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Special Test

Trail Making Test

The Trail Making Test (TMT) is a neuropsychological test that assesses visual attention and task switching. It is commonly used to evaluate cognitive function, particularly in areas such as processing speed, sequencing, mental flexibility, and executive functioning.

This test was introduced by Ralph Reitan, an American neuropsychologist. In 1944, it was used for assessing general intelligence, and was part of the Army Individual Test. Starting from 1950s researchers began using the test to assess cognitive dysfunction stemming from brain damage.

How do you perform the Trail Making Test?

The test consists of two parts, referred to as Trail Making Test Part A and Part B.

  1. Trail Making Test Part A:
  • In this part, the participant is presented with a sheet of paper containing 25 circles numbered 1 to 25.
  • The task is to draw lines to connect the numbers in ascending order (1 to 2, 2 to 3, and so on) as quickly as possible.
  • The participant must not lift the pencil from the paper while drawing lines.
  • The primary measure is the time taken to complete the task.
  1. Trail Making Test Part B:
  • In Part B, the paper contains 25 circles as well, but this time they are filled with both numbers (1-13) and letters (A-L).
  • The participant’s task is to draw lines to connect the circles in an alternating numeric and alphabetic sequence (1-A-2-B-3-C, etc.) as quickly as possible.
  • Like Part A, the participant should not lift the pencil from the paper while connecting the circles.
  • The primary measure in this part is also the time taken to complete the task.
See Also: Cognitive Tests & Assessments
Trail Making Test TMT

What is a normal Trail Making Test?

The test is scored based on the time taken to complete each part, for example, if the patient took 50 seconds to complete the task, the score is 50.

A normal Trail Making Test (TMT) result refers to performance on the test that falls within the expected range for an individual of a given age and educational background. The TMT, which includes Part A and Part B, is influenced by factors such as age, education, and general cognitive function. Therefore, what is considered normal can vary significantly among different individuals.

  1. Part A: Generally involves connecting numbered dots in sequence as quickly as possible. A normal range for this part of the test is typically shorter in duration, indicating faster processing speed. However, the expected time can vary based on the individual’s age and educational level. Older adults or individuals with less education may take longer to complete this task compared to younger adults or those with more education.
  2. Part B: Involves alternating between numbers and letters (e.g., 1-A-2-B-3-C, etc.). This part of the test is more complex and typically takes longer to complete than Part A. Again, “normal” performance varies with age and education. Older adults or those with less education might take more time to complete Part B than younger or more educated individuals.

Errors are noted, but the primary focus is on the speed of completion. Longer completion times or making errors can indicate difficulties in the cognitive functions being assessed.

References & More

  1. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
  2. Varjacic A, Mantini D, Demeyere N, Gillebert CR. Neural signatures of Trail Making Test performance: Evidence from lesion-mapping and neuroimaging studies. Neuropsychologia. 2018 Jul 1;115:78-87. doi: 10.1016/j.neuropsychologia.2018.03.031. Epub 2018 Mar 27. PMID: 29596856; PMCID: PMC6018614. Pubmed
  3. Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills. 1958;8(3):271–276
  4. Llinàs-Reglà J, Vilalta-Franch J, López-Pousa S, Calvó-Perxas L, Torrents Rodas D, Garre-Olmo J. The Trail Making Test. Assessment. 2017 Mar;24(2):183-196. doi: 10.1177/1073191115602552. Epub 2016 Jul 28. PMID: 26318386. Pubemd
Last Reviewed
January 20, 2024
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

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