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The Effects of Aging, Malingering, and Traumatic Brain Injury on Computerized Trail-Making Test Performance.

Woods DL, Wyma JM, Herron TJ, Yund EW - PLoS ONE (2015)

Bottom Line: Experiment 1 examined 165 subjects of various ages and found that completion times on both the C-TMT-A (where subjects connect successively numbered circles) and the C-TMT-B (where subjects connect circles containing alternating letters and numbers) were strongly influenced by age.The results of the first test session were well fit by the normative data gathered in Experiment 1.Sessions 2 and 3 demonstrated significant learning effects, particularly on the C-TMT-B, and showed good test-retest reliability.

View Article: PubMed Central - PubMed

Affiliation: Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America; University of California Davis, Department of Neurology, 4860 Y St., Suite 3700, Sacramento, CA, 95817, United States of America; Center for Neurosciences, University of California Davis, 1544 Newton Ct., Davis, CA, 95616, United States of America; Center for Mind and Brain, University of California Davis, 202 Cousteau Place, Suite 201, Davis, CA, 95616, United States of America.

ABSTRACT
The trail making test (TMT) is widely used to assess speed of processing and executive function. However, normative data sets gathered at different sites show significant inconsistencies. Here, we describe a computerized version of the TMT (C-TMT) that increases the precision and replicability of the TMT by permitting a segment-by-segment analysis of performance and separate analyses of dwell-time, move-time, and error time. Experiment 1 examined 165 subjects of various ages and found that completion times on both the C-TMT-A (where subjects connect successively numbered circles) and the C-TMT-B (where subjects connect circles containing alternating letters and numbers) were strongly influenced by age. Experiment 2 examined 50 subjects who underwent three test sessions. The results of the first test session were well fit by the normative data gathered in Experiment 1. Sessions 2 and 3 demonstrated significant learning effects, particularly on the C-TMT-B, and showed good test-retest reliability. Experiment 3 examined performance in subjects instructed to feign symptoms of traumatic brain injury: 44% of subjects produced abnormal completion times on the C-TMT-A, and 18% on the C-TMT-B. Malingering subjects could be distinguished from abnormally slow controls based on (1) disproportionate increases in dwell-time on the C-TMT-A, and (2) greater deficits on the C-TMT-A than on the C-TMT-B. Experiment 4 examined the performance of 28 patients with traumatic brain injury: C-TMT-B completion times were slowed, and TBI patients showed reduced movement velocities on both tests. The C-TMT improves the reliability and sensitivity of the trail making test of processing speed and executive function.

No MeSH data available.


Related in: MedlinePlus

C-TMT-B paths.A. A C-TMT-B path from a control subject containing an error shown in red. The subject drew a direct path from G to H (circling through 7) and was then returned to G (straight white line). No further errors were committed. B. The superimposed C-TMT-B paths of Experiment 1 control subjects. Paths drawn by individual subjects are shown in blue. Erroneous connections are shown as straight red lines.
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pone.0124345.g003: C-TMT-B paths.A. A C-TMT-B path from a control subject containing an error shown in red. The subject drew a direct path from G to H (circling through 7) and was then returned to G (straight white line). No further errors were committed. B. The superimposed C-TMT-B paths of Experiment 1 control subjects. Paths drawn by individual subjects are shown in blue. Erroneous connections are shown as straight red lines.

Mentions: Fig 3A shows the C-TMT-B path drawn by a single control subject, and Fig 3B shows the paths from all subjects in Experiment 1. S1 Table (bottom) shows the average metrics for the separate segments of the C-TMT-B, while Table 3 (bottom) shows the correlation matrix for performance on the different segments. As with the C-TMT-A, longer segments had longer completion times [r = 0.68, t(22) = 4.35, p < 0.0003], due primarily to increased move-time [r = 0.76, t(22) = 5.49, p < 0.0001]. Velocity increased with path length [r = 0.72, t(22) = 4.87, p < 0.0001], and was negatively correlated with circuitousness [r = -0.51, t(22) = 2.78, p < 0.01]. Unlike the C-TMT-A, completion times over successive segments did not decrease throughout the test [r = 0.03, NS], nor were there significant changes in dwell-time, move-time, line circuitousness, or velocity.


The Effects of Aging, Malingering, and Traumatic Brain Injury on Computerized Trail-Making Test Performance.

Woods DL, Wyma JM, Herron TJ, Yund EW - PLoS ONE (2015)

C-TMT-B paths.A. A C-TMT-B path from a control subject containing an error shown in red. The subject drew a direct path from G to H (circling through 7) and was then returned to G (straight white line). No further errors were committed. B. The superimposed C-TMT-B paths of Experiment 1 control subjects. Paths drawn by individual subjects are shown in blue. Erroneous connections are shown as straight red lines.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4465490&req=5

pone.0124345.g003: C-TMT-B paths.A. A C-TMT-B path from a control subject containing an error shown in red. The subject drew a direct path from G to H (circling through 7) and was then returned to G (straight white line). No further errors were committed. B. The superimposed C-TMT-B paths of Experiment 1 control subjects. Paths drawn by individual subjects are shown in blue. Erroneous connections are shown as straight red lines.
Mentions: Fig 3A shows the C-TMT-B path drawn by a single control subject, and Fig 3B shows the paths from all subjects in Experiment 1. S1 Table (bottom) shows the average metrics for the separate segments of the C-TMT-B, while Table 3 (bottom) shows the correlation matrix for performance on the different segments. As with the C-TMT-A, longer segments had longer completion times [r = 0.68, t(22) = 4.35, p < 0.0003], due primarily to increased move-time [r = 0.76, t(22) = 5.49, p < 0.0001]. Velocity increased with path length [r = 0.72, t(22) = 4.87, p < 0.0001], and was negatively correlated with circuitousness [r = -0.51, t(22) = 2.78, p < 0.01]. Unlike the C-TMT-A, completion times over successive segments did not decrease throughout the test [r = 0.03, NS], nor were there significant changes in dwell-time, move-time, line circuitousness, or velocity.

Bottom Line: Experiment 1 examined 165 subjects of various ages and found that completion times on both the C-TMT-A (where subjects connect successively numbered circles) and the C-TMT-B (where subjects connect circles containing alternating letters and numbers) were strongly influenced by age.The results of the first test session were well fit by the normative data gathered in Experiment 1.Sessions 2 and 3 demonstrated significant learning effects, particularly on the C-TMT-B, and showed good test-retest reliability.

View Article: PubMed Central - PubMed

Affiliation: Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America; University of California Davis, Department of Neurology, 4860 Y St., Suite 3700, Sacramento, CA, 95817, United States of America; Center for Neurosciences, University of California Davis, 1544 Newton Ct., Davis, CA, 95616, United States of America; Center for Mind and Brain, University of California Davis, 202 Cousteau Place, Suite 201, Davis, CA, 95616, United States of America.

ABSTRACT
The trail making test (TMT) is widely used to assess speed of processing and executive function. However, normative data sets gathered at different sites show significant inconsistencies. Here, we describe a computerized version of the TMT (C-TMT) that increases the precision and replicability of the TMT by permitting a segment-by-segment analysis of performance and separate analyses of dwell-time, move-time, and error time. Experiment 1 examined 165 subjects of various ages and found that completion times on both the C-TMT-A (where subjects connect successively numbered circles) and the C-TMT-B (where subjects connect circles containing alternating letters and numbers) were strongly influenced by age. Experiment 2 examined 50 subjects who underwent three test sessions. The results of the first test session were well fit by the normative data gathered in Experiment 1. Sessions 2 and 3 demonstrated significant learning effects, particularly on the C-TMT-B, and showed good test-retest reliability. Experiment 3 examined performance in subjects instructed to feign symptoms of traumatic brain injury: 44% of subjects produced abnormal completion times on the C-TMT-A, and 18% on the C-TMT-B. Malingering subjects could be distinguished from abnormally slow controls based on (1) disproportionate increases in dwell-time on the C-TMT-A, and (2) greater deficits on the C-TMT-A than on the C-TMT-B. Experiment 4 examined the performance of 28 patients with traumatic brain injury: C-TMT-B completion times were slowed, and TBI patients showed reduced movement velocities on both tests. The C-TMT improves the reliability and sensitivity of the trail making test of processing speed and executive function.

No MeSH data available.


Related in: MedlinePlus