Abstract
The trail-making test (TMT) is a popular neuropsychological test, which is used extensively to measure cognitive impairment associated with neurodegenerative disorders in older adults. Behavioural performance on the TMT has been investigated in older populations, but there is limited research on task-related brain activity in older adults. The current study administered a naturalistic version of the TMT to a healthy older-aged population in an MRI environment using a novel, MRI-compatible tablet. Functional MRI was conducted during task completion, allowing characterization of the brain activity associated with the TMT. Performance on the TMT was evaluated using number of errors and seconds per completion of each link. Results are reported for 36 cognitively healthy older adults between the ages of 52 and 85. Task-related activation was observed in extensive regions of the bilateral frontal, parietal, temporal and occipital lobes as well as key motor areas. Increased age was associated with reduced brain activity and worse task performance. Specifically, older age was correlated with decreased task-related activity in the bilateral occipital, temporal and parietal lobes. These results suggest that healthy older aging significantly affects brain function during the TMT, which consequently may result in performance decrements. The current study reveals the brain activation patterns underlying TMT performance in a healthy older aging population, which functions as an important, clinically-relevant control to compare to pathological aging in future investigations.
Highlights
The trail-making test (TMT) is a pen-and-paper neuropsychological test that is used extensively in research and clinical settings
Participants performed on neuropsychological testing with small interquartile ranges for the Montreal Cognitive Assessment (MoCA) and TMT-A, but with more variability in TMT-B and TMT-(B-A) performance
Using novel tablet technology and functional magnetic resonance imaging (fMRI), this was the first study to investigate neural areas recruited during a realistic version of the TMT in an older adult population (50+ years-old)
Summary
The trail-making test (TMT) is a pen-and-paper neuropsychological test that is used extensively in research and clinical settings. The TMT consists of two different conditions: TMT-A and TMT-B, each to be performed as quickly as possible while maintaining accuracy, and without removing the tip of the pen from the page[1]. For TMT-A, individuals must connect 25 randomly distributed encircled numbers from 1 to 25 in ascending order For TMT-B, individuals must connect numbers and letters in alternating, ascending order FMRI of the trail-making test data collection and analysis, decision to publish, or preparation of the manuscript
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