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Administration and interpretation of the Trail Making Test


Measurement of cognitive functions is an increasingly important goal for clinicians and researchers. Many neuropsychological test batteries are comprehensive and require specialized training to administer and interpret. The Trail Making Test is an accessible neuropsychological instrument that provides the examiner with information on a wide range of cognitive skills and can be completed in 5–10 min. Its background, psychometric properties, administration procedures and interpretive guidelines are provided in this protocol.

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  1. 1

    Army Individual Test Battery. Manual of Directions and Scoring. War Department, Adjutant General's Office, Washington, DC (1994).

  2. 2

    Reitan, R.M. & Wolfson, D. The Halstead–Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation 2nd edn (Neuropsychology Press, Tuscon, AZ, 1993).

    Google Scholar 

  3. 3

    Spreen, O. & Strauss, E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary edn. Oxford University Press, New York, 1998).

    Google Scholar 

  4. 4

    Thompson, M.D. et al. Clinical utility of the Trail Making Test practice time. Clin. Neuropsychol. 13, 450–455 (1999).

    CAS  Article  Google Scholar 

  5. 5

    Klusman, L.E., Cripe, L.I. & Dodrill, C.B. Analysis of errors on the Trail Making Test. Percept. Mot. Skills 68, 1199–1204 (1989).

    CAS  Article  Google Scholar 

  6. 6

    Crowe, S.F. The differential contribution of mental tracking, cognitive flexibility, visual search, and motor speed to performance on parts A and B of the Trail Making Test. J. Clin. Psychol. 54, 585–591 (1998).

    CAS  Article  Google Scholar 

  7. 7

    Gaudino, E.A., Geisler, M.W. & Squires, N.K. Construct validity in the Trail Making Test: what makes trail B harder? J. Clin. Exp. Neuropsychol. 17, 529–525 (1995).

    CAS  Article  Google Scholar 

  8. 8

    Arbuthnott, K. & Frank, J. Trail making test, part B as a measure of executive control: validation using a set-switching paradigm. J. Clin. Exp. Neuropsychol. 22, 518–528 (2000).

    CAS  Article  Google Scholar 

  9. 9

    Kortte, K.B., Horner, M.D. & Windham, W.K. The trail making test, part B: cognitive flexibility or ability to maintain set? Appl. Neuropsychol. 9, 106–109 (2002).

    Article  Google Scholar 

  10. 10

    Reitan, R.M. & Wolfson, D. Category test and trail making test as measures of frontal lobe functions. Clin. Neuropsychol. 10, 375–381 (1995).

    Article  Google Scholar 

  11. 11

    Waldmann, B.W., Dickson, A.L., Monahan, M.C. & Kazelskis, R. The relationship between intellectual abilities and adult performance on the Trail Making Test and the Symbol Digit Modalities Test. J. Clin. Psychol. 48, 360–363 (1992).

    CAS  Article  Google Scholar 

  12. 12

    Steinberg, B.A., Bieliauskas, L.A., Smith, G.E. & Ivnik, R.J. Mayo's older Americans normative studies: age- and IQ-adjusted norms for the Trail Making Test, the Stroop Test, and the MAE Controlled Oral Word Association Test. Clin. Neuropsychol. 19, 329–377 (2005).

    Article  Google Scholar 

  13. 13

    Reitan, R.M. & Wolfson, D. The Trail Making Test as an initial screening procedure for neuropsychological impairment in older children. Arch. Clin. Neuropsychol. 19, 281–288 (2004).

    Article  Google Scholar 

  14. 14

    Robins Wahlin, T.B., Backman, L., Wahlin, A. & Winblad, B. Trail Making Test performance in a community-based sample of healthy very old adults: effects on age and completion time, but not on accuracy. Arch. Gerontol. Geriatr. 22, 87–102 (1996).

    CAS  Article  Google Scholar 

  15. 15

    Amodio, P. et al. Variability of trail making test, symbol digit test and line trait test in normal people. A normative study taking into account age-dependent decline and sociobiological variables. Aging Clin. Exp. Res. 14, 117–131 (2002).

    Article  Google Scholar 

  16. 16

    Segalowitz, S.J., Unsal, A. & Dywan, J. CNV evidence for the distinctiveness of frontal and posterior neural processes in a traumatic brain injured population. J. Clin. Exp. Neuropsychol. 14, 545–565 (1992).

    CAS  Article  Google Scholar 

  17. 17

    Moll, J. deO. -S., Moll, F.T., Bramati, I.E. & Andreiuolo, P.A. The cerebral correlates of set-shifting: an fMRI study of the trail making test. Arqui Neuropsiquiatria 60, 900–905 (2002).

    Article  Google Scholar 

  18. 18

    Zakzanis, K.K., Mraz, R. & Graham, S.J. An fMRI study of the Trail Making Test. Neuropsychologia 43, 1878–1886 (2005).

    Article  Google Scholar 

  19. 19

    Marshall, G.A., Hendrickson, R., Kaufer, D.I., Ivanco, L.S. & Bohnen, N.I. Cognitive correlates of brain MRI subcortical signal hyperintensities in non-demented elderly. Int. J. Geriatr. Psychiatry 21, 32–35 (2006).

    Article  Google Scholar 

  20. 20

    Kadir, A., Almkvist, O., Wall, A., Langstrom, B. & Nordberg, A. PET imaging of cortical (11)C-nicotine binding correlates with the cognitive function of attention in Alzheimer's disease. Psychopharmacology 188, 509–520 (2006).

    CAS  Article  Google Scholar 

  21. 21

    Warner, T.D. et al. Diffusion tensor imaging of frontal white matter and executive functioning in cocaine-exposed children. Pediatrics 118, 2014–2024 (2006).

    Article  Google Scholar 

  22. 22

    D'Elia, L. & Satz, P. Color Trails 1 and 2. (Psychological Assessment Resources, Odessa, FL, 1989).

    Google Scholar 

  23. 23

    Dugbartey, A.T., Townes, B.D. & Mahurin, R.K. Equivalence of the Color Trials Test and Trail Making Test in nonnative English-speakers. Arch. Clin. Neuropsychol. 15, 425–431 (2000).

    CAS  Article  Google Scholar 

  24. 24

    Lee, T.M. & Chan, C.C. Are trail making and color trails tests of equivalent constructs? J. Clin. Exp. Neuropsychol. 22, 529–534 (2000).

    CAS  Article  Google Scholar 

  25. 25

    Ricker, J.H. & Axelrod, B.N. Analysis of an oral paradigm for the Trail Making Test. Assessment 1, 47–51 (1994).

    CAS  Article  Google Scholar 

  26. 26

    LoSasso, G.L., Rapport, L.J., Axelrod, B.N. & Reeder, K.P. Intermanual and alternate-form equivalence on trail making tests. J. Clin. Exp. Neuropsychol. 20, 107–110 (1998).

    CAS  Article  Google Scholar 

  27. 27

    Stuss, D.T., Stethem, L.L. & Poirier, C.A. Comparison of the three tests of attention and rapid information processing across six age groups. Clin. Neuropsychol. 1, 139–152 (1987).

    Article  Google Scholar 

  28. 28

    Basso, M.R., Bornstein, R.A. & Lang, J.M. Practice effects on commonly used measures of executive function across twelve months. Clin. Neuropsychol. 13, 283–292 (1999).

    CAS  Article  Google Scholar 

  29. 29

    Abe, M. et al. Normative data on tests for frontal lobe functions: Trail Making Test, verbal fluency, Wisconsin Card Sorting Test. No To Shinkei 56, 567–574 (2004).

    PubMed  Google Scholar 

  30. 30

    Giovagnoli, A.R. et al. Trail making test: normative values from 287 normal adult controls. Ital. J. Neurol. Sci. 17, 305–309 (1996).

    CAS  Article  Google Scholar 

  31. 31

    Frazen, M.D., Paul, D. & Iverson, G.L. Cross-validation of the alternate forms reliability of the Trail Making Test. Clin. Neuropsychol. 10, 125–129 (1996).

    Article  Google Scholar 

  32. 32

    Charter, R.A., Adkins, T.G., Alekoumbides, A. & Seacat, G.F. Reliability of the WAIS, WMS, and Reitan Battery: raw scores and standardized scores corrected for age and education. Int. J. Clin. Neuropsychol. 9, 28–32 (1987).

    Google Scholar 

  33. 33

    Tombaugh, T.N. Trail Making Test A and B: normative data stratified by age and education. Arch. Clin. Neuropsychol. 19, 203–214 (2004).

    Article  Google Scholar 

  34. 34

    Heaton, R.K., Avitable, N., Grant, I. & Matthews, G. Further crossvalidation of regression-based neuropsychological norms with an update for the Boston Naming Test. J. Clin. Exp. Neuropsychol. 21, 572–582 (1999).

    CAS  Article  Google Scholar 

  35. 35

    Dikmen, S., McLean, A., Temkin, N.R. & Wyler, A. Neuropsychological outcome at one-month postinjury. Arch. Phys. Med. Rehabil. 67, 507–513 (1986).

    CAS  PubMed  Google Scholar 

  36. 36

    Dikmen, S.S., Machamer, J.E., Winn, R. & Temkin, N.R. Neuropsychological outcome 1-year post head injury. Neuropsychology 9, 80–90 (1995).

    Article  Google Scholar 

  37. 37

    Rohling, M.L., Meyers, J.E. & Millis, S.R. Neuropsychological impairment following traumatic brain injury: a dose–response analysis. Clin. Neuropsychol. 17, 289–302 (2003).

    Article  Google Scholar 

  38. 38

    Lange, R.T., Iverson, G.L., Zakrzewski, M.J., Ethel-King, P.E. & Franzen, M.D. Interpreting the trail making test following traumatic brain injury: comparison of tradition time scores and derived indices. J. Clin. Exp. Neuropsychol. 27, 897–906 (2005).

    Article  Google Scholar 

  39. 39

    Klusman, L.E., Cripe, L.I. & Dodrill, C.B. Analysis of errors on the Trial Making Test. Percept. Motor Skills 68, 1199–1204 (1989).

    CAS  Article  Google Scholar 

  40. 40

    Ruffolo, L.F., Guilmette, T.J. & Willis, W.J. Comparison of time and error rates on the Trail Making Test among patients with head injuries, experimental malingerers, patients with suspected effort on testing, and normal controls. Clin. Neuropsychol. 14, 223–230 (2000).

    CAS  Article  Google Scholar 

  41. 41

    Ip, R.Y., Dornan, J. & Schentag, C. Traumatic brain injury: factors predicting return to work or school. Brain Inj. 9, 517–532 (1995).

    CAS  Article  Google Scholar 

  42. 42

    Boake, C. et al. Using early neuropsychologic testing to predict long-term productivity outcome from traumatic brain injury. Arch. Phys. Med. Rehabil. 82, 761–768 (2001).

    CAS  Article  Google Scholar 

  43. 43

    Atchison, T.B. et al. Relationship between neuropsychological test performance and productivity at 1-year following traumatic brain injury. Clin. Neuropsychol. 18, 249–265 (2004).

    Article  Google Scholar 

  44. 44

    Amieva, H. et al. Analysis of error types in the trail making test evidences an inhibitory deficit in the Alzheimer type. J. Clin. Exp. Neuropsychol. 20, 280–285 (1998).

    CAS  Article  Google Scholar 

  45. 45

    Stuss, D.T. et al. The Trail Making Test: a study of focal lesion patients. Psychol. Assess. 13, 230–239 (2001).

    CAS  Article  Google Scholar 

  46. 46

    Zimmerman, M.E., DelBello, M.P., Getz, G.E., Shear, P.K. & Strakowski, S.M. Anterior cingulate subregion volumes and executive function in bipolar disorder. Bipolar Disord. 8, 281–288 (2006).

    Article  Google Scholar 

  47. 47

    Torrent, C. et al. Cognitive impairment in bipolar II disorder. Br. J. Psychiatry 189, 254–259 (2006).

    Article  Google Scholar 

  48. 48

    Borkowska, A. & Rybakowski, J.K. Neuropsychological frontal lobe tests indicate that bipolar depressed patients are more impaired than unipolar. Bipolar Disord. 3, 88–94 (2001).

    CAS  Article  Google Scholar 

  49. 49

    Martinez-Aran, A. et al. Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome. Psychother. Psychosom. 71, 39–46 (2002).

    CAS  Article  Google Scholar 

  50. 50

    Heinrichs, R.W. & Zakzanis, K.K. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426–445 (1998).

    CAS  Article  Google Scholar 

  51. 51

    Rybakowski, J.K. & Borkowska, A. Eye movement and neuropsychological studies in first degree relatives of schizophrenia patients. Schizophr. Res. 54, 105–110 (2002).

    Article  Google Scholar 

  52. 52

    Wolwer, W. & Gaebel, W. Impaired Trail-Making Test-B performance in patients with acute schizophrenia is related to inefficient sequencing of planning and acting. J. Psychiatr. Res. 36, 407–416 (2002).

    Article  Google Scholar 

  53. 53

    Wolwer, W., Falkai, P., Streit, M. & Gaebel, W. Trait characteristic of impaired visuomotor integration during Trail-Making Test B performance in schizophrenia. Neuropsychobiology 48, 59–67 (2003).

    Article  Google Scholar 

  54. 54

    Novak, T.A. et al. UFOV performance and driving ability following traumatic brain injury. Brain Inj. 20, 455–461 (2006).

    Article  Google Scholar 

  55. 55

    Radford, K.A. & Linconln, N.B. Concurrent validity of the stroke drivers screening assessment. Arch. Phys. Med. Rehabil. 85, 324–328 (2004).

    Article  Google Scholar 

  56. 56

    Uc, E.Y. et al. Impaired visual search in drivers with Parkinson's disease. Ann. Neurol. 60, 407–413 (2006).

    Article  Google Scholar 

  57. 57

    Dickinson, D., Ramsey, M.B. & Gold, J.M. Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Arch. Gen. Psychiatry (in the press).

  58. 58

    Gold, J.M., Goldberg, R.W., McNary, S.W., Dixon, L.B. & Lehman, A.F. Cognitive correlates of job tenure among patients with severe mental illness. Am. J. Psychiatry 159, 1395–1402 (2002).

    Article  Google Scholar 

  59. 59

    Keefe, R.S. et al. Baseline neurocognitive deficits in the CATIE schizophrenia trial. Neuropsychopharmacology 31, 2033–2046 (2006).

    Article  Google Scholar 

  60. 60

    Borkowska, A. & Rybakowski, J.K. Does risperidone act better in schizophrenic patients who have a family or obstetric history? Prog. Neuropsychopharmacol. Biol. Psychiatry 26, 1349–1353 (2002).

    CAS  Article  Google Scholar 

  61. 61

    Harvey, P.D., Napolitano, J.A., Mao, L. & Gharabawi, G. Comparative effects of risperidone and olanzapine on cognition in patients with schizophrenia or schizoaffective disorder. Int. J. Geriatr. Psychiatry 18, 820–829 (2003).

    Article  Google Scholar 

  62. 62

    Harvey, P.D., Siu, C.O. & Romano, S. Randomized, controlled, double-blind, multicenter comparison of the cognitive effects of ziprasidone versus olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder. Psychopharmacology 172, 324–332 (2003).

    Article  Google Scholar 

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Correspondence to Philip D Harvey.

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Bowie, C., Harvey, P. Administration and interpretation of the Trail Making Test. Nat Protoc 1, 2277–2281 (2006).

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