Comprehensive Trail Making Test Research Articles

A Comparative Assessment of Comprehensive Trail Making Test and Wisconsin Card Sorting Test Among Alcohol Dependence Patients

Introduction: Alcohol, when used frequently, accelerates the ageing process, causes brain damage, and results in a reduced volume of grey and white matter, leading to frontal lobe abnormalities. The neurotoxicity resulting from alcohol overuse affects the higher functions of the brain. This study aimed to evaluate the effect of alcohol dependence on the executive functioning of the brain. Methods: This study was carried out as a case-control study among 60 patients with alcohol dependence and 60 controls. Assessment of executive function was carried out using the Comprehensive trail-making test (CTMT) and the Wisconsin card sorting test (WCST). Comparison between the alcohol dependence group and normal healthy controls were calculated using the Mann-Whitney U test as data followed a non-parametric distribution. Results: The mean age of the participants among the cases and controls was 38.3±5.5 years and 37.8±5.4 years, respectively. The results showed a significant difference in both WCST and CTMT between cases and controls (p<0.05). Conclusion: This study concludes that there was an impaired performance in executive functions in alcohol- dependence patients in early abstinence compared to normal controls showing frontal lobe impairment in alcohol-dependence patients.

Utility of the Comprehensive Trail Making Test in the Assessment of Mild Cognitive Impairment in Older Patients.

The purpose of this study is to determine the usefulness of the CTMT (Comprehensive Trail Making Test) in diagnosing mild cognitive impairment in older patients. The test is used to assess executive functions, of which impairment is already observed in the early stages of the neurodegenerative process. The study includes 98 patients of a geriatric ward assigned to 2 groups of 49 patients each: patients diagnosed with a mild cognitive impairment and patients without a cognitive impairment, constituting the control group (group K). A set of screening tests was used in the initial study: the MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment), and CDT (Clock Drawing Test), GDS (Geriatric Depression Scale). The second study included the performance of the CTMT; the performance indicator was the time of performance. Statistically significant differences are obtained between patients with mild cognitive impairments and those in cognitive normality in the performance of the CTMT test (p < 0.01). Patients with MCIs took longer to complete all trails of the test. To identify cognitive impairment, cutoff points were proposed for the CTMT total score and the other test trails. The CTMT overall score and CTMT 5 scored the highest AUCs (CTMT overall score = 0.77, CTMT Trail 5 = 0.80). The Comprehensive Trail Making Test may be useful in diagnosing mild cognitive impairment as a complementary screening tool.

Including cognitive assessments with functional testing predicts capabilities relevant to everyday walking in older adults

BackgroundDual-task (DT) testing reflects real-world walking demands in older adults but is not always feasible to perform in clinic. Whether clinical measures that predict single-task (ST) performance also predict DT performance or dual-task effects (DTEs) has not been fully explored. Research questionWhat are the relationships between cognitive performance, functional mobility, and self-reported physical activity and balance confidence and ST and DT Gait Speed and Cognitive Reaction Time, as well as DTEs on Gait Speed (DTEGS) and Cognitive Reaction Time (DTERT), in older adults? MethodsSixty-two older adults (71.5 ± 7.1 years, 17 males) completed cognitive performance, functional mobility, and self-report physical activity and balance confidence assessments. Three 1-min trials were performed: 1) ST Cognition (clock task), 2) ST Gait and 3) DT Cognition + Gait, with Cognitive Reaction Time (recorded during clock task performance via DirectRT) and Gait Speed (measured during walking trial via APDM system) recorded, and DTEGS and DTERT calculated, as the cognitive and gait outcomes. Six multivariate regressions were conducted to test whether cognitive performance, functional mobility, and self-report assessments predicted Gait Speed and Cognitive Reaction Time in ST and DT conditions and DTEs. ResultsThe Comprehensive Trail Making Test (CTMT) predicted Reaction Time in ST cognitive (β = − 0.525, p = .003) and DT (β = − 0.510, p = .006) trials. The Physical Activity Scale for the Elderly (PASE) predicted DTERT (β = − 0.397, p = .008). The 10-Meter Walk Test (10MWT) predicted Gait Speed in ST gait (β = 0.692, p < .001) and DT (β = 0.715, p < .001) trials. The Four Square Step Test (FSST) predicted ST Gait Speed (β = − 0.233, p = .034). The Montreal Cognitive Assessment (MoCA) (β = 0.293, p = .027), 10MWT (β = 0.322, p = .046), and the FSST (β = 0.378, p = .019) predicted DTEGS. SignificanceThe 10MWT, CTMT, and MoCA can be easily implemented in the clinic and may be good choices to assess cognitive and functional abilities necessary for ambulation in older adults.

Differences in executive functioning between adults with ADHD and those diagnosed with other psychiatric diagnoses: Utility of the CTMT and the WAIS-IV

In this study, the utility of the Comprehensive Trail Making Test (CTMT) and WAIS-IV working memory (WMI) and processing speed (PSI) indices in assessment of ADHD were examined. Using retrospective analysis of data from two private practices, patients were classified as having ADHD, having another psychiatric disorder, or having comorbid ADHD and other psychiatric disorder. Results indicated that significant differences existed in performance across the three groups [F(6, 246) = 3.38, p = .003; Pillai’s Trace = 0.152, partial η 2 = 0.076] on CTMT scores (p < .05), WMI scores (p ≤ .001) and PSI scores (p < .05). Logistic regression analyses indicated WMI and CTMT trail 5 scores were individually useful indicators in identifying the presence of ADHD. Analysis also indicated minimal increase in correct classification of presence or absence of ADHD through combining CTMT, WMI, and PSI scores. Clinical implications for neuropsychological assessment and differential diagnosis of ADHD are discussed.

The effects of polyphenols-rich tropical fruit juice on cognitive function and metabolomics profile – a randomized controlled trial in middle-aged women

ABSTRACT Objectives: Polyphenols, particularly anthocyanins, have received attention in improving health issues during old age, including decline in cognitive function and other health parameters. We aimed to determine the effects of polyphenols-rich tropical fruit TP 3-in-1™ juice towards improving cognitive function, oxidative stress and metabolomics profiles among middle-aged women. Methods: This clinical trial involved 31 subjects with signs of poor cognitive function, as assessed using the Rey Auditory Verbal Learning Test (RAVLT). They were randomized to receive either TP 3-in-1™ juice (n = 16) or placebo (n = 15). Study subjects consumed 500 ml of beverages for three times per day, three days per week, for a period of ten weeks. Juice supplementation provided 9135 mg GAE of total phenolic content and 194.1 mg cyanidin-3-glucoside of total anthocyanin monomer. Results: There was a significant interaction effects on RAVLT immediate recall (p < 0.05) and Comprehensive Trail Making Test (CTMT) Trail 4 (p < 0.05). Metabolomics analysis showed the presence of metabolites related to polyphenols intake and cognitive functions with the intervention group showed increased urinary excretion of thyroxine and 3-methyladenine. Thyroxine and 3-methyladenine give stability to human transthyretin (TTR) and activate autophagy, respectively, which are associated with the pathogenesis of Alzheimer’s disease. Conclusion: The result shows the potential of TP 3-in-1™ juice which is rich in anthocyanins in improving cognitive function, particularly learning, memory, processing speed, sequencing, mental flexibility and visual-motor skills domains, among middle-aged women.

Relationship between Traditional Malaysian Vegetables (Ulam) Intake and Cognitive Status Among Middle-aged Adults from Low Cost Residential Areas

Ulam is fresh traditional Malaysian vegetables which normally consumed in raw form or after a short blanching process. It contains high antioxidants and polyphenols. However, there is limited study about the relationship between ulam consumption and cognitive status. Thus, a cross sectional study was conducted to determine the relation with cognitive function among 132 middle-aged Malays adults (45-59 years old), recruited by convenient sampling from low income residences in Klang Valley. Respondents were interviewed to obtain data on sociodemography, dietary intake and total ulam intake and also measured for anthropometric parameters at respective community centres. Cognitive status was measured using Digit Span (attention and working memory), Rey auditory verbal learning test (RAVLT) (verbal memory) and comprehensive trail making test (CTMT) (cognitive flexibility). The average ulam intake by the respondents was 15.1 ± 8.2g/day and the top five highest consumed ulam were petai (68.1%), pucuk paku (62.9%), ulam raja (56.8%), pegaga (54.6%) and kesum (44.7%).There was a significant correlation between ulam intake with Digit Span (r = 0.265, p = 0.006), total immediate recall of RAVLT (r = 0.427, p < 0.001) and CTMT (r = 0.257, p = 0.007). Analysis of multiple regression indicated that total ulam intake was a significant predictor for Digit Span (R2 = 0.152, p < 0.05), RAVLT (R2 = 0.335, p = 0.001) and CTMT (R2 = 0.310, p < 0.001). In conclusion, this study showed that ulam has the potential to protect against cognitive decline, however, randomized control trials should be conducted to determine the efficacy of the ulam as neuroprotective agent.

Cognitive Effects of Combined Amisulpride and Quetiapine Treatment in Patients With Refractory Schizophrenia: A Naturalistic, Prospective Study.

Regarding the treatment of patients with resistant schizophrenia, different options exit, although they are supported by limited evidence. In this study, antipsychotic polypharmacy, comprising 1200 mg of amisulpride and 600 mg of quetiapine, was used. Clinical change evaluation was performed using neurocognitive evaluations. The use of amisulpride and quetiapine will imply a clinical improvement in patients affected by schizophrenia, which will be specially reflected in a cognitive improvement. Naturalistic and prospective study. Twenty-six patients were applied and assessed by a battery of neurocognitive evaluations since the pretreatment baseline until 6-month treatment. The patients had no biological response to medication, high social maladjustment, and a long clinical history of the disease. Kane and Brenner criteria for treatment-resistant schizophrenia were applied to choose the subjects. The cognitive improvement will imply a significant betterment, from the pretreatment baseline until 6-month treatment, in the following cognitive tests: Stroop Test, WAIS Coding Subtest, and Comprehensive Trail Making Test (CTMT). An improvement in the Calgary Depression Scale, Simpson-Angus Scale, and Visual Analogue Scale (EVA) will also be observed. This scales were been used during the baseline, 3 months after, and then, 6 months. Subjects, after 6-month treatment with amisulpride and quetiapine, did show statistically significant differences in the assessed areas: WAIS Coding Subtest (P < 0.001), CTMT A and B (CTMT A P < 0.034; CTMT B P < 0.000), and Stroop Tests: Word (P < 0.001), Word-Color (P < 0.007), and Interference (P < 0.039). Furthermore, they showed a statistically significant difference in the Calgary Depression Scale (P < 0.002), Simpson-Angus Scale (P < 0.019), and EVA (P < 0.001). The results of this report show a cognitive and clinical improvement in refractory patients after the administration of amisulpride and quetiapine.

Executive Function Profiles in Pediatric Traumatic Brain Injury

ABSTRACTTraumatic brain injury (TBI) results in heterogeneous patterns of neuropsychological impairment. This study investigated heterogeneity in executive function (EF) using the Comprehensive Trail Making Test (CTMT) to evaluate 121 children and adolescents with TBI and 121 matched normal controls. The TBI group performed approximately two standard deviations below controls. Cluster analyses indicated that a three-cluster solution best classified the TBI group and a four-cluster solution best classified controls. Greater impairment in EF was associated with lower intellectual, achievement, and neuropsychological test performance in the TBI group. Results suggest that EF deficits reflected in CTMT performance may be useful for classifying severity of TBI.

A targeted neuropsychological examination of children with a history of sport-related concussion

ABSTRACTExperimental research suggests that sport-related concussion can lead to persistent alterations in children’s neurophysiology and cognition. However, the search for neuropsychological tests with a similar ability to detect long-term deficits continues. Primary Objective: The current study assessed whether a target battery of neuropsychological measures of higher cognition and academic achievement would detect lingering deficits in children 2 years after injury. Research design: Cross-sectional. Methods and Procedure: A total of 32 pre-adolescent children (16 concussion history, 16 control) completed a targeted battery of neuropsychological and academic tests. Main Outcomes and Results: Children with a history of concussion exhibited selective deficits during the Raven’s Coloured Progressive Matrices, Comprehensive Trail-Making Test, and the mathematics sub-section of the WRAT-3. Deficit magnitude was significantly related to age at injury, but not time since injury. Conclusions: The current results suggest that neuropsychological measures of higher cognition and academic achievement may be sensitive to lingering deficits, and that children injured earlier in life may exhibit worse neuropsychological and academic performance.

Apolipoprotein Eε4: A Biomarker for Executive Dysfunction among Parkinson's Disease Patients with Mild Cognitive Impairment.

Background: Cognitive impairment is prevalent in Parkinson's disease (PD), affecting 15–20% of patients at diagnosis. α-synuclein expression and genetic polymorphisms of Apolipoprotein E (ApoE) have been associated with the presence of cognitive impairment in PD although data have been inconsistent.Objectives: To determine the prevalence of cognitive impairment in patients with PD using Montreal Cognitive Assessment (MoCA), Comprehensive Trail Making Test (CTMT) and Parkinson's disease-cognitive rating scale (PDCRS), and its association with plasma α-synuclein and ApoE genetic polymorphisms.Methods: This was across-sectional study involving 46 PD patients. Patients were evaluated using Montreal cognitive assessment test (MoCA), and detailed neuropsychological tests. The Parkinson's disease cognitive rating scale (PDCRS) was used for cognitive function and comprehensive trail making test (CTMT) for executive function. Blood was drawn for plasma α-synuclein measurements and ApoE genetic analysis. ApoE polymorphism was detected using MutaGELAPoE from ImmunDiagnostik. Plasma α-synuclein was detected using the ELISA Technique (USCN Life Science Inc.) according to the standard protocol.Results: Based on MoCA, 26 (56.5%) patients had mild cognitive impairment (PD-MCI) and 20 (43.5%) had normal cognition (PD-NC). Based on the PDCRS, 18 (39.1%) had normal cognition (PDCRS-NC), 17 (37%) had mild cognitive impairment (PDCRS-MCI), and 11 (23.9%) had dementia (PDCRS-PDD). In the PDCRS-MCI group, 5 (25%) patients were from PD-NC group and all PDCRS-PDD patients were from PD-MCI group. CTMT scores were significantly different between patients with MCI and normal cognition on MoCA (p = 0.003). Twenty one patients (72.4%) with executive dysfunction were from the PD-MCI group; 17 (77.3%) with severe executive dysfunction and 4 (57.1%) had mild to moderate executive dysfunction. There were no differences in the plasma α-synuclein concentration between the presence or types of cognitive impairment based on MoCA, PDCRS, and CTMT. TheApoEe4 allele carrier frequency was significantly higher in patients with executive dysfunction (p = 0.014).Conclusion: MCI was prevalent in our PD population. PDCRS appeared to be more discriminatory in detecting MCI and PDD than MoCA. Plasma α-synuclein level was not associated with presence nor type of cognitive impairment, but the ApoEe4 allele carrier status was significantly associated with executive dysfunction in PD.

The Contribution of Cognitive Factors to Individual Differences in Understanding Noise-Vocoded Speech in Young and Older Adults.

Noise-vocoded speech is commonly used to simulate the sensation after cochlear implantation as it consists of spectrally degraded speech. High individual variability exists in learning to understand both noise-vocoded speech and speech perceived through a cochlear implant (CI). This variability is partly ascribed to differing cognitive abilities like working memory, verbal skills or attention. Although clinically highly relevant, up to now, no consensus has been achieved about which cognitive factors exactly predict the intelligibility of speech in noise-vocoded situations in healthy subjects or in patients after cochlear implantation. We aimed to establish a test battery that can be used to predict speech understanding in patients prior to receiving a CI. Young and old healthy listeners completed a noise-vocoded speech test in addition to cognitive tests tapping on verbal memory, working memory, lexicon and retrieval skills as well as cognitive flexibility and attention. Partial-least-squares analysis revealed that six variables were important to significantly predict vocoded-speech performance. These were the ability to perceive visually degraded speech tested by the Text Reception Threshold, vocabulary size assessed with the Multiple Choice Word Test, working memory gauged with the Operation Span Test, verbal learning and recall of the Verbal Learning and Retention Test and task switching abilities tested by the Comprehensive Trail-Making Test. Thus, these cognitive abilities explain individual differences in noise-vocoded speech understanding and should be considered when aiming to predict hearing-aid outcome.

Mood, Cognitive Function and Quality of Life Improvements in Middle Aged Women Following Supplementation with Polygonum minus Extract

Polygonum minus is a plant rich in flavonoids and antioxidants beneficial for reducing oxidative stress and lipid peroxidation in neuronal membranes. This randomized, double-blind, placebo-controlled study evaluated the potential benefits of P. minus extract (LineMinusTM) towards improving cognitive function, mood status and quality of life. Thirty five middle-aged women (35-55 years old) were randomized into intervention (n=17) and control group (n=18). Two capsules of P. minus (250 mg) or placebo (100 mg maltodextrin) each were taken once daily for six weeks. Cognitive tests, mood and anthropometric measurements were measured at baseline, week 3 and week 6, whilst biomarkers were measured at baseline and week 6. Parameters related to mood and quality of life including energy/fatigue, social functioning and general health significantly improved from baseline to week 6 in the intervention group (p<0.05). Mean score for cognitive tests (i.e. digit span, comprehensive trail making test (CTMT) and three domains of CNS vital sign (CNSVS)] improved significantly in both intervention and control groups (p<0.05). There was a significant decrease of mean uric acid, estimated glomerular filtration rate (eGFR), total cholesterol and glycated hemoglobin (HbA1C) in the intervention group from baseline to week 6. P. minus supplementation has the potential to improve mood and quality of life and no adverse effects were reported by the participants after 6 weeks supplementation.

A randomised controlled trial of a web-based multi-modal therapy program to improve executive functioning in children and adolescents with acquired brain injury

Objective: To examine the efficacy of a multi-modal web-based therapy program, Move it to improve it (Mitii™) delivered at home to improve Executive Functioning (EF) in children with an acquired brain injury (ABI). Design: Randomised Waitlist controlled trial. Setting: Home environment. Participants: Sixty children with an ABI were matched in pairs by age and intelligence quotient then randomised to either 20-weeks of Mitii™ training or 20 weeks of Care As Usual (waitlist control; n=30; 17 males; mean age=11y, 11m (±2y, 6m); Full Scale IQ=76.24±17.84). Fifty-eight children completed baseline assessments (32 males; mean age=11.87±2.47; Full Scale IQ=75.21±16.76). Main Measures: Executive functioning was assessed on four domains: attentional control, cognitive flexibility, goal setting, and information processing using subtests from the Wechsler Intelligence Scale for Children (WISC-IV), Delis-Kaplan Executive Functioning System (D-KEFS), Comprehensive Trail Making Test (CTMT), Tower of London (TOL), and Test of Everyday Attention for Children (Tea-Ch). Executive functioning performance in everyday life was assessed via parent questionnaire (Behaviour Rating Inventory of Executive Functioning; BRIEF). Results: No differences were observed at baseline measures. Groups were compared at 20-weeks using linear regression with no significant differences found between groups on all measures of EF. Out of a potential total dose of 60 hours, children in the Mitii™ group completed a mean of 17 hours of Mitii™ intervention. Conclusion: Results indicate no additional benefit to receiving Mitii™ compared to standard care. Mitii™, in its current form, was not shown to improve EF in children with ABI.

C-25Neurocognitive Correlates of the Comprehensive Trail Making Test (CTMT) in Children with Neurological Disorders

C-25Neurocognitive Correlates of the Comprehensive Trail Making Test (CTMT) in Children with Neurological Disorders

Two-Factor Structure of the Comprehensive Trail-Making Test in Adults

Previous evaluation of the Comprehensive Trail-Making Test (CTMT) using a confirmatory factor analysis (CFA) revealed that for children, a two-factor model provided a better fit than did a one-factor model. The purpose of this study was to explore whether these findings suggested a developmental factor structure or if the two-factor structure also would be supported for adults. CFA was conducted using M-plus to examine the factor structure for adults in the standardization sample using all five trails tasks from the CTMT. The findings of the CFA indicated an excellent fit for the two-factor model. In contrast, the one-factor structure (i.e., use of a composite score) was not supported. Results were the same when younger (younger than 50 years of age) and older (50 years old or older) adults were considered separately. These data suggest that a single score may not be a valid representation of executive functioning. The results support a two-factor structure that represents attention/sequencing and set switching/inhibition.

Factor structure of the Comprehensive Trail Making Test in children and adolescents with brain dysfunction.

The Comprehensive Trail Making Test (CTMT) is a relatively new version of the Trail Making Test that has a number of appealing features, including a large normative sample that allows raw scores to be converted to standard T scores adjusted for age. Preliminary validity information suggests that CTMT scores are sensitive to brain injury and demonstrate expected correlations with other neuropsychological tests, although the evidence also suggests that the factor structure of the CTMT may differ in children with brain dysfunction in comparison to the standardization sample. The present study addresses this matter by conducting a confirmatory factor analysis (CFA) of the CTMT in 382 children and adolescents. Of the 382, 191 were diagnosed with various forms of brain dysfunction, including 140 who had sustained a traumatic brain injury. The other 191 participants were healthy controls who were individually matched on age and gender to the clinical group with brain dysfunction. Results of the CFA indicated that for the clinical group, a 2-factor model composed of Simple Sequencing and Complex Sequencing/Shifting factors provided the best fit for the data. Although these 2 factors were also identified in the controls, differences in pattern of loadings were present. Results suggest that the presence of brain dysfunction may alter the factor structure of the CTMT in children and adolescents.

Comprehensive Trail-Making Test: Gender and Ethnic Differences for Ages 8 to 18 Years Old

There is increasing concern for possible gender and ethnic differences on neuropsychological measures. The purpose of this study was to examine gender and ethnicity differences on the Comprehensive Trail-Making Test (CTMT) with a focus on individuals from 8 to 18 years of age. From the standardization sample, this included 251 boys and 306 girls with a mean age of 12.76 years (SD = 3.07 years) and who were predominantly White (81.51%). Only those participants who completed all five tasks that comprise the CTMT were considered; participants representing special groups were excluded. For ethnic group, no significant differences emerged; for gender, significant differences emerged; and no interaction effects for sex by ethnicity were found. Further, no differences based on ethnicity were found. Implications and possible explanations for this difference for practice and additional research are discussed.

Using Versions of the Trail Making Test as Alternate Forms

Alternate forms of neuropsychological instruments are often made parallel by developing tests with similar numbers of items, formats, and psychometric properties. The present study offers an alternative approach by examining three different trail-making tests that could potentially be used as alternate forms. Over a 3-week period, the Trail Making Test of the Delis-Kaplan Executive Functioning System (DK-TMT), Comprehensive Trail Making Test (CTMT), and Connections Task (CT) were individually administered to 154 undergraduate psychology students in each of six possible orders. Consistent with hypotheses, the three tests share the same underlying factors of sequencing and shifting as alternatives to one- and three-factor models; statistical evidence is provided to support that the two-factor solution is invariant regardless of test order. These findings support the notion that three different trail-making tests can be administered without discernable practice effects, increasing the flexibility of a serial neuropsychological assessment battery.

Utilization of the Comprehensive Trail Making Test as a Measure of Executive Functioning in Children and Adolescents with Traumatic Brain Injuries

Traumatic brain injury (TBI) often results in long-term negative effects in attention, memory, perception, language, and executive functioning. Children and adolescents are the most vulnerable as TBIs are the leading cause of death and disability for this age group. Despite these high proportions and detrimental effects, few studies have utilized a developmentally appropriate, standardized measure to assess executive functioning within a pediatric TBI population. The current study compared children and adolescents who had sustained a TBI with a non-injured, matched control group on executive functioning using the Comprehensive Trail Making Test (CTMT). Data analyses revealed significant differences between groups on the CTMT Composite Index, each individual trail, and a combination of trails but with no within-group differences. Confirmatory factor analysis revealed that a single-factor model was a better fit for the present sample of TBI participants than the two-factor model evident within the CTMT standardization sample.

Construct and Criterion Validity of the Comprehensive Trail Making Test in Children and Adolescents with Traumatic Brain Injury

The current study examined the construct and criterion validity of the Comprehensive Trail Making Test (CTMT) when used to evaluate children and adolescents with traumatic brain injury (TBI). Participants included 100 children and adolescents, 50 who had sustained TBI and 50 normal comparisons (NC). Analyses indicated that the CTMT factor scores were significantly correlated with tests of perceptual organizational ability, processing speed, and motor function and provided support for its construct validity. Additionally, correlations between the various CTMT scores suggested that a different pattern of associations was present in the TBI group compared to the NC group. Finally, the TBI group performed significantly worse (p < .001) on all of the CTMT scores, including each of the five CTMT trails as well as the factor and composite index scores. Results support the construct and criterion validity of the CTMT when used to assess children and adolescents with TBI.