Trail Making Test Completion Time Research Articles

Measuring Executive Function Using Eye Movements on a Computerized Trail Making Test: A Pilot Study

Objective: The current study investigated the validity of a novel computerized version of the Trail Making Test, and tested whether the integration of eye-tracking increased specificity and predictive power with other tests of executive function. We were specifically interested in whether eye movements, recorded during the completion of a computerized version of the Trail Making Test, served as a predictor of executive function as measured by the computerized Wisconsin Card Sorting Test. Methods: Forty participants completed the pencil-and-paper Trail Making Test, the computerized Wisconsin Card Sorting Test and the computerized Trail Making Test. Eye movements were recorded during the completion of the computerized Trail Making Test. Results: Eye-tracking measures for part B of the computerized Trail Making Test were correlated with T-scores for perseverative and non-perseverative responses/errors on the computerized Wisconsin Card Sorting Test. Hierarchical linear regression revealed that eye-tracking measures predicted variance for perseverative and non-perseverative errors/responses on the computerized Wisconsin Card Sorting Test, above and beyond Trail Making Test completion time. Conclusions: The current pilot study supported the use of computerized versions of the Trail Making Test and provided preliminary evidence that eye movements may significantly add to the specificity in assessing executive function using the Trail Making Test.

Solving the Puzzle of Cognitive Reserve Effects on Cognitive Decline: The Importance of Considering Functional Impairment

Aims: We investigated whether the longitudinal relation between cognitive reserve accumulated across the lifespan and rate of cognitive decline over 6 years differed by the individual’s degree of functional impairment. Methods: We analyzed longitudinal data from 897 older adults (M = 74.33 years) tested on the Trail Making Test (TMT) in 2 waves 6 years apart. Results: There was a significant interaction of functional impairment with cognitive reserve on latent change in cognitive functioning. Specifically, with no functional impairment in the first wave of assessment, greater cognitive reserve accumulated across the lifespan significantly predicted a reduced cognitive decline over 6 years (i.e., smaller increase in TMT completion time). In contrast, with certain functional impairment (in at least some activities) in the first wave, greater cognitive reserve build-up predicted a steeper cognitive decline (i.e., larger increase in TMT completion time). Conclusion: Individuals with greater cognitive reserve accumulated across the lifespan show a reduced cognitive decline if they still have relatively little functional impairment, while they will show a steeper decline (compared to individuals with less cognitive reserve) as soon as functional impairment becomes substantial.

Cognitive Reserve Moderates the Predictive Role of Memory Complaints for Subsequent Decline in Executive Functioning

Aims: We investigated whether the longitudinal relation between memory complaints and subsequent decline in executive functioning over 6 years differed by leisure activity engagement as major contributor to cognitive reserve in old age. Methods: We analyzed longitudinal data from 897 older adults (M = 74.33 years) tested on the Trail Making Test (TMT) in two waves 6 years apart. Participants reported information on memory complaints and leisure activity engagement. Results: There was a significant interaction of memory complaints with leisure activity engagement on latent change in executive functioning. Specifically, only for individuals with less (but not those with greater) leisure activity engagement, memory complaints significantly predicted a steeper subsequent decline in executive functioning across 6 years (i.e., increases in TMT completion time). Conclusion: The role of memory complaints as an early predictor of decline in executive functioning seems to vary by individuals’ cognitive reserve.

Interactional Effects Between Relational and Cognitive Reserves on Decline in Executive Functioning.

The present study set out to investigate associations of cognitive reserve (as indicated by education) and relational reserve (as indicated by the family network size and indices of emotional support) to decline in executive functioning over 6 years as measured by changes in Trail Making Test (TMT) completion time in older adults and whether education and network size interacted with age and sex as covariates with respect to this longitudinal association. We analyzed data from 897 participants tested on TMT parts A and B in two waves 6 years apart. The mean age in the first wave was 74.33 years. Participants reported information on their family networks and their level of education. Latent change score modeling testing for moderation effects revealed a significant interaction of network size in the first wave of data assessment with education. Specifically, for lower levels of cognitive reserve (-1 SD of education), the longitudinal association between relational reserve in the first wave and subsequent changes in executive functioning was not significant. In contrast, for higher levels of cognitive reserve (+1 SD of education), a higher relational reserve in the first wave significantly predicted a smaller subsequent increase in TMT completion time from the first to the second wave (i.e., a smaller decline in executive functioning). The present longitudinal study provides evidence for the interaction between cognitive and relational reserves. This confirms the hypothesis that reserves from different domains are intertwined and their combined effects contribute to less cognitive decline in old age.

Cognitive Reserve Attenuates 6-Year Decline in Executive Functioning after Stroke

Aims: We investigated whether the longitudinal relationship between history of stroke and subsequent decline in executive functioning over 6 years differed by cognitive reserve. Methods: We analyzed longitudinal data from 897 older adults (mean age, 74.33 years) tested on the Trail Making Test (TMT) in two waves 6 years apart. Participants reported information on key frequently used proxies of lifelong cognitive reserve accumulation (i.e., education, occupation, and leisure activity engagement), and history of stroke. Results: There was a significant interaction of stroke with leisure activity engagement on latent change in executive functioning. Specifically, only for individuals with low (but not those with high) leisure activity engagement, history of stroke significantly predicted a steeper subsequent decline in executive functioning across 6 years (i.e., increases in TMT completion time). Conclusion: The detrimental aftereffects of stroke on subsequent decline in executive functioning may be attenuated in individuals who have accumulated greater cognitive reserve through leisure activity engagement across their life.

The longitudinal relation between social reserve and smaller subsequent decline in executive functioning in old age is mediated via cognitive reserve.

Social reserve such as having close friends helps promoting activity engagement in old age. Activity engagement in turn contributes to the accumulation of cognitive reserve and is a key predictor for maintaining executive functioning in aging. We investigated the mediating role of leisure activity engagement in the longitudinal relation between close friends and subsequent change in executive functioning as measured through performance changes in the Trail Making Test (TMT). Longitudinal study with 897 older adults tested in two waves 6 years apart, analyzed using latent change score modeling. TMT parts A and B, leisure activity engagement, and close friends. A larger number of close friends in the first wave of data collection was related to a higher frequency of leisure activities in the first wave. A higher frequency of leisure activities in the first wave significantly predicted a smaller subsequent increase in TMT completion time from the first to the second wave (i.e. a smaller decline in executive functioning). Importantly, 41.3% of the longitudinal relation between a larger number of close friends in the first wave and a smaller subsequent increase in TMT completion time (i.e. a smaller decline in executive functioning) was mediated via a higher frequency of leisure activities in the first wave. Social reserve such as having close friends may help promoting activity engagement in old age. By enhancing individuals' cognitive reserve, this activity engagement may finally result in smaller subsequent decline in executive functioning in aging.

Cognitive Reserve Mediates the Relation between Openness to Experience and Smaller Decline in Executive Functioning

Aims: We investigated the mediating role of leisure activity engagement in the longitudinal relation between openness to experience and subsequent change in executive functioning over 6 years as measured through performance changes in the Trail Making Test (TMT). Methods: We analyzed longitudinal data from 897 older adults (mean = 74.33 years in the first wave) tested on TMT parts A and B in two waves 6 years apart. Participants reported information on leisure activity engagement and openness to experience. Results: Latent change score modeling revealed that 37.2% of the longitudinal relation between higher openness to experience in the first wave of data collection and a smaller subsequent increase in TMT completion time from the first to the second wave (i.e., a smaller decline in executive functioning) was mediated via a higher frequency of leisure activities in the first wave. Conclusion: Individuals with higher openness to experience show greater activity engagement in old age. By enhancing their cognitive reserve, this activity engagement may finally result in smaller subsequent decline in executive functioning.

The role of cognitive reserve accumulated in midlife for the relation between chronic diseases and cognitive decline in old age: A longitudinal follow-up across six years

ObjectivesThe present study set out to investigate relations of the number of chronic diseases (as a global indicator of individuals’ multimorbidity) to cognitive status and cognitive decline over six years as measured by changes in Trail Making Test (TMT) completion time in old adults and whether those relations differed by key life course markers of cognitive reserve (education, occupation, and cognitively stimulating leisure activities). MethodWe analyzed data from 897 participants tested on TMT parts A and B in two waves six years apart. Mean age in the first wave was 74.33 years. Participants reported information on chronic diseases, education, occupation, and cognitively stimulating leisure activities. ResultsLatent change score modeling testing for moderation effects revealed that a larger number of chronic diseases significantly predicted stronger increase in TMT completion time (i.e., steeper cognitive performance decline). Notably, the detrimental relation of the number of chronic diseases to stronger increase in TMT completion time (i.e., cognitive performance decline) was significantly stronger in individuals with less engagement in cognitively stimulating leisure activities in midlife. DiscussionPresent data suggest that disease-related cognitive decline may be steeper in individuals who have accumulated less cognitive reserve in midlife. However, greater midlife activity engagement seemed to be associated with steeper cognitive decline in any case. Implications for current cognitive reserve and neuropsychological aging research are discussed.

Diagnostic Accuracy of the Chinese Version of the Trail-Making Test for Screening Cognitive Impairment.

The Trail-Making Test (TMT), which is commonly used to measure executive function, consists of two components (TMT-A and TMTB). There is a lack of normative TMT data for Chinese elderly adults. This study aimed to evaluate the validity of the TMT in screening for cognitive impairment. 2,294 Chinese-speaking adults aged 50 to 85: 1,026 with normal cognition (NC), 462 with mild cognitive impairment (MCI), 108 with Alzheimer's disease (AD), 113 with vascular mild cognitive impairment (VaMCI), 121 with vascular dementia (VaD), 282 with uncertain types of dementia, and 15 with mixed dementia. Receiver operating characteristic curve analysis was performed to test the ability of TMT scores to differentiate between NC and cognitive impairment. Age, education, and sex were significantly associated with TMT completion time. The TMT-A exhibited sensitivity of 77.8% and specificity of 92.0% with cut-off value of 98.5seconds for discriminating AD from NC. The TMT-B had sensitivity of 83.3% and specificity of 91.8% with a cut-off value of 188.5seconds for discriminating AD from NC. The TMT-A had sensitivity of 85.7% and specificity of 81.6% for discriminating NC from VaD with a cut-off value of 77.5seconds, and the TMT-s had sensitivity of 81.6% and specificity of 83.9% with a cut-off value of 147.5seconds. The TMT had less sensitivity distinguishing MCI from NC. The Chinese version of the TMT is reliable for detecting AD or VaD but poor at distinguishing MCI from NC.

Assessment of different anesthesia depth under total intravenous anesthesia on postoperative cognitive function in laparoscopic patients.

Background:This study aimed to compare the effects of different depths of sedation during total intravenous anesthesia (TIVA) with remifentanil and propofol given by target-controlled infusion (TCI) on postoperative cognitive function in young and middle-aged patients undergoing gynecological laparoscopic surgery.Materials and Methods:A total of 150 American Society of Anesthesiologists physical Status I/II patients scheduled for gynecological laparoscopic operation were randomly divided into three groups. Anesthesia was maintained with intravenous infusion of TCI propofol and remifentanil, intermittent injected intravenously with rocuronium. The infusion concentration of propofol and remifentanil was adjusted to maintain bispectral index (BIS) at 30 < BIS ≤ 40 in the first group, 40 < BIS ≤ 50 in the second group, and 50 < BIS ≤ 60 in the third group. Mini–mental state examination (MMSE) and trail-making test (TMT) were used to assess the cognitive function one day preoperatively and one day postoperatively.Results:MMSE scores were > 24 sores on the day before anesthesia and the day after surgery in all three groups. However, the first group had the significantly higher MMSE scores than the other two groups after surgery (P < 0.05). Compared with that before anesthesia, TMT completion time was shorter on the day after surgery in the first group, while prolonged in the third group (P < 0.05). The first group had the significantly lower TMT completion time than the other two groups (P < 0.05).Conclusion:The depth of sedation, 30 < BIS value ≤ 40, under TIVA with remifentanil and propofol given by TCI had the minimal influence on postoperative cognitive function.

Effect of different depths of anesthesia on postoperative cognitive function in laparoscopic patients: a randomized clinical trial

Objective:Postoperative cognitive dysfunction (POCD) is caused by many factors. This work was conducted to investigate the effect of different depths of anesthesia during combined intravenous–inhalational anesthesia on postoperative cognitive function in young and middle-aged laparoscopic patients.Methods:A total of 192 patients scheduled for gynecologic laparoscopic operations were randomly divided into three groups. Anesthesia was maintained with inhalation of sevoflurane and infusion of remifentanil, which was adjusted to maintain bispectral index (BIS) at 30 < BIS ≤ 40 in Group I, 40 < BIS ≤ 50 in Group II and 50 < BIS ≤ 60 in Group III. The Mini-Mental State Examination (MMSE) and Trail-Making Test (TMT) were used to assess cognitive function on the day before anesthesia and the day after surgery.Results:There were no significant differences in age, body mass index, educational level and surgery time. On the day before anesthesia, the average MMSE scores and TMT completion times in the three groups were not significantly different. On the day after surgery, Group II had a significantly higher average MMSE score (29.00 ± 0.89) than Group I (28.36 ± 1.42, p = 0.010) and Group III (28.45 ± 1.27, p = 0.035) and lower TMT completion time (33.68 ± 10.34) than Group I (39.45 ± 13.99, p = 0.027) and Group III (39.50 ± 12.50, p = 0.026).Conclusion:These results indicated that the depth of anesthesia, 40 < BIS ≤ 50, under combined intravenous–inhalational anesthesia yielded milder influence on postoperative cognitive function in young and middle-aged laparoscopic patients.

Effects of different depths of sedation during combined intravenous-inhalational anesthesia on postoperative cognitive function in patients undergoing gynecological laparoscopic surgery

Objective To investigate the effects of different depths of sedation during combined intravenous-inhalational anesthesia on postoperative cognitive function in patients undergoing gynecological laparoscopic surgery.Methods Ninety ASA Ⅰ or Ⅱ patients,aged 20-64 yr,with a body mass index of 19-30 kg/m2,scheduled for elective gynecological laparoscopic operation,were randomly divided into 3 groups (n =30 each).Anesthesia was induced with midazolam,fentanyl,propofol and rocuronium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration 1.0％-1.5 ％),iv infusion of remifentanil and intermittent iv boluses of rocuronium.The infusion rate of remifentanil was adjusted to maintain BIS value:30 ＜ BIS value ≤ 40 in group Ⅰ,40 BIS value ≤ 50 in group Ⅱ and 50 ＜ BIS value≤60 in group Ⅲ.Cognitive function was assessed using Mini-Mental State Examination (MMSE) and TrailMaking Test (TMT) at 1 d before anesthesia and 1 d after surgery.Results MMSE scores were ＞ 24 at 1 d before anesthesia and 1 d after surgery in all the three groups,and there was no significant difference within each group and among the three groups (P ＞ 0.05).Compared with the baseline value,TMT completion time was significantly prolonged at 1 d after surgery in groups Ⅰ and Ⅲ,while shortened in group Ⅱ (P ＜ 0.05).Compared with groups Ⅰ and Ⅲ,TMT completion time was significantly shortened at 1 d after surgery in group Ⅱ (P ＜0.05).Conclusion The depth of sedation,40 ＜ BIS value ≤ 50,during combined intravenous-inhalational anesthesia with sevoflurane and remifentanil has less influence on postoperative cognitive function in patients undergoing gynecological laparoscopic surgery. Key words: Anesthesia, inhalation; Anesthesia, intravenous; Deep sedation; Cognition disorders; Postoperative complications