Trail Making Test Scores Research Articles

Efficacy and safety of Ginkgo biloba extract EGb 761® in mild cognitive impairment with neuropsychiatric symptoms: a randomized, placebo‐controlled, double‐blind, multi‐center trial

The study was conducted to explore the effects of EGb 761 (Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany) on neuropsychiatric symptoms (NPS) and cognition in patients with mild cognitive impairment (MCI). One hundred and sixty patients with MCI who scored at least 6 on the 12-item Neuropsychiatric Inventory (NPI) were enrolled in this double-blind, multi-center trial and randomized to receive 240 mg EGb 761 daily or placebo for a period of 24 weeks. Effects on NPS were assessed using the NPI, the state sub-score of the State-Trait Anxiety Inventory and the Geriatric Depression Scale. Further outcome measures were the Trail-Making Test (A/B) for cognition and global ratings of change. Statistical analyses followed the intention-to-treat principle. The NPI composite score decreased by 7.0 ± 4.5 (mean, standard deviation) points in the EGb 761-treated group and by 5.5 ± 5.2 in the placebo group (p = 0.001). Improvement by at least 4 points was found in 78.8% of patients treated with EGb 761 and in 55.7% of those receiving placebo (p = 0.002). Superiority of EGb 761 over placebo (p < 0.05) was also found for the State-Trait Anxiety Inventory score, the informants' global impression of change, and both Trail-Making Test scores. There were statistical trends favoring EGb 761 in the Geriatric Depression Scale and the patients' global impression of change. Adverse events (all non-serious) were reported by 37 patients taking EGb 761 and 36 patients receiving placebo. EGb 761 improved NPS and cognitive performance in patients with MCI. The drug was safe and well tolerated.

Do Age, Sex and Education affect Trail Making Test Scores? A Standardization Study in 20-49 Age Group in Turkey

Do Age, Sex and Education affect Trail Making Test Scores? A Standardization Study in 20-49 Age Group in Turkey

Clinical and radiological impact of liver transplantation for brain in cirrhosis patients without hepatic encephalopathy

ObjectiveTo elucidate the effect of liver transplantation (LT) on brain dysfunctions in cirrhotic patients who had no clinical evidence of hepatic encephalopathy (HE), we performed a prospective study of voxel-based diffusion tensor imaging (DTI) and detailed cognitive examination. MethodsWe assessed 12 consecutive patients as transplant candidates by DTI, with neurological and cognitive examinations just before and at 6 months after LT. ResultsAfter LT, cirrhotic patients showed significant improvement in visual reproduction, digit symbol, digit span, Stroop test, and Trail-making test scores, suggesting recovery of frontal-temporal function. As for voxel-based DTI, increased mean diffusivity (MD) and reduced fractional anisotropy (FA) values were found before LT in the frontal and temporal lobes of cirrhotic patients. After LT, the unusual FA and MD values observed in the frontal and temporal lobes preoperatively were significantly reduced. ConclusionEnd-stage cirrhotic patients without clinical evidence of HE showed increased MD and decreased FA values in both frontal and temporal lobes. These parameters improved after LT, in line with cognitive function. MD and FA values might be of value as a biomarker in end-stage cirrhotic patients for investigating brain tissue dysfunctions and evaluating the efficacy of LT.

천마를 이용한 기억력 향상 효과 연구

Objectives : This study was designed to investigate the effects of Gastrodia elata Blume on the improvement of memory. Methods : This study was a 12 week, double blind, comparative clinical study. There were eligible who worked with a group of healthy seniors, all 60 years of age or older. 50 subjects were randomized either to Gastrodia elata Blume in powder form and steep in hot water or placebo. We measured the faculty of memory by using K-DRS, MMSE-K, Digit Span, Letter Fluency Test, Word List Memory Test, and the Trail Making Test, and after 12 weeks we measured the faculty of memory again using the same methods. Results : Gastrodia elata Blume steeps in the hot water group significantly increased. Initiation, perseveration level, and Memory level of K-DRS and MMSE-K score. There were no considerable differences between three groups in Digit Span and Trail Making Test score. Gastrodia elata Blume group showed significant advances in Letter Fluency Test and recognition of Word List Memory Test. Conclusions : The results suggest that Gastrodia elata Blume may have positive effects on memory improvement and function of the frontal lobe activation.

518 – Intermittent theta burst stimulation (iTBS) for the treatment of negative symptoms in schizophrenia

Introduction High frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) has been shown effective for reducing persistant negative symptoms of schizophrenia. Intermittent theta burst stimulation (iTBS) is a new paradigm of rTMS that allowed more sustained facilitation effect. Aims The aim of this study is to investigate the effect of theta burst in reduction of persistant negative symptoms in schizophrenia. Methods 24 adult schizophrenia outpatients were assigned to receive iTBSat 80% motor threshold, or sham TMS over the left DLPFC, daily; for 20 sessions. The primary outcome measure was the Scale for the Assessment of Negative Symptoms (SANS).score. Secondary outcomes included depression as measured with the Calgary Depression Scale (CDS), and cogntion as assessed with digit span and trail making test. Patients were followed-up 6 months afterwards. Results The primary outcome measure (change in Scale for Assessment of Negative Symptoms score) showed a statistically significant drop at month 1, 3 and 6 for the iTBS group, but not ther placebo groups. Digit span and trail making test score were also significally improved after treatment in iTBS group. Calgary depression scale score did not demontrate any significant change. Conclusions iTBS may serve as a relatively noninvasive treatment of the negative and neurocognitive deficits associated with schizophrenia. ClinicalTrials.gov Identifier: NCT00875498

A study of neurobehavioral, clinical psychometric, and P3 changes in vitamin B12 deficiency neurological syndrome

ObjectiveTo evaluate cognitive functions and behavioral changes in the patients with vitamin B12 deficiency neurological syndromes (VBDNS) using detailed clinical psychometric and P3 studies and their response to treatment.MethodsThe patients with VBDNS were included and their detailed medical history was recorded. Neurobehavioral and cognitive functions were evaluated by neuropsychiatry inventory (NPI), forward and backward digit span, mini mental state examination (MMSE), Luria's three-step test, trail making test (TMT), motor speed and precision test (MSPT), Benton's visual retention test (BVRT), clock drawing (CD), category fluency, hospital anxiety and depression (HAD) scale, and cognitive evoked potential using oddball paradigm at baseline and 3 and 6 months following treatment. Complete hemogram, serum chemistry, vitamin B12, homocysteine, and craniospinal magnetic resonance imaging (MRI) were done.ResultsThirty-three patients with VBDNS, whose median age was 43 (12–68) years, five (15.2%) of whom were females were included. Twenty-one patients had neurobehavioral/cognitive decline, 26 myelopathy, and 17 neuropathy. MSPT, TMT, CD, and HAD scores improved significantly at 3 months and category naming and MMSE improved at 6 months compared to baseline. The P3 latency also improved significantly at 3 months. The baseline P3 changes correlated with MMSE, Luria's three-step test, and MSPT. Hemoglobin and mean corpuscular volume also correlated with some of the cognitive tests.ConclusionVBDNS results in frontal–subcortical neurobehavioral and cognitive abnormalities which may be due to cortical and subcortical dysfunction. The reversibility of these changes is suggestive of metabolic alteration in neuronal or myelin function.

A Preliminary Study on the Trail-Making Test in Arabic–English Bilingual Young Adults

The Trail-Making Test (TMT) is used in different neuropsychological test batteries. It consists of two parts: TMT-Part A, which tests visual scanning and psychomotor speed, and TMT-Part B, which assesses more complex cognitive processes. TMT normative data have been established in many non-Arab countries either using the original English version or a version developed with the native language. The aim of this study was to compare TMT performance between the English TMT and a constructed Arabic TMT in young Arabic–English bilingual college students from three Arabian Gulf states. Scores from 83 participants who took the English TMT and 52 who took the Arabic TMT were included. Arabic TMT (both parts) scores were significantly poorer compared with English TMT scores. Arabic TMT scores were also poorer than were other norms for this age group and education level, but they were better than those reported from another study using the Arabic TMT. Moreover, there were nonsignificant differences in performance between participants from these three countries; however, these findings are inconclusive as sample sizes were small. These findings suggest that Arabic TMT norms cannot be unified for all Arabic countries, and separate Arabic TMT norms including all age groups and education levels must be established for each Arabic country.

The impact of co-morbid factors on the psychological outcome of tinnitus patients

The study was carried out to determine the impact of some co-morbid otological symptoms and demographic factors on the emotional distress and cognitive functioning in patients with tinnitus. One hundred consecutive patients, complaining of constant idiopathic tinnitus, were enrolled into the study. Four tests were administered: Beck Depression Inventory, Hospital Anxiety Depression Scale (HADS, A--anxiety, D--depression), Mini-Mental State Examination (MMSE) and Trail Making Test (TMT). A multivariate stepwise linear regression analysis was performed to estimate the relationship between the results of each of the tests and following co-morbid factors: age, sex, tinnitus duration, tinnitus laterality, hearing status (normal hearing, unilateral hearing loss and bilateral hearing loss) and vertigo/dizziness. It was found that the scores of MMSE and TMT were negatively correlated with age and with hearing status and the scores of HADS-A were slightly correlated with sex. In regression analysis, in HADS-A, sex and to a lesser extent tinnitus duration, in MMSE and TMT age and to a lesser extent tinnitus laterality were the variables that were comprised in the final model. Demographic factors had contributed more than overlapping otological symptoms to the psychological outcome in tinnitus patients.

Impaired memory and executive function associated with decreased medial temporal and prefrontal blood flow in Clinical Dementia Rating 0.5 status: the Osaki‐Tajiri project

The Clinical Dementia Rating (CDR) is an assessment of dementia severity based on observations of activities of daily living, and a CDR of 0.5 (CDR 0.5) represents questionable dementia. A combination of the Cognitive Abilities Screening Instrument (CASI) and the Trail Making Test (TMT) scores discriminated CDR 0.5 subjects from healthy participants with a high degree of accuracy. We investigated the neurological background of CDR 0.5 subjects by correlating CASI and TMT scores with regional cerebral blood flow (rCBF) as measured by single photon emission computed tomography (SPECT). From a community-based cohort, 22 CDR 0.5 participants were recruited. CASI and TMT scores, rCBF measure using [(123) I]-N-isopropyl-p-iodoamphetamine and SPECT were obtained. We evaluated the relationships between the CASI domain scores, between TMT scores and rCBF in a regions-of-interest-based analysis, and voxel-based analysis using Statistical Parametric Mapping 5 software. We found that lower rCBF in the left medial temporal cortex correlated with a decreased CASI domain recent memory score both in the regions-of-interest and statistical parametric mapping analysis. In both the regions-of-interest and statistical parametric mapping analysis, the rCBF in the left prefrontal cortex correlated with CASI domain remote memory and mental manipulation and concentration. Our results indicate that some CDR 0.5 subjects have functional impairments in the medial temporal lobe as well as in the prefrontal cortex, as reflected in the cognitive decline measured by CASI and TMT.

P-1317 - Evaluation of insight and fuctional recovery in patients with schizophrenia

Objective The purpose of this study is to examine the factors which influence schizophrenia patients’ levels of insight and functional remission. Method In this study, 70 outpatients between the ages of 18–65 who applied to the Karadeniz Technical University Psychiatry Clinic and were diagnosed with schizophrenia according to DSM-IV were evaluated. Patients who have disease which affects the central nervous system, whose CGI disease severity score is above four, who were taken as inpatients to the hospital in the last two months were excluded from the study. The patients were evaluated by using socio-demographic data collection form, clinical interview structured for DSM (SCID-I), the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), the Functional Remission of General Schizophrenia Scale (FROGS), Schedule for Assessing the Three Components of Insight (SAI-E) and cognitive test battery. Results Patients SAI-E levels were found to be correlated with the PANSS, Stroop Test (ST), Controlled Word Association Test (FAS) and Trail Making Test (TMT) A-B scores. In the regression analysis, FAS scores were the predictor of SAI-E total scores .The FROGS functional levels of patients were found to be related with occupational status, gender, age of onset illness, comorbid psychiatric illness, PANSS, CDS, SAI-E, FAS, TMT, ST and Wisconsin Card Sorting Test scores. In the regression analysis, occupational status, comorbid obsessive compulsive disorder, PANNS negative and general psychopathology and FAS scores were the predictors of patients’ functional status. Discussion The effect of cognitive functioning and insight on the patients’ level of functionality is prominent.

Temporary deterioration of executive function after subthalamic deep brain stimulation in Parkinson's disease

ObjectiveSelective impairment of executive function has been shown in Parkinson's Disease (PD) patients undergoing Deep Brain Stimulation (DBS) of the Subthalamic Nucleus (STN). However, some patients experience difficulties in daily life, such as dissension in interpersonal relationships or a loss of lifestyle balance, in the short term after surgery. Our hypothesis is that these difficulties might be related to executive dysfunction. To elucidate the involvement of executive dysfunction in these difficulties, we assessed motor and executive function in the short term and long term after surgery. MethodsWe examined motor function and executive function in 30 patients who underwent bilateral STN–DBS for medically refractory PD. Patients were evaluated for executive function 1 month before surgery, 1 month after surgery, and 12 months after surgery using the Trail Making Test (TMT), the Modified Stroop Color Word Interference Test (MST) and tests of Verbal Fluency (VF). ResultsTMT-B, TMT (B/A), MST-B, VF-phonemic and VF-semantic scores were significantly poorer 1 month after STN–DBS. TMT-B, TMT (B/A) and VF-phonemic recovered to preoperative levels by 12 months after surgery. A reduction in dopaminergic medication 1 month after surgery was significantly correlated with deterioration of TMT (B/A). ConclusionTemporary deterioration of executive function may occur in the short term after STN–DBS, whereas motor function is usually improved. PD patients undergoing STN–DBS should be managed during this period to better predict temporary executive dysfunction. Excessive reduction of dopaminergic medication after surgery might, at least in part, result in this deterioration of executive function.

The Trail Making Test in prodromal Huntington disease: Contributions of disease progression to test performance

We examined the Trail Making Test (TMT) in a sample of 767 participants with prodromal Huntington disease (prodromal HD) and 217 healthy comparisons to determine the contributions of motor, psychiatric, and cognitive changes to TMT scores. Eight traditional and derived TMT scores were also evaluated for their ability to differentiate prodromal participants closer to estimated age of diagnosis from those farther away and prodromal individuals from healthy comparisons. Results indicate that motor signs only mildly affected Part A, and psychiatric symptoms did not affect either part. Tests of perceptual processing, visual scanning, and attention were primarily associated with Part A, and executive functioning (response inhibition, set-shifting), processing speed, and working memory were associated with Part B. Additionally, TMT scores differentiated between healthy comparisons and prodromal HD individuals as far as 9–15 years before estimated diagnosis. In participants manifesting prodromal motor signs and psychiatric symptoms, the TMT primarily measures cognition and is able to discriminate between groups based on health status and estimated time to diagnosis.

Identification of Three Factors Influencing Trail Making Test Performance Using Multichannel Near-Infrared Spectroscopy

Recent advances in medical care have facilitated the survival of patients with stroke or traffic-related injuries. However, such patients may suffer from higher brain dysfunction; i.e., an impaired ability to plan and perform behaviors based on prior knowledge. The Trail Making Test (TMT) is a cognitive task that is used to evaluate higher brain dysfunction caused by frontal lobe injury. TMT consists of two tasks; TMT-A involves connecting consecutive numbers, and TMT-B involves connecting numbers and letters alternately. In this study, using near-infrared spectroscopy (NIRS) and the achievement value (TMT score), we investigated the effects of three factors on TMT performance: knowledge of the TMT, the order of TMT-A and TMT-B performance, and gender. The subjects were 48 healthy adults, consisting of college graduates and undergraduates (age: 22.8 ± 2.5 years, education: 16.0 ± 1.2 years, 24 males and 24 females). We measured the changes in oxygenated hemoglobin (oxy-Hb) levels using NIRS, showing that the increase in oxy-Hb was higher in subjects who had no knowledge of the TMT than those who had prior knowledge. In both TMT-A and TMT-B, the subjects who performed their first task displayed higher oxy-Hb levels. Moreover, the oxy-Hb level in males was higher than that in females. In contrast, only the order of TMT performance showed noticeable effect on the TMT score. In the present study, using NIRS we have shown that either knowledge of the TMT, the order of the TMT, or gender affects TMT performance, providing invaluable information for interpreting TMT results.

Does Bacopa monnieri Improve Memory Performance in Older Persons? Results of a Randomized, Placebo-Controlled, Double-Blind Trial

The objective of this study was to investigate the effectiveness of Bacopa monnieri Linn. for improvement of memory performance in healthy older persons. This was a randomized, double-blind, placebo-controlled trial. The trial took place in Lismore, NSW, Australia between February and July 2005. Ninety-eight (98) healthy participants over 55 years of age were recruited from the general population. Participants were randomized to receive an extract of Bacopa monnieri called BacoMind(TM) (Natural Remedies Pvt. Ltd.), 300 mg/day, or an identical placebo. Following screening, neuropsychologic and subjective memory assessments were performed at baseline and at 12 weeks. Audioverbal and visual memory performance were measured by the Rey Auditory Verbal Learning Test (AVLT), the Rey-Osterrieth Complex Figure Test (CFT), and the Reitan Trail Making Test (TMT). Subjective memory performance was measured by the Memory Complaint Questionnaire (MAC-Q). One hundred and thirty-six (136) subjects volunteered; 103 met entry criteria, 98 commenced, and 81 completed the trial. Bacopa significantly improved verbal learning, memory acquisition, and delayed recall as measured by the AVLT: trial a4 (p = 0.000), trial a5 (p = 0.016); trial a6 (p = 0.000); trial a7 (delayed recall) (p = 0.001); total learning (p = 0.011); and retroactive interference (p = 0.048). CFT, MAC-Q, and TMT scores improved but group differences were not significant. Bacopa versus placebo caused gastrointestinal tract (GIT) side-effects. Bacopa significantly improved memory acquisition and retention in healthy older Australians. This concurs with previous findings and traditional use. Bacopa caused GIT side-effects of increased stool frequency, abdominal cramps, and nausea.

Trail Making Test Predicts Physical Impairment and Mortality in Older Persons

To examine whether performance in the Trail Making Test (TMT) predicts mobility impairment and mortality in older persons. Prospective cohort study. Community-dwelling older persons enrolled in the Invecchiare in Chianti (InCHIANTI) Study. Five hundred eighty-three participants aged 65 and older and free of major cognitive impairment (Mini-Mental State Examination score >21) with baseline data on TMT performance. Of these, 427 performed the Short Physical Performance Battery (SPPB) for the assessment of lower extremity function at baseline and after 6 years. Of the initial 583 participants, 106 died during a 9-year follow-up. The TMT Parts A and B (TMT-A and TMT-B) and SPPB were administered at baseline and 6-year follow-up. Impaired mobility was defined as an SPPB score less than 10. Vital status was ascertained over a 9-year follow-up. InCHIANTI participants in the fourth quartile of the time to complete TMT-B minus time to complete TMT-A (TMT (B-A)) were significantly more likely to develop an SPPB score less than 10 during the 6-year follow-up than those in the first quartile (relative risk (RR)=2.4, 95% confidence interval (CI)=1.4-3.9, P=.001). After adjusting for potential confounders, these findings were substantially unchanged (RR=2.2, 95% CI=1.4-3.6, P=.001). Worse performance on the TMT was associated with significantly greater decline in SPPB score over the 6-year follow-up, after adjusting for age, sex, and baseline SPPB scores (beta=-0.01, standard error=0.003, P=.004). During the 9-year follow-up, 18.2% of the participants died. After adjustment for age and sex, the proportion of participants who died was higher in participants in the worst than the best performance quartile of TMT (B-A) scores (hazard ratio (HR)=1.7, 95% CI=1.0-2.9, P=.048). Results were similar in a parsimonious adjusted model (HR=1.8, 95% CI=1.0-3.2, P=.04). Performance on the TMT is a strong, independent predictor of mobility impairment, accelerated decline in lower extremity function, and death in older adults living in the community. The TMT could be a useful addition to geriatric assessment.

Reference data for derived Trail Making Test scores in Greek healthy population

Background The Trail Making Test (TMT) via part B (TMT-B) has been widely used in the evaluation of the executive functions [1]. Apart from the direct scores (time to complete part A and B), derived TMT scores (B-A, B/A, B-A/A) are more and more used, as sensitive measures of prefrontal functioning [2-4]. The aim of the present study was to provide reference data from a large sample of Greek healthy participants in derived TMT scores.

Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills

Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia. Patients scheduled for extracorporeal shock wave lithotripsy were randomly assigned to one of four groups. Two groups received a combination of fentanyl/midazolam with either modafinil or placebo. The remaining groups received remifentanil/propofol with either modafinil or placebo. Modafinil 200 mg was administered to the treatment group patients 1 h before sedation/analgesia. Groups were compared using the digital symbol substitution test (DSST), trail making test (TMT), observer scale of sedation and analgesia (OAA/S) and Aldrete score. Verbal rating scale (VRS) scores for secondary outcome variables e.g. energy, tiredness and dizziness were also recorded before and after treatment. Sixty-seven patients successfully completed the study. Groups received similar doses of sedation and analgesic drugs. No statistically significant difference was found for DSST between groups. No significant adverse effects occurred in relation to modafinil. No statistically significant difference between groups was identified for TMT, OAA/S and Aldrete scores. The mean VRS score for tiredness was lesser in the modafinil/fentanyl/midazolam group [1.3 (2.0)] compared with the placebo group [3.8 (2.5)], P=0.02. Such a difference was not found between the remifentanil/propofol groups [placebo 2.6 (2.2) vs. modafinil 3.1(2.7)], p>0.05. Dizziness was greater in the modafinil/remifentanil/propofol group 1.7 (2.0) vs. placebo 0.0 (0.5), p<0.05. Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve recovery in terms of objective measures of patient psychomotor skills.

Spectrum of neurocognitive impairment in cirrhosis: Implications for the assessment of hepatic encephalopathy

Spectrum of neurocognitive impairment in cirrhosis: Implications for the assessment of hepatic encephalopathy

Effects of age and education level on the Trail Making Test in a healthy Brazilian sample.

Trail Making Test (TMT) has been a useful tool for neuropsychological assessment. The present study analyzed the influence of age and education level on TMT performance in healthy adult Portuguese speakers. The criteria for exclusion were a history of neurological disease, psychiatric illness, substance abuse, learning disabilities, or any other difficulty that may interfere with testing. The sample (n = 318) was divided into four age groups: (i) very young (n = 92; 18-34 years old), (ii) young (n = 66; 35-49 years old), (iii) middle-age (n = 117; 50-64 years old), and (iv) elderly (n = 43; 65-81 years old). The sample was also divided into three education levels: (i) low (2-8 years), (ii) middle (9-11 years), and (iii) high (≥ 12 years). Correlations among the demographic variables and scores on Trails A and B showed that age and education level were the two variables that most affected TMT scores (p < 0.001, analysis of covariance). Post hoc analyses of age did not reveal significant differences between the middle-age and elderly groups in TMT-A performance or between middle and high education level in TMT-A or TMT-B performance. These results are consistent with previous studies and demonstrate that age and education level affect the performance of Brazilian subjects on the TMT. Keywords: aging, Trail Making Test, neuropsychological test, education level. Received 30 October 2009; received in revised form 16 December 2009; accepted 17 December 2009. Available on line 29 December 2009.

Construct validity of the Trail Making Test: Role of task-switching, working memory, inhibition/interference control, and visuomotor abilities

The aim of this study was to clarify which cognitive mechanisms underlie Trail Making Test (TMT) direct and derived scores. A comprehensive review of the literature on the topic was carried out to clarify which cognitive factors had been related to TMT performance. Following the review, we explored the relative contribution from working memory, inhibition/interference control, task-switching ability, and visuomotor speed to TMT performance. Forty-one healthy old subjects participated in the study and performed a battery of neuropsychological tests including the TMT, the Digit Symbol subtest [Wechsler Adult Intelligence Scale (Third Version) (WAIS-III)], a Finger Tapping Test, the Digits Forward and Backward subtests (WAIS-III), Stroop Test, and a task-switching paradigm inspired in the Wisconsin Card Sorting Test. Correlation and regression analyses were used in order to clarify the joint and unique contributions from different cognitive factors to the prediction of TMT scores. The results suggest that TMT-A requires mainly visuoperceptual abilities, TMT-B reflects primarily working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, providing a relatively pure indicator of executive control abilities.