Trail Making Test Part A Research Articles

Cognitive Test Performance and Brain Pathology

Cognitive impairment, assessed using paper-and-pencil tests, occurs with multiple syndromes, including heart failure; however, relationships between test performance and brain injury are unclear. To determine the extent of brain injury assessed by magnetic resonance T2 relaxometry procedures in a mixed sample with cognitive impairment as measured by the Mini-Mental State Examination, Trailmaking Test parts A (TMT-A) and B (TMT-B), and the Watson Clock-Drawing Test (CDT). A comparative design was used with a convenience sample of 66 participants (age 48.2 +/- 8.4 years, 41 males, 52 right-handed). Normal and abnormal performances on cognitive tests were compared using T2 relaxation values across the brain (p < .005). Fifty-four of the participants were healthy, and 12 had heart failure (New York Heart Association classes II-III, left ventricular ejection fraction <0.40). All participants scored normally on the Mini-Mental State Examination; thus, this test was excluded from further analysis. Abnormal cognitive scores were found in 14-20% of the participants, with significant brain injury appearing in participants with abnormal test scores. Injured structures included frontal, temporal, parietal, insular, and cingulate cortices; corpus callosum; and caudate. The CDT results showed the greatest extent of structural injury. The TMT-A test demonstrated relationships to specific injury sites, whereas the TMT-B showed relationships only to isolated areas of damage. The findings suggest that paper-and-pencil cognitive tests relate to injury in brain structures, with CDT values relating to the greatest extent of injury. Specific damage sites may correlate with unique tests, such as TMT-A. Specialized tests should be developed that would indicate neural injury in specific areas.

P.5.a.004 Validity of the Korean version of the Mini-Cog

The P300 is a useful psychophysiological index that reflects cognitive functions; however, the relationship between P300 indices and neuropsychological tests in Alzheimer's disease (AD) patients is unclear.Thirty-one AD patients and 31 elderly normal control (NC) subjects were recruited. Age and education level were matched between the two groups. The relationship between the P300 and the Korean version of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K) assessment packet (including 11 neuropsychological tests) was examined in AD patients.Compared to the NC subjects, the AD patients exhibited significantly decreased P300 amplitudes; however, there was no significant difference between the two groups in terms of P300 latency. After a permutation-based correction for multiple tests, P300 amplitudes at the Cz and Pz electrodes were significantly correlated with performance on the word list recognition, constructional praxis, and word fluency neuropsychological tests in the AD patients. Additionally, P300 latencies at the Pz and C6 electrodes were also significantly correlated with performance on the Mini-Mental State Examination, CERAD-K version (MMSE-K), and Trail Making Test part A (TMT-A) neuropsychological tests in the AD patients.The results suggest that the P300 is responsive to the deterioration of language, memory, and executive functions observed in AD patients. Although there was no significant difference between the AD patients and NC subjects in the P300 latency, P300 latency has been shown to reflect impaired global cognition and attention deficits associated with AD. Our results suggest that P300 indices could be used as biological markers that indicate impaired neuropsychological functions in AD patients.

Prevention of first overt episode of hepatic encephalopathy after TIPS: No easy task

Abstract Background/Aims: Hepatic encephalopathy is a frequent event after transjugular-intrahepatic-portosystemic-shunt (TIPS), especially during the first months. Aim of this study was to compare two different treatments (lactitol 60 g/day, rifaximin 1200 mg/day) with no-treatment in the prevention of post-TIPS hepatic encephalopathy. Methods: Seventy-five consecutive cirrhotics submitted to TIPS were randomized to receive either one of the above treatments or no-treatment. The main end-point was the occurrence of an episode of overt hepatic encephalopathy during the first month post-TIPS. Before the procedure and weekly thereafter the patients were evaluated by examining their mental status, asterixis, ammonia and trail-making-test Part-A (TMT-A). Results: The three groups were comparable for age, sex, etiology, Child-Pugh-score, post-TIPS porto-systemic gradient, previous hepatic encephalopathy, basal values of ammonia and psychometric performance. Twenty-five patients developed hepatic encephalopathy (33%, CI 95%=22-45%). One-month incidence was similar in the three groups (P=0.97). Previous hepatic encephalopathy (Relative Hazard=3.79;1.27-11.31) and basal-TMT-A Z-score1.5 (RH=3.55;1.24-10.2) were predictors of post-TIPS encephalopathy at multivariate analysis. A &lt;5 mmHg porto-systemic gradient was also significantly related to the occurrence of encephalopathy. Conclusions: Our data show that treatment with lactitol or rifaximin is not effective in the prophylaxis of hepatic encephalopathy during the first month after a TIPS.

Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: a randomized controlled study

Hepatic encephalopathy is a frequent event after transjugular-intrahepatic-portosystemic-shunt (TIPS), especially during the first months. Aim of this study was to compare two different treatments (lactitol 60 g/day, rifaximin 1200 mg/day) with no-treatment in the prevention of post-TIPS hepatic encephalopathy. Seventy-five consecutive cirrhotics submitted to TIPS were randomized to receive either one of the above treatments or no-treatment. The main end-point was the occurrence of an episode of overt hepatic encephalopathy during the first month post-TIPS. Before the procedure and weekly thereafter the patients were evaluated by examining their mental status, asterixis, ammonia and trail-making-test Part-A (TMT-A). The three groups were comparable for age, sex, etiology, Child-Pugh-score, post-TIPS porto-systemic gradient, previous hepatic encephalopathy, basal values of ammonia and psychometric performance. Twenty-five patients developed hepatic encephalopathy (33%, CI 95%=22-45%). One-month incidence was similar in the three groups (P=0.97). Previous hepatic encephalopathy (Relative Hazard=3.79;1.27-11.31) and basal-TMT-A Z-score>1.5 (RH=3.55;1.24-10.2) were predictors of post-TIPS encephalopathy at multivariate analysis. A <5 mmHg porto-systemic gradient was also significantly related to the occurrence of encephalopathy. Our data show that treatment with lactitol or rifaximin is not effective in the prophylaxis of hepatic encephalopathy during the first month after a TIPS.