Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T18:10:37.408Z Has data issue: false hasContentIssue false
  • English
  • Français

Limitations of the Trail Making Test Part-B in Assessing Frontal Executive Dysfunction

Published online by Cambridge University Press:  20 February 2015

Edgar Chan ,
Sarah E. MacPherson ,
Gail Robinson ,
Martha Turner ,
Francesca Lecce ,
Tim Shallice  and
Lisa Cipolotti
Edgar Chan*
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom
Sarah E. MacPherson
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom Department of Psychology, University of Edinburgh, Scotland, United Kingdom
Gail Robinson
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom School of Psychology, University of Queensland, Brisbane, Australia
Martha Turner
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom Institute of Cognitive Neuroscience, University College, London, United Kingdom
Francesca Lecce
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom Institute of Cognitive Neuroscience, University College, London, United Kingdom
Tim Shallice
Affiliation:
Institute of Cognitive Neuroscience, University College, London, United Kingdom International School for Advanced Studies (SISSA), Trieste, Italy
Lisa Cipolotti
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom Dipartimento di Psicologia, University of Palermo, Italy
*
Correspondence and reprint requests to: Edgar Chan, Box 37, NHNN, Queen Square, London WC1N 3BG. E-mail edgar.chan@uclh.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Part B of the Trail Making Test (TMT-B) is one of the most widely used neuropsychological tests of “executive” function. A commonly held assumption is that the TMT-B can be used to detect frontal executive dysfunction. However, so far, research evidence has been limited and somewhat inconclusive. In this retrospective study, performance on the TMT-B of 55 patients with known focal frontal lesions, 27 patients with focal non-frontal lesions and 70 healthy controls was compared. Completion time and the number of errors made were examined. Patients with frontal and non-frontal lesions performed significantly worse than healthy controls for both completion time and the number of errors. However, there was no significant difference for both completion time and the number of errors when patients with frontal and non-frontal lesions were compared. Performance was also not significantly different between patients with focal lesions within different regions of the frontal lobe (orbital, left lateral, right lateral, medial). Our findings suggest that the TMT-B is a robust test for detection of brain dysfunction. However, its capacity for detecting frontal executive dysfunction appears rather limited. Clinicians should be cautious when drawing conclusions from performance on the TMT-B alone. (JINS, 2015, 21, 169–174)

Keywords

Frontal lobesFocal lesionsExecutive functionNeuropsychologyNeuropsychological testsBrain diseases
Type
Brief Communications
Information
Journal of the International Neuropsychological Society , Volume 21 , Issue 2 , February 2015 , pp. 169 - 174
Copyright
Copyright © The International Neuropsychological Society 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Army Individual Test Battery (1944). Manual of directions and scoring. Washington, DC: War Department, Adjutant General’s Office.Google Scholar
Bowie, C.R., & Harvey, P.D. (2006). Administration and interpretation of the trail making test. Nature Protocols, 1(5), 2277–2281.CrossRefGoogle ScholarPubMed
Cipolotti, L., Healy, C., Chan, E., Bolsover, F., Lecce, F., White, M., &Shallice, T. (2014). The impact of different aetiologies on the performance of frontal patients on cognitive tasks. Neuropsychologia, doi: 10.1016/j.neuropsychologia.2014.12.025 Google Scholar
Davidson, P.S.R., Gao, F.Q., Mason, W.P., Winocur, G., & Anderson, N.D. (2008). Verbal fluency, trail making, and Wisconsin Card Sorting Test performance following right frontal lobe tumor resection. Journal of Clinical and Experimental Neuropsychology, 30(1), 18–32.CrossRefGoogle ScholarPubMed
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). Delis-Kaplan executive function system (D-KEFS). San Antonio, TX: Psychological Corporation.Google Scholar
Demakis, G.J. (2004). Frontal lobe damage and tests of executive processing: A meta-analysis of the category test, stroop test, and trail-making test. Journal of Clinical and Experimental Neuropsychology, 26(3), 441–450.CrossRefGoogle ScholarPubMed
Ettlin, T.M., Kischka, U., Beckson, M., Gaggiotti, M., Rauchfleisch, U., & Benson, D.F. (2000). The frontal lobe score: Part 1: Construction of a mental status of frontal systems. Clinical Rehabilitation, 14(3), 260–271.CrossRefGoogle Scholar
Gallistel, C.R. (2009). The importance of proving the null. Psychological Review, 116(2), 439–453.CrossRefGoogle ScholarPubMed
Jacobson, S.C., Blanchard, M., Connolly, C.C., Cannon, M., & Garavan, H. (2011). An fMRI investigation of a novel analogue to the trail-making test. Brain and Cognition, 77, 60–70.Google Scholar
Lange, R.T., Iverson, G.L., Zakrzewski, M.J., Ethel-King, P.E., & Franzen, M.D. (2005). Interpreting the trail making test following traumatic brain injury: comparison of tradition time scores and derived indices. Journal of Clinical and Experimental Neuropsychology, 27, 897–890.CrossRefGoogle ScholarPubMed
Mahurin, R.K., Velligan, D.I., Hazleton, B., Davis, J.M., Eckert, S., & Miller, A.L. (2006). Trail making test errrors and executive function in schizophrenia and depression. The Clinical Neuropsychologist, 20, 271–288.CrossRefGoogle Scholar
Moll, J., de Oliveira-Souza, R., Moll, F.T., Bramati, I.E., & Andreiuolo, P.A. (2002). The cerebral correlates of set-shifting: An fMRI study of the trail making test. Arquivos de Neuro-psiquiatria, 60(4), 900–905.CrossRefGoogle ScholarPubMed
Murphy, P., Shallice, T., Robinson, G., MacPherson, S.E., Turner, M., Woollett, K., &Cipolotti, L. (2013). Impairments in proverb interpretation following focal frontal lobe lesions. Neuropsychologia, 51(11), 2075–2086.Google Scholar
Rasmusson, D.X., Zonderman, A.B., Kawas, C., & Resnick, S.M. (1998). Effects of age and dementia on the trail making test. The Clinical Neuropsychologist, 12(2), 169–178.CrossRefGoogle Scholar
Reitan, R.M., & Wolfson, D. (1995). Category test and trail making test as measures of frontal lobe functions. The Clinical Neuropsychologist, 9(1), 50–56.CrossRefGoogle Scholar
Robinson, G., Shallice, T., Bozzali, M., & Cipolotti, L. (2012). The differing roles of the frontal cortex in fluency tests. Brian, 135(7), 2202–2214.CrossRefGoogle ScholarPubMed
Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests: Administration, norms, and commentary (2nd ed.). New York: Oxford University Press.Google Scholar
Stuss, D.T., Bisschop, S.M., Alexander, M.P., Levine, B., Katz, D., & Izukawa, D. (2001). The Trail Making Test: A study in focal lesion patients. Psychological Assessment, 13(2), 230–239.Google Scholar
Tamez, E., Myerson, J., Morris, L., White, D.A., Baum, C., & Connor, L.T. (2011). Assessing executive abilities following acute stroke with the trail making test and digit span. Behavioural Neurology, 24, 177–185.CrossRefGoogle ScholarPubMed
Zakzanis, K.K., Mraz, R., & Graham, S.J. (2005). An fMRI study of the trail making test. Neuropsychologia, 43, 1878–1886.CrossRefGoogle ScholarPubMed