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

David L. Woods · John M. Wyma · Timothy J. Herron · E. William Yund

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Psychological Testing and Assessment Cognitive Functions and Memory Historical and Modern Theater Studies

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.

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References

1993The Halstead-Reitan neuropsychological test battery: Theory and clinical interpretation 1995Neuropsychological assessment.2003Trail Making Test A and B: Normative data stratified by age and education 2001Delis-Kaplan Executive Function System 2006TEST REVIEW: Dean C. Delis, Edith Kaplan & Joel H. Kramer, Delis Kaplan Executive Function System (D-KEFS), The Psychological Corporation, San Antonio, TX, 2001. $415.00 (complete kit)2006Administration and interpretation of the Trail Making Test 1996Trail making test: normative values from 287 normal adult controls 2010Improving digit span assessment of short-term verbal memory

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2015Trail Making Test: Normative data for the Latin American Spanish speaking adult population 2020Marrying Past and Present Neuropsychology: Is the Future of the Process-Based Approach Technology-Based?2019The Importance of Demographically Adjusted Cutoffs: Age and Education Bias in Raw Score Cutoffs Within the Trail Making Test 2019Sequential Information Processing: The "Elevated First Response Effect" Can Contribute to Exaggerated Intra-Individual Variability in Older Adults.

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