The Trails Making Test. Does a Single Trial Reflect Performance Capability?

Abstract

Information processing speed (Reaction time, RT) to a single administration of the Trails A and Trails B components of the Trail Making Test (TMT) is used in the assessment of brain and behavioural functional integrity across the lifespan in both clinical and research contexts. Although the clinical utility of such single trial-related and thus rapidly gained results, is recognised, it is possible that its administration as a single trial only, precludes its ability to provide a more in-depth and thus relevant representation of functional integrity per se, and it does not allow a range of ability to be examined. Because outcome from a single trial can be susceptible to the influence of spurious and extraneous effects we examined how, within a single testing session, RT varied with respect to the administration of four trials of both Trails A and B of the TMT, and how the effects may be associated with anxiety and self-consciousness. We examined how RT varied with respect to the administration of four trials of the Trail making test and compared the performance over each of these trials with that of the first trial. Between the third and fourth trial, questionnaires on anxiety and self-consciousness were administered. This paradigm was tested with fifty five younger adults (age range eighteen - thirty years). Our results indicated that repeating both Trails A and B of the TMT, administering the tests over four trials, revealed a significantly disproportionately slowed information processing speed (RT) to the first compared to consecutive trials, with the effect greatest for the more difficult or resource-demanding Trails B test. There were no significant correlations between change in information processing speed and anxiety or self-consciousness. The first of the four trials represents the only trial typically performed in the clinical application of this test. Our finding that the time to complete one single trial can be significantly slower compared to the response to additional trials, indicates that an individuals’ information processing speed can appear much slower than their actual ability. Such findings can be expected to be of particular relevance to the future use of this test clinically when an individual’s performance is measured and judged with respect to possible diagnosis, and in future research when group-level TMT performance is compared between younger and older adults for example.