Color Trails Test: A New Set of Data on Cognitive Flexibility and Processing Speed in Schizophrenia.

Ernest Tyburski,Jerzy Samochowiec,Ewa Karabanowicz,Justyna Pełka-Wysiecka,Leszek Sagan,Agnieszka Samochowiec,Monika Mak,Zofia Lebiecka

doi:10.3389/fpsyt.2020.00521

Abstract

BackgroundAlthough schizophrenia patients have been reported to manifest deficits in cognitive flexibility and lower processing speed (measured with i.a., the Color Trails Test, CTT), there still remain a few matters that require further investigation. We have therefore formulated three research aims: 1) to examine the factor structure of CTT in schizophrenia patients and healthy controls, 2) to compare different CTT performance measures in the two groups, 3) to investigate the relationship between these measures and selected psychopathological symptoms in the patient group.MethodsSixty-seven patients with paranoid schizophrenia and 67 healthy controls, matched for gender, age, number of years of education, and overall cognitive functioning underwent assessment of cognitive flexibility and processing speed with the CTT.ResultsFactor analysis of CTT variables based on the principal component method revealed a four-factor solution in both groups. Compared with healthy controls, the patients performed poorer on CTT 1 time, CTT 2 time, 2-1 difference, prompts in CTT 2, and had higher regression factor scores for Factor 1 (reflecting the slower speed of perceptual tracking). Furthermore, significant links were found between some CTT measures, and negative and disorganization symptoms.ConclusionsSchizophrenia patients exhibit problems with speed of perceptual tracking and executive processes dependent on processing speed. Our results may be useful for the development of neuropsychological diagnostic methods for schizophrenia patients. It seems that, compared to other CTT indices, CTT 1 time, CTT 2 time, and 2-1 difference are more appropriate measures of cognitive performance in schizophrenia patients.

Highlights

Cognitive flexibility is defined as the ability to flexibly transition between at least two processes or tasks [i.e., alternating attention between two goals [1]]
Sixty-seven inpatients of three psychiatric wards were diagnosed with paranoid schizophrenia according to ICD-10 diagnostic criteria [World Health Organization (WHO), [31]] by three licensed psychiatrists
The groups did not differ in terms of gender, age, years of education or global cognitive function (MMSE score, see Table 1)

Summary

Introduction

Cognitive flexibility is defined as the ability to flexibly transition between at least two processes or tasks [i.e., alternating attention between two goals [1]]. As a consequence of structural and functional abnormalities in the brain, both processes may be severely disturbed in schizophrenia [4, 5] These processes can be measured with two corresponding neuropsychological tests—the Color Trails Test [CTT, [6]] and the Trail Making Test [TMT, [7]]. Introduced in the 1990s, the CTT was primarily created to meet the demand for a cultureneutral equivalent to the TMT Even though their scores are comparable in most tested populations, CTT’s lack of numbers and letters and use of colors for responses seems to place people from cultures which don’t use the Latin alphabet, illiterate persons, or those experiencing language difficulties at an advantage [6]. We have formulated three research aims: 1) to examine the factor structure of CTT in schizophrenia patients and healthy controls, 2) to compare different CTT performance measures in the two groups, 3) to investigate the relationship between these measures and selected psychopathological symptoms in the patient group

Methods

Results

Discussion

Conclusion