The Trail Making Test

The Trail Making Test (TMT) is used as an indicator of visual scanning, graphomotor speed, and executive function. The aim of this study was to examine the TMT relationships with several neuropsychological measures and to provide normative data in community-dwelling participants of 55 years and older. A population-based Spanish-speaking sample of 2,564 participants was used. The TMT, Symbol Digit Test, Stroop Color–Word Test, Digit Span Test, Verbal Fluency tests, and the MacQuarrie Test for Mechanical Ability tapping subtest were administered. Exploratory factor analyses and regression lineal models were used. Normative data for the TMT scores were obtained. A total of 1,923 participants (76.3%) participated, 52.4% were women, and the mean age was 66.5 years (Digit Span = 8.0). The Symbol Digit Test, MacQuarrie Test for Mechanical Ability tapping subtest, Stroop Color–Word Test, and Digit Span Test scores were associated in the performance of most TMT scores, but the contribution of each measure was different depending on the TMT score. Normative tables according to significant factors such as age, education level, and sex were created. Measures of visual scanning, graphomotor speed, and visuomotor processing speed were more related to the performance of the TMT-A score, while working memory and inhibition control were mainly associated with the TMT-B and derived TMT scores.

[1]  Stewart G. Armitage,et al.  An Analysis of Certain Psychological Tests Used for the Evaluation of Brain Injury , 2017 .

[2]  S. Terada,et al.  Trail Making Test B and brain perfusion imaging in mild cognitive impairment and mild Alzheimer's disease , 2013, Psychiatry Research: Neuroimaging.

[3]  T. Wasserman,et al.  Toward an Integrated Model of Executive Functioning in Children , 2013, Applied neuropsychology. Child.

[4]  A. Teixeira-Pinto,et al.  Trail Making Test: regression-based norms for the Portuguese population. , 2013, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[5]  E. Růžička,et al.  Czech version of the Trail Making Test: normative data and clinical utility. , 2012, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[6]  Jamie L. Emerson,et al.  Predictors of driving outcomes in advancing age. , 2012, Psychology and aging.

[7]  C. Jack,et al.  Prediction of conversion from mild cognitive impairment to Alzheimer's disease dementia based upon biomarkers and neuropsychological test performance , 2012, Neurobiology of Aging.

[8]  L. Lind,et al.  The relationship between executive dysfunction and post-stroke mortality: a population-based cohort study , 2012, BMJ Open.

[9]  H. Wagner,et al.  Neuropsychological predictors of dementia in late-life major depressive disorder. , 2012, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[10]  E. Agranov,et al.  The Delis–Kaplan Executive Function System Sorting Test as an evaluative tool for executive functions after severe traumatic brain injury: A comparative study , 2012, Journal of clinical and experimental neuropsychology.

[11]  H. Garavan,et al.  An fMRI investigation of a novel analogue to the Trail-Making Test , 2011, Brain and Cognition.

[12]  T. Goldberg,et al.  Utility of combinations of biomarkers, cognitive markers, and risk factors to predict conversion from mild cognitive impairment to Alzheimer disease in patients in the Alzheimer's disease neuroimaging initiative. , 2011, Archives of general psychiatry.

[13]  T. Salthouse,et al.  What cognitive abilities are involved in trail-making performance? , 2011, Intelligence.

[14]  Jane S. Paulsen,et al.  The Trail Making Test in prodromal Huntington disease: Contributions of disease progression to test performance , 2011, Journal of clinical and experimental neuropsychology.

[15]  R. Chapman,et al.  Please Scroll down for Article Journal of Clinical and Experimental Neuropsychology Predicting Conversion from Mild Cognitive Impairment to Alzheimer's Disease Using Neuropsychological Tests and Multivariate Methods , 2022 .

[16]  I. Zalonis,et al.  Reference data for derived Trail Making Test scores in Greek healthy population , 2010, Annals of General Psychiatry.

[17]  S. Bandinelli,et al.  Trail Making Test Predicts Physical Impairment and Mortality in Older Persons , 2010, Journal of the American Geriatrics Society.

[18]  C. Gass,et al.  The Trail Making Test and its neurobehavioral components , 2010, Journal of clinical and experimental neuropsychology.

[19]  B. Cangoz,et al.  Trail Making Test: Normative data for Turkish elderly population by age, sex and education , 2009, Journal of the Neurological Sciences.

[20]  J. Molinuevo,et al.  Spanish Multicenter Normative Studies (NEURONORMA Project): norms for verbal span, visuospatial span, letter and number sequencing, trail making test, and symbol digit modalities test. , 2009, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[21]  J. Molinuevo,et al.  Spanish Multicenter Normative Studies (NEURONORMA Project): methods and sample characteristics. , 2009, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[22]  F. Barceló,et al.  Construct validity of the Trail Making Test: Role of task-switching, working memory, inhibition/interference control, and visuomotor abilities , 2009, Journal of the International Neuropsychological Society.

[23]  J D Dawson,et al.  Predictors of driving safety in early Alzheimer disease , 2009, Neurology.

[24]  S. Millis,et al.  Sensitivity to Brain Dysfunction of the Halstead-Reitan vs an Ability-Focused Neuropsychological Battery , 2008, The Clinical neuropsychologist.

[25]  Alberto L Fernández,et al.  A comparison of normative data for the Trail Making Test from several countries: equivalence of norms and considerations for interpretation. , 2008, Scandinavian journal of psychology.

[26]  J. Giacino,et al.  The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain injury. , 2008, Archives of physical medicine and rehabilitation.

[27]  R. Green,et al.  Trail Making Test errors in normal aging, mild cognitive impairment, and dementia. , 2008, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[28]  R. Elosua,et al.  Trends in cardiovascular risk factor prevalence (1995-2000-2005) in northeastern Spain , 2007, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[29]  M. B. Jurado,et al.  The Elusive Nature of Executive Functions: A Review of our Current Understanding , 2007, Neuropsychology Review.

[30]  Ronald C Petersen,et al.  Neuropsychological Differentiation of Dementia with Lewy Bodies from Normal Aging and Alzheimer's Disease , 2006, The Clinical neuropsychologist.

[31]  Dong Young Lee,et al.  A normative study of the Trail Making Test in Korean elders , 2006, International journal of geriatric psychiatry.

[32]  Hiroshi Ishii,et al.  Effect of age and education on the Trail Making Test and determination of normative data for Japanese elderly people: The Tajiri Project , 2006, Psychiatry and clinical neurosciences.

[33]  Jelle Jolles,et al.  The Stroop Color-Word Test , 2006, Assessment.

[34]  G. Iverson,et al.  Interpreting the Trail Making Test Following Traumatic Brain Injury: Comparison of Traditional Time Scores and Derived Indices , 2005, Journal of clinical and experimental neuropsychology.

[35]  Linas A. Bieliauskas,et al.  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 , 2005, The Clinical neuropsychologist.

[36]  T. Salthouse.  Relations between cognitive abilities and measures of executive functioning. , 2005, Neuropsychology.

[37]  R. Jung.  Neuropsychological Assessment, 4th ed. , 2005 .

[38]  R. Petersen,et al.  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 , 2005, The Clinical neuropsychologist.

[39]  G. Kinsella,et al.  DEMOGRAPHIC INFLUENCES ON BASELINE AND DERIVED SCORES FROM THE TRAIL MAKING TEST IN HEALTHY OLDER AUSTRALIAN ADULTS , 2005, The Clinical neuropsychologist.

[40]  P. Rabbitt.  Introduction: Methodologies and models in the study of executive function , 2004 .

[41]  E. Vandenbussche,et al.  Cognitive changes in patients with Huntington’s disease (HD) and asymptomatic carriers of the HD mutation , 2004, Journal of Neurology.

[42]  J. Vilalta-Franch,et al.  Incidence of Dementia in a Rural Community in Spain: The Girona Cohort Study , 2004, Neuroepidemiology.

[43]  Á. OteroPuime,et al.  Cognitive assessment in the elderly. Normative data of a Spanish population sample older than 70 years , 2004 .

[44]  T. Tombaugh.  Trail Making Test A and B: normative data stratified by age and education. , 2004, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[45]  M. Ríos,et al.  Attentional control and slowness of information processing after severe traumatic brain injury , 2004, Brain injury.

[46]  Kenneth Podell,et al.  Standard measures of executive function in predicting instrumental activities of daily living in older adults , 2002, International journal of geriatric psychiatry.

[47]  G Ratcliff,et al.  Patterns of cognitive decline in presymptomatic Alzheimer disease: a prospective community study. , 2001, Archives of general psychiatry.

[48]  S. Edland,et al.  Neuropsychological test performance in a cognitively intact sample of older Japanese American adults. , 2001, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[49]  K. Arbuthnott,et al.  Trail Making Test, Part B as a Measure of Executive Control: Validation Using a Set-Switching Paradigm , 2000, Journal of clinical and experimental neuropsychology.

[50]  K. Boone,et al.  Handbook of Normative Data for Neuropsychological Assessment , 1999 .

[51]  S. Crowe,et al.  The differential contribution of mental tracking, cognitive flexibility, visual search, and motor speed to performance on parts A and B of the Trail Making Test. , 1998, Journal of clinical psychology.

[52]  S. Resnick,et al.  Effects of Age and Dementia on the Trail Making Test , 1998 .

[53]  E. Capitani,et al.  Trail making test: normative values from 287 normal adult controls , 1996, The Italian Journal of Neurological Sciences.

[54]  J. P. O'donnell,et al.  Construct validity of neuropsychological tests of conceptual and attentional abilities. , 1994, Journal of clinical psychology.

[55]  D P Salmon,et al.  Effects of Age, Gender and Education on Selected Neuropsychological Tests in an Elderly Community Cohort , 1993, Journal of the American Geriatrics Society.

[56]  H. Levin.  A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary , 1993 .

[57]  Russell W. Hardy.  The Adult Spine , 1991, Neurology.

[58]  J. Morris,et al.  The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assesment of Alzheimer's disease , 1989, Neurology.

[59]  D. Stuss,et al.  Traumatic brain injury: A comparison of three clinical tests, and analysis of recovery , 1989 .

[60]  J. D. Pauker.  Constructing overlapping cell tables to maximize the clinical usefulness of normative test data: rationale and an example from neuropsychology. , 1988, Journal of clinical psychology.

[61]  J. Corrigan,et al.  Relationships between parts A and B of the Trail Making Test. , 1987, Journal of clinical psychology.

[62]  Donald T. Stuss,et al.  Comparison of three tests of attention and rapid information processing across six age groups , 1987 .

[63]  Robert A. Bornstein,et al.  Normative data on selected neuropsychological measures from a nonclinical sample , 1985 .

[64]  S. Weisberg,et al.  Residuals and Influence in Regression , 1982 .

[65]  David A. Belsley,et al.  Regression Diagnostics: Identifying Influential Data and Sources of Collinearity , 1980 .

[66]  J. Matarazzo,et al.  PSYCHOMETRIC AND CLINICAL TEST-RETEST RELIABILITY OF THE HALSTEAD IMPAIRMENT INDEX IN A SAMPLE OF HEALTHY, YOUNG, NORMAL MEN , 1974, The Journal of nervous and mental disease.

[67]  R. Reitan.  The comparative effects of brain damage on the Halstead impairment index and the Wechsler-Bellevue scale. , 1959, Journal of clinical psychology.

[68]  R. Reitan.  The relation of the trail making test to organic brain damage. , 1955, Journal of consulting psychology.

[69]  R. Chapman.  The MacQuarrie test for mechanical ability , 1948, Psychometrika.

[70]  Laura Manea,et al.  A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. , 2015, General hospital psychiatry.

[71]  Leonard F. Koziol,et al.  The Myth of Executive Functioning , 2014, SpringerBriefs in Neuroscience.

[72]  P. Scheltens,et al.  Mental flexibility: Neuroanatomical and neuropsychological correlates of the Trail Making Test in elderly people , 2009 .

[73]  K. Boone,et al.  Handbook of normative data for neuropsychological assessment, 2nd ed. , 2005 .

[74]  Johan W S Vlaeyen,et al.  Norming clinical questionnaires with multiple regression: the Pain Cognition List. , 2005, Psychological assessment.

[75]  Á. Otero Puime,et al.  [Cognitive assessment in the elderly. Normative data of a Spanish population sample older than 70 years]. , 2004, Medicina clinica.

[76]  W. Ehrenstein,et al.  Trail Making Test and visual search , 2004, Archiv für Psychiatrie und Nervenkrankheiten.

[77]  A. Horton,et al.  Demographic effects on the Trail Making Test in a drug abuse treatment sample. , 2003, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[78]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[79]  E. Kaplan,et al.  Age effects on executive ability. , 2000, Neuropsychology.

[80]  Colleen M. Parks,et al.  Effects of aging on efficiency of task switching in a variant of the trail making test. , 2000, Neuropsychology.

[81]  M. Schiess,et al.  Trail Making Test: issues in normative data selection. , 1998, Applied neuropsychology.

[82]  P. Rabbitt,et al.  Cognitive Models of Ageing and Frontal Lobe Deficits , 1997 .

[83]  E. Tangalos,et al.  Neuropsychological tests' norms above age 55: COWAT, BNT, MAE token, WRAT-R reading, AMNART, STROOP, TMT, and JLO , 1996 .

[84]  Lawrence Weiskrantz,et al.  Introduction: Dissociated Issues , 1992 .

[85]  R. Bornstein,et al.  Educational level and neuropsychological performance in healthy elderly subjects , 1988 .

[86]  B. Townes,et al.  Age group differences on neuropsychological battery performance in a neuropsychiatric population: an international descriptive study with replications. , 1987, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[87]  M. Schlossberg.  The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. , 1986 .

[88]  R. Gorsuch,et al.  Continuous norming: implications for the WAIS-R. , 1985, Journal of clinical psychology.

[89]  W. Holtzman.  Fundamental statistics in psychology and education. , 1951 .

[90]  S. Theodoridis,et al.  Non-commercial Research and Educational Use including without Limitation Use in Instruction at Your Institution, Sending It to Specific Colleagues That You Know, and Providing a Copy to Your Institution's Administrator. All Other Uses, Reproduction and Distribution, including without Limitation Comm , 2022 .