity groups. A clear linear relation between injury severity and TMT performance was demonstrated, with the more severely brain injured patients performing more poorly on most measures. Hierarchical logistic regression analysis of TMT time scores across binary extreme groups based on injury severity resulted in high classification rates for patients with very mild TBI (93.0% correctly classified) and low classification rates for patients with moderate to severe TBI (50.0% correctly classified). However, TMT derived indices did not provide a unique contribution to test interpretation beyond what is already available from Part A and B separately.

Adult↗
PubMed2006

Regional brain metabolism as the predictor of performance on the Trail Making Test in schizophrenia. A 18FDG PET covariation study.

OBJECTIVES: With the aim to indicate the functional anatomical substrate of cognitive dysfunction in schizophrenia we evaluated the relationship between resting brain metabolism and performance on the Trail Making Test (TMT). As the prerequisite analysis we compared the performance in Part A and B of the TMT between schizophrenic patients and controls. Resting brain metabolism was investigated by (18)FDG positron emission tomography (PET) as the probe for the relative regional synaptic strength and density. METHODS: (18)FDG PET data were analyzed by SPM99 with TMT A and B as the covariate (p< or =0.001). RESULTS: Schizophrenic patients (N=42) had worse performance in both TMT A and B compared to controls (N=42). In schizophrenic subjects (18)FDG PET did not predict the performance on Part A (psychomotor speed) but predicted that for Part B (set-shifting and flexibility) of the TMT. The (18)FDG uptake in the superior, middle and inferior frontal gyruses bilaterally was associated with better performance in the TMT B. The negative covariation between 18FDG uptake and time spent in the TMT B was detected in the temporal and parietal cortices, pre- and postcentral gyruses, precuneus limbic regions (anterior cingulate, uncus) and the pons. CONCLUSIONS: Our data indicate that hypometabolism in the frontal lobes and hypermetabolism in the temporo-parieto-limbic regions is the neurobiological basis for deficient TMT B performance in schizophrenia.

Adolescent↗
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↗
PubMedDate not supplied

Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Trail-Making Test, the Stroop Test, and MAE Controlled Oral Word Association Test.

Although normative data sets for standardized neuropsychometric instruments often include adjustments for subject variables, there are reasons to believe that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, years of formal education may be less closely related to test performances than is general intellectual functioning. In this second of four reanalyses of results from the Mayo Clinic's Older Americans Normative Studies (MOANS) databases, age-adjusted scores for the Trail-Making Test, the Stroop Color-Word Test, and the MAE Controlled Oral Word Associations Test were found to be more strongly associated with Mayo age-adjusted WAIS-R Full Scale IQ scores (rs=.368 to .495) than with education (rs=.174 to .367) for healthy older examinees between 56 and 99 years of age. For the TMT and the COWAT, but not the Stroop, these associations became stronger as IQ increased (cf. Dodrill, 1997, 1999). Tables of age- and IQ-adjusted percentile equivalents of MOANS age-adjusted TMT, Stroop, and COWAT scores are presented for eleven age ranges and seven IQ ranges.

Age Factors↗
PubMed1999

Trail making test in chronic toxic encephalopathy: performance and discriminative potential.

The objective of this study was to examine the influence of chronic toxic encephalopathy (CTE) on Trail Making Test (TMT) performance, with special focus on the discriminative potential of this test. We assessed TMT performance in patients diagnosed with CTE, patients with similar symptoms but no diagnosis, and healthy participants. Inferior performance was seen in CTE, and increasing age had a negative effect on TMT performance only for the CTE group. This effect was most pronounced in TMT-B. However, the ability of the TMT to identify CTE was low, whereas all healthy participants were identified as healthy. Thus, the sensitivity of TMT alone was low, but it succeeded in correctly classifying normal subjects. The pattern of results indicates that normal TMT performance may be seen in individuals with mild to moderate brain syndromes, such as CTE, whereas poor performance should not be expected in healthy individuals.

Adult↗
PubMed1985

False negatives, Canter's Background Interference Procedure, the trail making test, and epileptics.

This study correlated the Canter's Background Interference Procedure (BIP) scores of 141 adult epileptics with the five variables of age at onset of symptoms, etiology, type of symptoms, severity of generalized background dysrhythmia, and locus of lesion. These variables did not correlate significantly with the BIP scores, contrary to expectations. The BIP's nearly 50% false negative rate was much higher than that of the Trail Making Test, using either Reitan's or Russell's cutting scores for Trails A (33% and 21%, respectively) or Trails B (35% and 28.5%, respectively). The BIP often does not agree with abnormal neurological diagnoses, but often does agree with psychiatric diagnoses of Organic Brain Syndrome (OBS). The authors argue that this is due to the BIP's normative history and to its sensitivity to organic concreteness. The authors suggest that future BIP validity studies include a behavioral measure of OBS as criterion.

Adult↗
PubMedDate not supplied

Trail Making Test performance in a community-based sample of healthy very old adults: effects of age on completion time, but not on accuracy.

A population-based sample of healthy old adults ranging from 76 to 93 years of age (n=94) was examined in the Trail Making Test (TMT), and in tests assessing motor functions of the hands (the dynamic and optic-spatial organization of the motor act). Results indicated no age-related differences in TMT accuracy, although the time required to complete the test increased with increasing age. Similar patterns of results were observed for TMT-A and TMT-B. There were no age-related differences in the tests of hand-motor functioning, and subjects were carefully screened on visual and auditory capacity, hence making it unlikely that motor and sensory factors contributed to the results obtained. A test of visuo-spatial skill (Block Design Test) was marginally related to performance on TMT-B, whereas sex, education, a marker of global cognitive status (the Mini-Mental State Exam), and tests of primary memory (digit dpan forward and digit span backward) made no contribution to TMT performance. Several biological variables (e.g. vitamin B12, albumin, blood pressure) were also unrelated to TMT performance, although a positive relationship between thyroid stimulating hormone and TMT-B performance was documented. It was suggested that the influence of age on TMT speed may reflect age-related deficits in a variety of task-relevant skills, including perceptual speed, attentional functions (e.g. vigilance, concentration, visual scanning), and visuo-spatial ability.

Journal Article↗
PubMed1992

The relationship between intellectual ability and adult performance on the Trail Making Test and the Symbol Digit Modalities Test.

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.

Adult↗