title: Alternative type of the trail making test in nonnative English-speakers: the trail making test-black & white.
abstract: OBJECTIVE
  The Trail Making Test (TMT) has its limitations when applied to Eastern cultures due to its reliance on the alphabet. We looked for an alternative tool that is reliable and distinguishable like the TMT and devised the Trail Making Test Black & White (TMT-B&W) as a new variant. This study identifies the applicability of the TMT-B&W as a useful neuropsychological tool and determines whether the TMT-B&W could play an equivalent role as the TMT.
  
  
  METHODS
  The TMT-B&W uses numbers encircled by black or white circles as stimuli, instead of using the alphabet. A total of 138 participants were including containing groups of 31 cognitively normal controls (NC), 55 mild cognitive impairment (MCI), and 52 people with Alzheimer's disease (AD). Along with the TMT-B&W, the TMT and other neuropsychological tests were administered to all subjects.
  
  
  RESULTS
  A considerably low dropout rate for TMT B&W demonstrates that all participants were more willingly engaged in the TMT B&W than the TMT. In particular, subjects with cognitive impairments or lower levels of education performed better on the TMT-B&W than the TMT. The difference in time-to-completion of the TMT-B&W was significant according to the level of cognitive impairment. The TMT-B&W revealed a high correlation with the TMT and frontal lobe function test.
  
  
  CONCLUSIONS
  The TMT-B&W is as reliable and effective as the TMT. It is worth developing a new variant of the TMT.
authors.affiliation: Clinical Neuroscience Institute, Seoul National University Bundang Hospital, Bundang-gu, Seoungnam-si, Kyeonggi-do, Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Clinical Neuroscience Institute, Seoul National University Bundang Hospital, Bundang-gu, Seoungnam-si, Kyeonggi-do, Korea.
authors.forename: Min Jae
authors.initials: MJ
authors.lastname: Baek
authors.affiliation: Clinical Neuroscience Institute, Seoul National University Bundang Hospital, Bundang-gu, Seoungnam-si, Kyeonggi-do, Korea ; Department of Neurology, Seoul National University Bundang Hospital, Bundang-gu, Seoungnam-si, Kyeonggi-do, Korea.
authors.forename: Sangyun
authors.initials: S
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology / Q000523:psychology*; D016022:Case-Control Studies; D060825:Cognitive Dysfunction / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013647:Task Performance and Analysis; D013997:Time Factors; D014145:Trail Making Test