title: The Effects of Aging, Malingering, and Traumatic Brain Injury on Computerized Trail-Making Test Performance.
abstract: The trail making test (TMT) is widely used to assess speed of processing and executive function. However, normative data sets gathered at different sites show significant inconsistencies. Here, we describe a computerized version of the TMT (C-TMT) that increases the precision and replicability of the TMT by permitting a segment-by-segment analysis of performance and separate analyses of dwell-time, move-time, and error time. Experiment 1 examined 165 subjects of various ages and found that completion times on both the C-TMT-A (where subjects connect successively numbered circles) and the C-TMT-B (where subjects connect circles containing alternating letters and numbers) were strongly influenced by age. Experiment 2 examined 50 subjects who underwent three test sessions. The results of the first test session were well fit by the normative data gathered in Experiment 1. Sessions 2 and 3 demonstrated significant learning effects, particularly on the C-TMT-B, and showed good test-retest reliability. Experiment 3 examined performance in subjects instructed to feign symptoms of traumatic brain injury: 44% of subjects produced abnormal completion times on the C-TMT-A, and 18% on the C-TMT-B. Malingering subjects could be distinguished from abnormally slow controls based on (1) disproportionate increases in dwell-time on the C-TMT-A, and (2) greater deficits on the C-TMT-A than on the C-TMT-B. Experiment 4 examined the performance of 28 patients with traumatic brain injury: C-TMT-B completion times were slowed, and TBI patients showed reduced movement velocities on both tests. The C-TMT improves the reliability and sensitivity of the trail making test of processing speed and executive function.
authors.affiliation: Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America; University of California Davis, Department of Neurology, 4860 Y St., Suite 3700, Sacramento, CA, 95817, United States of America; Center for Neurosciences, University of California Davis, 1544 Newton Ct., Davis, CA, 95616, United States of America; Center for Mind and Brain, University of California Davis, 202 Cousteau Place, Suite 201, Davis, CA, 95616, United States of America.
authors.forename: David L
authors.initials: DL
authors.lastname: Woods
authors.affiliation: Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America.
authors.forename: John M
authors.initials: JM
authors.lastname: Wyma
authors.affiliation: Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Herron
authors.affiliation: Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America.
authors.forename: E William
authors.initials: EW
authors.lastname: Yund
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D001930:Brain Injuries / Q000503:physiopathology*; D003201:Computers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014145:Trail Making Test; D055815:Young Adult