Abstract
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Army Individual Test Battery. Manual of Directions and Scoring. War Department, Adjutant General's Office, Washington, DC (1994).
Reitan, R.M. & Wolfson, D. The Halstead–Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation 2nd edn (Neuropsychology Press, Tuscon, AZ, 1993).
Spreen, O. & Strauss, E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary edn. Oxford University Press, New York, 1998).
Thompson, M.D. et al. Clinical utility of the Trail Making Test practice time. Clin. Neuropsychol. 13, 450–455 (1999).
Klusman, L.E., Cripe, L.I. & Dodrill, C.B. Analysis of errors on the Trail Making Test. Percept. Mot. Skills 68, 1199–1204 (1989).
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).
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).
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).
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).
Reitan, R.M. & Wolfson, D. Category test and trail making test as measures of frontal lobe functions. Clin. Neuropsychol. 10, 375–381 (1995).
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).
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).
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).
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).
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).
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).
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).
Zakzanis, K.K., Mraz, R. & Graham, S.J. An fMRI study of the Trail Making Test. Neuropsychologia 43, 1878–1886 (2005).
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).
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).
Warner, T.D. et al. Diffusion tensor imaging of frontal white matter and executive functioning in cocaine-exposed children. Pediatrics 118, 2014–2024 (2006).
D'Elia, L. & Satz, P. Color Trails 1 and 2. (Psychological Assessment Resources, Odessa, FL, 1989).
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).
Lee, T.M. & Chan, C.C. Are trail making and color trails tests of equivalent constructs? J. Clin. Exp. Neuropsychol. 22, 529–534 (2000).
Ricker, J.H. & Axelrod, B.N. Analysis of an oral paradigm for the Trail Making Test. Assessment 1, 47–51 (1994).
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).
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).
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).
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).
Giovagnoli, A.R. et al. Trail making test: normative values from 287 normal adult controls. Ital. J. Neurol. Sci. 17, 305–309 (1996).
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).
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).
Tombaugh, T.N. Trail Making Test A and B: normative data stratified by age and education. Arch. Clin. Neuropsychol. 19, 203–214 (2004).
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).
Dikmen, S., McLean, A., Temkin, N.R. & Wyler, A. Neuropsychological outcome at one-month postinjury. Arch. Phys. Med. Rehabil. 67, 507–513 (1986).
Dikmen, S.S., Machamer, J.E., Winn, R. & Temkin, N.R. Neuropsychological outcome 1-year post head injury. Neuropsychology 9, 80–90 (1995).
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).
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).
Klusman, L.E., Cripe, L.I. & Dodrill, C.B. Analysis of errors on the Trial Making Test. Percept. Motor Skills 68, 1199–1204 (1989).
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).
Ip, R.Y., Dornan, J. & Schentag, C. Traumatic brain injury: factors predicting return to work or school. Brain Inj. 9, 517–532 (1995).
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).
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).
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).
Stuss, D.T. et al. The Trail Making Test: a study of focal lesion patients. Psychol. Assess. 13, 230–239 (2001).
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).
Torrent, C. et al. Cognitive impairment in bipolar II disorder. Br. J. Psychiatry 189, 254–259 (2006).
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).
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).
Heinrichs, R.W. & Zakzanis, K.K. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426–445 (1998).
Rybakowski, J.K. & Borkowska, A. Eye movement and neuropsychological studies in first degree relatives of schizophrenia patients. Schizophr. Res. 54, 105–110 (2002).
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).
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).
Novak, T.A. et al. UFOV performance and driving ability following traumatic brain injury. Brain Inj. 20, 455–461 (2006).
Radford, K.A. & Linconln, N.B. Concurrent validity of the stroke drivers screening assessment. Arch. Phys. Med. Rehabil. 85, 324–328 (2004).
Uc, E.Y. et al. Impaired visual search in drivers with Parkinson's disease. Ann. Neurol. 60, 407–413 (2006).
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).
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).
Keefe, R.S. et al. Baseline neurocognitive deficits in the CATIE schizophrenia trial. Neuropsychopharmacology 31, 2033–2046 (2006).
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).
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).
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).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Bowie, C., Harvey, P. Administration and interpretation of the Trail Making Test. Nat Protoc 1, 2277–2281 (2006). https://doi.org/10.1038/nprot.2006.390
Published:
Issue Date:
DOI: https://doi.org/10.1038/nprot.2006.390
This article is cited by
-
Body composition is related to cognitive function among young adults in Ghana
BMC Psychology (2024)
-
Polygenic effects on brain functional endophenotype for deficit and non-deficit schizophrenia
Schizophrenia (2024)
-
Effect of Cenobamate on Cognition in Patients with Drug-Resistant Epilepsy with Focal Onset Seizures: An Exploratory Study
CNS Drugs (2024)
-
New balance capability index as a screening tool for mild cognitive impairment
BMC Geriatrics (2023)
-
Minding your steps: a cross-sectional pilot study using foot-worn inertial sensors and dual-task gait analysis to assess the cognitive status of older adults with mobility limitations
BMC Geriatrics (2023)
Comments
By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.