About

Trail Making Test in Qolty allows you to do neuropsychometric testing in the home or in the laboratory with automated data collection and trail path data for easy collection. Trail making tests are a popular neuropsychological assessments with two key variations. Trail Making A requires the participant to draw lines between numbers in circled numbers to create a sequence, while Trail Making B requires alternations of 1-A-2-B, etc as rapidly as possible.

The Qolty Trail Making Test creates these conditions, marks trails created by the user, and allows you to set limits and create countdown on the screen to induce pressure on the patient at your option.

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Introduction

Measuring cognitive functioning is one of the main aspects of psychological research. However, neuropsychological tests may be hard to administer, and research staff may need special training to interpret results. To help research, the Trail Making Test is one of the few short and undemanding to use neuropsychological instruments (Bowie & Harvey, 2006).

The Qolty Trail Making Test (TMT) is a great indicator for various cognitive domains, such as visual search skills, motor speed skills, sequencing, abstraction, mental flexibility, and even overall intelligence. TMT is also a crucial part of any larger battery of psychological tests, which are used to detect neurological impairments and diseases.

The TMT has been introduced by Partington (Parkington & Leiter, 1949), and included in the Army Individual Test Battery. Note that the most popular version of the TMT has been developed from the Taylor number series test, which includes numbers from 1 to 50.

Usually, the TMT consists of two conditions. In condition A, the subject must draw lines between numbers to create a numerical sequence (1-2-3, etc.). In condition B, the subject must draw lines between circled numbers and letters (1-A-2-B-3-C, etc.).

With its good psychometric properties, easy procedures, and insightful findings, the Trail Making Test is among the best neuropsychological tools to detect patients’ cognitive functioning.

Methods

As mentioned above, the TMT consists of two conditions. Condition A requires from participants to join circled numbers in a numerical sequence (1-2-3, etc.), while condition B – to draw lines between circled numbers and letters in a sequence (1-A-2-B-3-C, etc.). The items are placed in a semi-random order to avoid overlapping of lines and low readability. Training is provided, and participants can ask for clarifications. The main variable of research interest is the time required to complete the test. Note that 300 seconds is accepted as a cut-off level, after which the test can be discontinued. In traditional tests, errors are not included in the score because usually, the examiner stops the subject and sends him or her to the last correct response. The TMT takes between 5 and 10 minutes to complete.

It’s interesting to mention that the Connections version of the TMT is one of the most popular variations of the test. This form was validated after the assessment of 3665 adults (18-98 years of age). Age, gender, education, and overall health were considered. The test consists of several different conditions, and each condition involves different sequences. Unlike the traditional TMT, in the Connections version of the test, participants were given 20 seconds for each condition, and errors weren’t pointed out.

Statistics revealed good consistency and validity of all TMT tests.

Applications

The TMT is a widely used tool in neuropsychological research. The test is used to detect various cognitive abilities (Salthouse, 2011):

  •             Visual search
  •             Attention
  •             Scanning
  •             Sequencing
  •             Shifting
  •             Speed
  •             Abstraction
  •             Ability to maintain two sequences simultaneously
  •             Flexibility
  •             Working memory
  •             Intelligence

In addition, TMT can be used as an indicator of various conditions and impairments (Bowie & Harvey, 2006):

  •             Sensitivity of injury severity
  •             Functional recovery
  •             Alzheimer

Note that it’s been proven that subjects who’ve made more than one error had frontal lesions. Moderate impairments on both conditions, with a focus on condition B, have been found in bipolar patients, including depressed bipolar patients, while moderate to severe impairment on condition A – in schizophrenic patients.

The TMT can be used as a tool for driving ability, including Parkinson patients.

Findings show that TMT can be sensitive to normal age-related declines in speed and cognitive functioning, which does not indicate a disease.

Comparisons

A wide range of versions of TMT, with great psychometric properties, has been created. As mentioned above, the Connections version is one of the most popular forms used in research (Salthouse, 2011).

Alternative version for children aged 9-14, of 15 stimuli for each condition, exists. There’s also a Color Trails Test for people suffering from language difficulties. In addition, there’s an oral version of the test, which can be used for people with a disability.

Translations

Alternate forms of TMT have been created because condition B may become an obstacle for non-native English speakers. Therefore, various translations, such as in Spanish and Hindi, have been developed. Note that the Color Trails Test can also be applied for non-English speakers.

Results & Data Analysis

Alternate forms of TMT have been created because condition B may become an obstacle for non-native English speakers. Therefore, various translations, such as in Spanish and Hindi, have been developed. Note that the Color Trails Test can also be applied for non-English speakers.

As mentioned above, the TMT may indicate a neuropsychological condition. For instance, moderate to severe impairment on condition A has been observed in schizophrenic patients (Bowie & Harvey, 2006). On top of that, the TMT shows one’s processing speed, which is a predictor of vocational potential.

Last but not the least, strong age relations exist. It’s been observed that the correlations with age for condition A were -.61, while for B -.48 (Salthouse, 2011). Education and individual differences also affect TMT scores.

Cosmin

Internal Consistency

TMTs have great psychometric properties. All forms show good internal consistency. For instance, the Comprehensive Trail Making Test shows Alpha coefficients for internal consistency above 0.70 for all its five subtests (Reynolds, 2002).

Test-Retest Reliability

Reliability is also high. For the Comprehensive Trail Making Test, the test-retest scores range from 0.70 to 0.78, and the inter-rater reliabilities from 0.96 to 0.98.

With its multiple conditions, the Connections form of the test gives clear scores on reliability. It gives the chance to include different variables, in other words – different cognitive abilities (all with median Alpha 0.84, and validity factors over .65) (Salthouse, 2011).

Validity

TMTs show good validity.

Strengths and Limitations

The TMT is one of the most popular tests in the field of neuropsychology. The test forms are easy to administer, and the test takes less than 10 minutes to complete. One of the main advantages is the fact that TMTs are relatively simple, with many adaptations and translations.

Interestingly enough, the simplicity of the test contrasts with its wide usage. The test can be used to measure numerous constructs, such as one’s processing speed, working memory, flexibility, overall health, intelligence, and abstraction.

However, one of the main limitations of TMT is that most of the studies use weak statistical procedures, small samples, and a limited set of constructs (Salthouse, 2011). To resolve these issues, researchers need to enrich their samples and include various correlational analyses of observed variables and latent constructs at the same time.

Nevertheless, TMTs are among the most popular and effective tools in neuropsychology.

Summary & Key Points

  • The TMT measures people’s cognitive functioning and constructs, such as processing speed, visual search, attention, overall intelligence, and health.
  • The test can be used as an indicator of brain injuries and neuropsychological diseases.
  • The TMT was introduced in 1938 by Partington (Partington & Leiter, 1949).
  • Usually, the test consists of two conditions: condition A – to connect circled numbers in a sequence (1-2-3), and condition B – to draw lines between numbers and letters (1-A-2-B-3-C, etc.)
  • There are various versions of the test, such as the Color form, which can be used for non-native English speakers or patients with a disability.
  • The Connections version of the TMT assessment has been validated after the assessment of 3665 adults (Salthouse, 2011).
  • TMTs show great psychometric properties. For instance, for the Comprehensive Trail Making Test, the test-retest scores range from 0.70 to 0.78, and the inter-rater reliabilities from 0.96 to 0.98.
    • Overall results show that individual differences, such as age, affect performance and results.

References

Bowie, C., & Harvey, P. (2006). Administration and interpretation of the Trail Making Test.  Nature Protocols.

Parkington, J. E., & Leiter, R. G. (1949). Partington’s pathway test. The Psychological Service Center Bulletin, 1, 9−20.

Reynolds, C. R. (2002). Comprehensive Trail Making Test: Examiner’s Manual. Austin, Texas: PRO-E.

Salthouse, T. (2011). What cognitive abilities are involved in trail-making performance? Intelligence, 39, 222-232.