title: Lowering the Floor on Trail Making Test Part B: Psychometric Evidence for a New Scoring Metric.
abstract: The Trail Making Test Part B (TMT-B) is widely used in clinical and research settings as a measure of executive function. Standard administration allows a maximal time score (i.e., floor score) of 300 s. This practice potentially masks performance variability among cognitively impaired individuals who cannot complete the task. For example, performances that are nearly complete receive the same 300-s score as a performance of only a few moves. Such performance differences may have utility in research and clinical settings. To address this, we propose a new TMT-B efficiency metric designed to capture clinically relevant performance variability below the standard administration floor. Our metric takes into account time, correct moves, and errors of commission and omission. We demonstrate that the metric has concurrent validity, permits statistical analysis of performances that fall below the test floor, and captures clinically relevant performance variability missed by alternative methods.
authors.affiliation: Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA Providence Veterans Affairs Medical Center, Providence, RI 02908, USA stephen.correia@va.gov.
authors.forename: Stephen
authors.initials: S
authors.lastname: Correia
authors.affiliation: Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA The Miriam Hospital, Providence, RI 02906, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Ahern
authors.affiliation: Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Rabinowitz
authors.affiliation: Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Farrer
authors.affiliation: Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Ashley K
authors.initials: AK
authors.lastname: Smith Watts
authors.affiliation: Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA Department of Neurology, Alpert Medical School of Brown University, Providence, RI 02903, USA Butler Hospital, Providence, RI 02906, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Salloway
authors.affiliation: Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA Butler Hospital, Providence, RI 02906, USA.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Malloy
authors.affiliation: School of Engineering, Brown University, Providence, RI 02903, USA Department of Radiology, School of Medicine, University of Colorado, Aurora, CO, 80045, USA.
authors.forename: Sean C L
authors.initials: SC
authors.lastname: Deoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D011594:Psychometrics; D012016:Reference Values; D018709:Statistics, Nonparametric; D014145:Trail Making Test
keywords: Alzheimer's disease; Executive function; Mild cognitive impairment