title: Trail Making Test predicts physical impairment and mortality in older persons.
abstract: OBJECTIVE
  To examine whether performance in the Trail Making Test (TMT) predicts mobility impairment and mortality in older persons.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Community-dwelling older persons enrolled in the Invecchiare in Chianti (InCHIANTI) Study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine and Sciences of Aging, Laboratory of Clinical Epidemiology, University G. D'Annunzio, Chieti, Italy.
authors.forename: Rosamaria
authors.initials: R
authors.lastname: Vazzana
authors.forename: Stefania
authors.initials: S
authors.lastname: Bandinelli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Lauretani
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpato
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lauretani
authors.forename: Angelo
authors.initials: A
authors.lastname: Di Iorio
authors.forename: Michele
authors.initials: M
authors.lastname: Abate
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Corsi
authors.forename: Yuri
authors.initials: Y
authors.lastname: Milaneschi
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D051346:Mobility Limitation; D009026:Mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods; D014145:Trail Making Test / Q000592:standards
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