The ability of Trail Making Test Parts A and B for children and adolescents to discriminate between learning disabled students and non-learning disabled students

The Trail Making Test Parts A and B is a neuropsychological test that has long been thought to be a highly reliable and valid test that is able to discriminate cerebral dysfunction. In the present study, an investigation was completed in order to determine whether or not the Trail Making Test Parts A and B could differentiate learning disabled students from non-learning disabled students in four counties in West Virginia. Fifty-six students ranging from ages 9-16 (mean age 9.9) were involved in the study. The convenience sample consisted of 27 learning disabled students and 29 controls or non-learning disabled students. Results indicated, using a one-way ANOVA, that there was a statistically significant difference between the performance on Trail Making Test Part B but not on Part A. The results of the present study confirmed the previously held belief that Trail Making Test Part B is able to differentiate between learning disabled children and non-learning disabled children. Trail Making Test Part B is more sensitive to neurological deficits than Trail Making Test Part A since it requires that the individual be able to switch between a numerical and an alphabetical series. In summary, the present study supports the premise that the Trail Making Test can be employed as a tool to distinguish between LD and non-LD children. Further research needs to be completed

Trail Making Test performance contributes to subjective judgment of visual efficiency in older adults

Introduction: The determinant factors that influence self-reported quality of vision have yet to be fully elucidated. This study evaluated a range of contextual information, established psychophysical tests, and in particular, a series of cognitive tests as potentially novel determinant factors.   Materials & Methods: Community dwelling adults (aged 50+) recruited to Wave 1 of The Irish Longitudinal Study on Ageing, excluding those registered blind, participated in this study (N = 5,021). Self-reports of vision were analysed in relation to visual acuity and contrast sensitivity, ocular pathology, visual (Choice Response Time task; Trail Making Test) and global cognition. Contextual factors such as having visited an optometrist and wearing glasses were also considered. Ordinal logistic regression was used to determine univariate and multivariate associations.   Results and Discussion: Poor Trail Making Test performance (Odds ratio, OR = 1.36), visual acuity (OR = 1.72) and ocular pathology (OR = 2.25) were determinant factors for poor versus excellent vision in self-reports. Education, wealth, age, depressive symptoms and general cognitive fitness also contributed to determining self-reported vision.   Conclusions: Trail Making Test contribution to self-reports may capture higher level visual processing and should be considered when using self-reports to assess vision and its role in cognitive and functional health

Hubungan Lama Hemodialisis dengan Fungsi Kognitif yang Diukur Menggunakan Metode Trail Making Test A dan B

Latar Belakang: Penyakit ginjal kronik (PGK) telah menjadi masalah kesehatan  masyarakat global di seluruh dunia, sehingga perlu dilakukan hemodialisis (HD) yang merupakan terapi paling banyak dilakukan. Angka kejadian yang tinggi dari gangguan kognitif dan demensia telah banyak dilaporkan pada berbagai penelitian. Prevalensi terjadinya penurunan fungsi kognitif meningkat yaitu sebesar 30% sampai 70% pada pasien PGK yang menjalani hemodialisis. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan lamanya hemodialisis dengan fungsi kognitif yang diukur menggunakan metode Trail Making Test A and B di RS. Anna Medika Bekasi.  Metode: Merupakan penelitian cross sectional, dengan sampel penelitian adalah 156 penderita PGK yang sedang menjalani HD di Rumah Sakit Anna Medika Bekasi, namun hanya 73 subjek yang memenuhi kriteria inklusi. Subjek diwawancarai dan mengisi kuisioner Trail Making Test A and B. Data dianalisis menggunakan uji chi square. Hasil: Dari tes Trail Making Test A (TMT-A) diperoleh hasil yang mengalami penurunan fungsi kognitif sebanyak 40 orang (54.8%) dan sebanyak 33 orang (45.2%) normal. Sedangkan pada TMT-B, hanya 9 orang (12.3%) yang mengalami penurunan dan 64 orang (87.7%) normal. Hasil uji statistik menunjukkan tidak terdapat hubungan yang signifikan antara lama hemodialisis dengan fungsi kognitif pada pasien yang menjalani hemodialisis, dengan nilai p 0,297 pada TMT-A dan nilai p sebesar 0,220 pada TMT-B. Simpulan: Tidak  terdapat  hubungan  yang  signifikan antara  lama hemodialisis dengan fungsi kognitif pada pasien yang menjalani hemodialisis menggunakan metode Trail Making Test A and B

Force Steadiness During a Cognitively Challenging Motor Task Is Predicted by Executive Function in Older Adults

Motor performance and cognitive function both decline with aging. Older adults for example are usually less steady for a constant-force task than young adults when performing low-intensity contractions with limb muscles. Healthy older adults can also show varying degrees of cognitive decline, particularly in executive function skills. It is not known, however, whether age-related changes in steadiness of low-force tasks and cognitive function are independent of one another. In this study, we determined if executive function skills in aging are associated with the steadiness during a low-force muscle contraction performed with and without the imposition of a cognitive challenge. We recruited 60 older adults (60–85 years old, 34 women, 26 men) and 48 young adults (19–30 years old, 24 women, 24 men) to perform elbow flexor muscle contractions at 5% of maximal voluntary contraction (MVC) force in the presence and absence of a difficult mental-math task (counting backward by 13 from a four-digit number). Force steadiness was quantified as the coefficient of variation (CV) of force and executive function was estimated with the Trail-making Test part A and B. The cognitive challenge increased the CV of force (i.e., decreased force steadiness) with greater changes in older adults than young adults (5.2 vs. 1.3%, respectively, cognitive challenge × age: P \u3c 0.001). Older adults were 35% slower in both parts A and B of the Trail-making Test (P \u3c 0.001), and to eliminate the effects of age and education on this variable, all further analyses were performed with the age-corrected z-scores for each individual using established normative values. Hierarchical regression models indicated that decreased force steadiness during a cognitive challenge trial was in part, explained by the performance in the Trail-making Test part A and B in older (r = 0.53 and 0.50, respectively, P \u3c 0.05), but not in young adults (P \u3e 0.05). Thus, healthy community-dwelling older adults, who have poorer executive function skills, exhibit reduced force steadiness during tasks when also required to perform a high cognitive demand task, and are likely at risk of reduced capacity to perform daily activities that involve cognitively challenging motor tasks

Correlation between Hemoglobin Level, Attention and Working Memory Scores

Background: Attention and working memory functions have important roles in daily activities. Normal level of hemoglobin is required for optimum attention and working memory functions. This study aims to analyze the correlation between hemoglobin level, attention, and working memory scores in medical students who attended Atlas Medical Pioneer (AMP) Basic Program XXI.Methods: The total population sample for this cross-sectional study included 27 males and 19 females. The hemoglobin level was meassured by using cyanmethemoglobin method. Digit Symbol Test, Digit Span Forward and Backward Test, Trail Making Test A and B, and Stroop Test were used to assess attention and working memory scores. The study was conducted from September to November 2012 in Jatinangor campus of the Faculty of Medicine, Universitas Padjadjaran and Clinical Pathology Laboratory of Dr. Hasan Sadikin General Hospital. The correlation analysis was performed using computer.Results: The correlation between hemoglobin level in males and attention on Trail Making Test A score was (r=0.144) (p=0.474). While the correlations with theTrail-Making Test B and Stroop Test scores were (r=0.332) (0.091), and (r=-0.320) (p=-0.103), respectively. For females, the correlations with the Trail Making Test A, Trail Making Test B, and Stroop Test scores were (r=0.121) (p=0.622), (r=-0.232) (p=0.338), and (r=0.137) (p=0.576), respectively. Meanwhile, the correlation between hemoglobin level and the working memory on Digit Symbol Test, Digit Span Forward Test, and Digit Span Backward Test scores for-males were (r=0.256) (p=0.197), (r=0.419) (p=0.029), and (r=0.113) (p=0.576), respectively. For-females, the same correlations were (r=0.412) (p=0.080), (r=-0.299) (p=0.213), and (r=-0.028) (p=0.909), respectively. The only test that showed statistically significant result was Digit Span Forward Test in males.Conclusions: There is evident of weak correlation between hemoglobin level, attention, and working memory scores in medical students who attended AMP Basic Program XXI. This may be due to the confounding factors affecting attention and working memory as well as a small sample size. [AMJ.2014;1(1):1–5]Keywords: attention score, hemoglobin level, working memory scoreKorelasi antara Kadar Hemoglobin, Pencapaian Skor Atensi, dan Skor Memori KerjaLatar Belakang: Fungsi atensi dan memori kerja memiliki peranan penting dalam aktivitas sehari-hari. Kadar hemoglobin yang normal dibutuhkan untuk mencapai fungsi atensi dan memori kerja yang optimal. Penelitian bertujuan untuk menganalisis korelasi antara kadar hemoglobin, skor atensi, dan memori kerja pada mahasiswa kedokteran yang mengikuti Pendidikan Dasar XXI Atlas Medical Pioneer (AMP).Metode: Studi potong lintang dengan jumlah sampel 46 orang, terdiri atas 27 orang laki-laki dan 19 orang perempuan. Perhitungan kadar hemoglobin menggunakan metode cyanmethemoglobin. Digit Symbol Test, Digit Span Forward dan Backward Test, Trail Making Test A dan B, dan Stroop Test digunakan untuk menilai skor atensi dan memori kerja. Penelitian dilaksanakan dari bulan September–November 2012 di Kampus Fakultas Kedokteran Universitas Padjadjaran Jatinangor dan Laboratorium Patologi Klinik Rumah Sakit Dr. Hasan Sadikin. Analisis korelasi menggunakan komputer.Hasil: Korelasi antara kadar hemoglobin laki-laki dengan skor atensi pada Trail Making Test A (r=0,144) (p=0,474), Trail Making Test B (r=0,332) (0,091), dan Stroop Test (r=-0,320) (p=-0,103). Pada perempuan hasil Trail Making Test A (r=0,121) (p=0,622), Trail Making Test B (r=-0,232) (p=0,338), dan Stroop Test (r=0,137) (p=0,576). Hasil korelasi antara kadar hemoglobin laki-laki dengan skor memori kerja pada Digit Symbol Test (r=0,256) (p=0,197), Digit Span Forward Test (r=0,419) (p=0,029), dan-Digit Span Backward Test (r=0,113) (p=0,576). Pada perempuan hasil Digit Symbol Test (r=0,412) (p=0,080), Digit Span Forward Test (r=-0,299) (p=0,213), dan Digit Span Backward Test (r=-0,028) (p=0,909). Tes yang memiliki nilai signifikan hanya Digit Span Forward Test pada laki-laki.Simpulan: Terdapat korelasi lemah antara kadar hemoglobin, atensi, dan memori kerja pada mahasiswa yang mengikuti Pendidikan Dasar XXI AMP. Hal ini dapat terjadi karena confounding factor yang dapat memengaruhi atensi dan memori kerja seseorang serta jumlah sampel penelitian yang sedikit.Kata kunci: kadar hemoglobin, skor atensi, skor memori kerja DOI: dx.doi.org/10.15850/amj.v1n1.28

The Trail Making test : a study of its ability to predict falls in the acute neurological in-patient population

Objective: To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls. Design: Prospective cohort study. Setting: Tertiary neurological and neurosurgical center. Subjects: In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care. Main Measures: Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function). Results: The principal outcome was a fall during the in-patient stay (n = 54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P < 0.001). Classical linear statistical modeling methods were then compared with more recent machine learning based strategies, for example, random forests, neural networks, support vector machines. The random forest was the best modeling strategy when utilizing just the Trail Making Test data (Wilcoxon signed-rank P < 0.001) with 68% (± 7.7) sensitivity, and 90% (± 2.3) specificity. Conclusion: This study identifies a simple yet powerful machine learning (Random Forest) based predictive model for an in-patient neurological population, utilizing a single neuropsychological test of cognitive function, the Trail Making test

Cognitive and Neuropsychological Assessments for Co-Occurring Opioid and Amphetamine-Type stimulant (COATS) Dependent Patients

Introduction: Several studies have shown that individuals with drug dependence have poorer cognitive functioning in the domain of executive functions. Studies investigating cognitive impairments in people with poly-drug use are limited. This study is designed to assess executive functions of patients with dual drug dependence (DDD) on opioid and (Amphetamine-Type Stimulants) ATS entering medication-assisted-treatment at Hospital Universiti Sains Malaysia. Methodology: A total of n=96 male respondents (n=56 patients, and n=40 control group) were recruited for this cross-sectional study. Six neuropsychological tests (Rey-Osterrieth Complex Figure, Trail Making Test, Raven’s Progressive Matrices, Digit Span Test, Digit Symbol Test, and Stroop Test) were administered. Findings: Results showed patients performed significantly worse in perceptual motor speed, and visual scanning measured by Trail Making Test Part A, cognitive flexibility measured by Trail Making Test Part B, mental processing speed measured by Digit Symbol Test, and response inhibition measured by Stroop Test, compared to those in the control group. Conclusion: Results suggests that perceptual motor speed, visual scanning, cognitive flexibility, mental processing speed, and response inhibition may be impaired in patients with dual drug dependence. Proper prevention and treatment interventions should consider addressing cognitive deficits for patients with dual dependenc

Improving validity of the trail making test with alphabet support

The Trail Making Test (TMT) is commonly used worldwide to evaluate cognitive decline and car driving ability. However, it has received critique for its dependence on the Latin alphabet and thus, the risk of misclassifying some participants. Alphabet support potentially increases test validity by avoiding misclassification of executive dysfunction in participants with dyslexia and those with insufficient automatization of the Latin alphabet. However, Alphabet support might render the test less sensitive to set-shifting, thus compromising the validity of the test. This study compares two versions of the TMT: with and without alphabet support. Methods: We compared the TMT-A, TMT-B, and TMT-B:A ratios in two independent normative samples with (n = 220) and without (n = 64) alphabet support using multiple regression analysis adjusted for age and education. The sample comprised Scandinavians aged 70–84 years. Alphabet support was included by adding the Latin alphabet A–L on top of the page on the TMT-B. We hypothesized that alphabet support would not change the TMT-B:A ratio. Results: After adjusting for age and years of education, there were no significant differences between the two samples in the TMT-A, TMT-B, or the ratio score (TMT-B:A). Conclusion: Our results suggest that the inclusion of alphabet support does not alter TMT’s ability to measure set-shifting in a sample of older Scandinavian adults

The Interaction of Type II Diabetes and Gonadal Steroids on Cognition in Middle-Aged Women

Diabetes is not commonly thought to be a women’s health issue, however, it appears to have an association with increased cognitive impairment in women during menopause as compared to women without diabetes (Espeland et al., 2011). The present study investigated the effects of type II diabetes and menopause on cognition in women between the ages of 46 and 55 years. To assess cognition, participants performed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph 1998), Letter Number Sequencing Test (Wechsler, 1997), Trail Making Test (Delis, 2001), Verbal Fluency Test (Delis, 2001), Wechsler Test of Adult Reading (Wechsler, 2001), and the Buschke Selective Reminding and Delayed Recall Tests (Buschke, 1974). Participants also answered questionnaires on mood, diabetes, and hormone and reproductive history. No premenopausal women or perimenopausal women with diabetes participated. Women were divided into the following groups to examine the interactions of diabetes and hormones on cognition: perimenopausal women without diabetes, postmenopausal women with diabetes, and postmenopausal women without diabetes. It was predicted that women with diabetes would score lower on all tests, with an emphasis on difficulties with executive function and memory. Postmenopausal women with diabetes showed lower scores in working memory, executive control, visual attention, task switching, and episodic memory as seen in data from the Letter Number Sequencing Test, Verbal Fluency Test, Trail Making Test, and Buschke Selective Reminding and Delayed Recall Tests, respectively. Perimenopausal women without diabetes showed lower scores than postmenopausal women with and without diabetes on verbal memory and executive control. The sample of eight women was small, though there were indications of differences between groups highlighting the need for further research

The relationship between age and performance on the Trail Making test in a Chilean population

According to literature, the Trail Making Test A-B is one of the most frequently used tests in the US. The TMT test has been adapted in different countries including France, Italy, Israel, Spain and Brazil. The relationship between TMT and age has also been studied in Chinese, Arabian, and Korean speakers. In South America as well as Chile, the Bender Gestalt continues to be the most frequently used “neuropsychological” test instrument. In order to ameliorate this situation, studies need to be completed that provide evidence of sensibility, adaptability, and normative information about commonly used tests, such as the Trail Making Test in Latino countries. The Trail Making Test, with instructions in Spanish (and available from the authors in written or video form), was administered by three independently licensed health professionals as part of their routine clinical activities. Subjects were 165 Chilean adults with ages ranging from 21 to 82 years and at least 12 years of education. Results corroborated the previous findings from other countries in which age was positively related to time in completing Trails A and B. Variability of performance in parts A and B 7of TMT was significantly accounted by age in 36% and 27% respectively. As a consequence, TMT appears to be a sensitive test to normal cognitive decline in Chilean Spanish speakers