Alternative Type of the Trail Making Test in Nonnative English-Speakers: The Trail Making Test-Black &amp; White

Hyun Jung Kim,Min Jae Baek,Sangyun Kim,Wang Zhan

doi:10.1371/journal.pone.0089078

Abstract

ObjectiveThe Trail Making Test (TMT) has its limitations when applied to Eastern cultures due to its reliance on the alphabet. We looked for an alternative tool that is reliable and distinguishable like the TMT and devised the Trail Making Test Black & White (TMT-B&W) as a new variant. This study identifies the applicability of the TMT-B&W as a useful neuropsychological tool and determines whether the TMT-B&W could play an equivalent role as the TMT.MethodsThe TMT-B&W uses numbers encircled by black or white circles as stimuli, instead of using the alphabet. A total of 138 participants were including containing groups of 31 cognitively normal controls (NC), 55 mild cognitive impairment (MCI), and 52 people with Alzheimer’s disease (AD). Along with the TMT-B&W, the TMT and other neuropsychological tests were administered to all subjects.ResultsA considerably low dropout rate for TMT B&W demonstrates that all participants were more willingly engaged in the TMT B&W than the TMT. In particular, subjects with cognitive impairments or lower levels of education performed better on the TMT-B&W than the TMT. The difference in time-to-completion of the TMT-B&W was significant according to the level of cognitive impairment. The TMT-B&W revealed a high correlation with the TMT and frontal lobe function test.ConclusionThe TMT-B&W is as reliable and effective as the TMT. It is worth developing a new variant of the TMT.

Highlights

The Trail Making Test (TMT) [1] is a widely used neuropsychological test for identifying mild cognitive impairment and mild dementia [2,3,4]
The TMT-A is primarily a test of visual attention skills. It includes perceptual tracking and simple sequencing tasks, whereas the TMT-B, with the additional tasks associated with alternating the sequence pattern, is a test which is used as an index of the frontal executive function [9,10,11]
We developed the Trail Making Test-Black & White (TMT-B&W)

Summary

Introduction

The Trail Making Test (TMT) [1] is a widely used neuropsychological test for identifying mild cognitive impairment and mild dementia [2,3,4]. The TMT measures psychomotor speed, attention, sequencing, mental flexibility, and visual scanning [5,6,7]. TMT-A requires an individual to connect randomly distributed numbers in an ascending order, while on the other hand TMT-B, consists of both numbers and letters, requiring participants to connect numbers and letters alternatively (See Figure 1–a and b). The TMT-A is primarily a test of visual attention skills. It includes perceptual tracking and simple sequencing tasks, whereas the TMT-B, with the additional tasks associated with alternating the sequence pattern, is a test which is used as an index of the frontal executive function [9,10,11]. Part B is thought to be a more sensitive measure for cerebral dysfunction than Part A [12]

Methods

Results

Conclusion