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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 completion time z-scores for Trails A (top) and Trails B (bottom).Shown as a function of age. Regression functions from Experiment 1 were used to adjust Z-scores for age and computer use. Dashed lines show p< 0.05 abnormality thresholds.
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pone.0124345.g005: C-TMT completion time z-scores for Trails A (top) and Trails B (bottom).Shown as a function of age. Regression functions from Experiment 1 were used to adjust Z-scores for age and computer use. Dashed lines show p< 0.05 abnormality thresholds.

Mentions: Because completion times were positively skewed (skew = 2.60), they were log transformed before further statistical analysis. Log-transformed completion times (skew = 1.17) showed strong correlations with age [r = 0.59, t(163) = 9.36, p < 0.0001] and computer-use [r = -0.39, t(163) = -5.42, p < 0.0001], with the correlation with age stronger than that with computer-use [z = 2.4, p < 0.02]. Linear regression analysis showed that age and computer-use conjointly accounted for 42.5% of the C-TMT-A log-completion time variance, with both making significant individual contributions [Age, t(163) = 8.78, p < 0.0001; Computer-use, t(163) = -4.70, p < 0.0001]. Individual z-scores, calculated from age- and computer-use regressed log completion times, are shown for subjects of different ages in Fig 5 (top, blue diamonds). Z-scores did not correlate significantly with sex, education, or handedness. As expected, z-scores correlated with dwell-time [r = 0.54, t(163) = 8.22, p < 0.0001] and move-time [r = 0.58, t(163) = 9.22, p < 0.0001], reflecting proportional increases in both measures: i.e., there was no significant correlation between z-scores and the dwell-time/total-time ratio [r = 0.09, NS].


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 completion time z-scores for Trails A (top) and Trails B (bottom).Shown as a function of age. Regression functions from Experiment 1 were used to adjust Z-scores for age and computer use. Dashed lines show p< 0.05 abnormality thresholds.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0124345.g005: C-TMT completion time z-scores for Trails A (top) and Trails B (bottom).Shown as a function of age. Regression functions from Experiment 1 were used to adjust Z-scores for age and computer use. Dashed lines show p< 0.05 abnormality thresholds.
Mentions: Because completion times were positively skewed (skew = 2.60), they were log transformed before further statistical analysis. Log-transformed completion times (skew = 1.17) showed strong correlations with age [r = 0.59, t(163) = 9.36, p < 0.0001] and computer-use [r = -0.39, t(163) = -5.42, p < 0.0001], with the correlation with age stronger than that with computer-use [z = 2.4, p < 0.02]. Linear regression analysis showed that age and computer-use conjointly accounted for 42.5% of the C-TMT-A log-completion time variance, with both making significant individual contributions [Age, t(163) = 8.78, p < 0.0001; Computer-use, t(163) = -4.70, p < 0.0001]. Individual z-scores, calculated from age- and computer-use regressed log completion times, are shown for subjects of different ages in Fig 5 (top, blue diamonds). Z-scores did not correlate significantly with sex, education, or handedness. As expected, z-scores correlated with dwell-time [r = 0.54, t(163) = 8.22, p < 0.0001] and move-time [r = 0.58, t(163) = 9.22, p < 0.0001], reflecting proportional increases in both measures: i.e., there was no significant correlation between z-scores and the dwell-time/total-time ratio [r = 0.09, NS].

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