To determine the cognitive ability (or to screen dementia) of an individual using Trail making test.
Trail making test (TMT) :
It was developed by Reitan, and the Turkish validity and reliability study was conducted by Türkeş et al.19,20 Trial Making Test (B) is a psychomotor measure to evaluate the cognitive control in a sense of ability to change the cognitive sets. To do this, participants are required to switch between numbers (1-13) and letters (A-L). The participants must draw a line between encircled numbers and letters. While they are in session the response time (RT) is recorded by the experimenter. The perseveration and the response time is the dependent variable to give an idea about the participants’ cognitive control.
History of Trail Making Test-
The test was used in 1944 for assessing general intelligence and was part of the Army Individual Test of General Ability. In the 1950s researchers began using the test to assess cognitive dysfunction stemming from brain damage, and it has since been incorporated into the Halstead-Reitan battery. The Trail Making Test is now commonly used as a diagnostic tool in clinical settings. Poor performance is known to be associated with many types of brain impairment, in particular frontal lobe lesions.
Parts of the Test
- Part- A The TMT Part A consists of 25 circles on a piece of paper with the numbers 1-25 written randomly in the circles.1 The test taker’s task is to start with number one and draw a line from that circle to the circle with the number two in it to the circle with the three in it, etc. The person continues to connect the circles in numerical order until they reach number 25.
- Part- B The TMT Part B consists of 24 circles on a piece of paper, but rather than all of the circles containing numbers, half of the circles have the numbers 1-12 in them and the other half (12) contain the letters A-L.1 The person taking the test has the more difficult task of drawing a line from one circle to the next in ascending order; however, he must alternate the circles with numbers in them (1-13) with circles with letters in them (A-L). In other words, he is to connect the circles in order like this: 1-A-2-B-3-C-4-D-5-E and so on.
Type/Purpose of Test: The purpose of the TMT is to test for the presence of brain injury. The TMT is a measure of attention, speed, and mental flexibility. It also tests spatial organization, visual pursuits, recall, and recognition. Part A requires the individual to draw lines to connect 25 encircled numbers distributed on a page. Part A tests visual scanning, numeric sequencing, and visuomotor speed. Part B is similar except the person must alternate between numbers and letters and is believed to be more difficult and takes longer to complete. Part B tests cognitive demands including visual motor and visual spatial abilities and mental flexibility. Both sections are timed and the score represents the amount of time required to complete the task.
Effectiveness of Screening :
The TMT measures attention, visual screening ability and processing speed, and is a good measure of overall cognitive functioning. Part A is a good measure of rote memory. Part B is generally quite sensitive to executive functioning since the test requires multiple abilities to complete it. The TMT Part B has also been suggested as a useful tool to evaluate if a loved one with dementia can safely drive since it requires visual ability, motor functioning, and cognitive processes.
According to the TMT directions for administration, an average score for the TMT Part A is 29 seconds and a deficient score is greater than 78 seconds.
For the TMT Part B, an average score is 75 seconds and a deficient score is greater than 273 seconds. The results of the TMT were found to be influenced significantly by age; as people age, they require a longer time to complete the TMT.
• Test-retest error: Once an individual has taken the test, he/she is familiar with it and will take less time to complete.
• Could be skewed towards more educated individuals.
• Instructions can be confusing for some individuals
• Can be frustrating for individuals if they lose track of where they are and cannot proceed
• Not occupation-based
• Results do not translate into or give clear picture of function; relies on therapist judgment to interpret findings
• Quick and easy to administer
• No training required
• Free, easy to get
• Tests specific cognitive processes
MATERIAL REQUIRED :
Pencil, Trial making sheets (A,B), and stopwatch.
PROCEDURE TO FIND THE PARTICIPANT-
The participant was chosen as random based on convenient family members as it was highly difficult to find a person suffering from or diagnosed with any neurological disorder or brain dysfunction.
The participant was first given a brief description of the test. He was also informed that this test would be conducted entirely at his own discretion which implies that he could decline his participation in this experiment if it was not convenient.
He was then given a consent form and all the relevant details related to the form were explained before soliciting the signature.
INFORMED CONSENT FORM
This form seeks to take your consent to participate in a study. The following will provide you with information about the study that will help you in deciding whether or not you wish to participate. If you agree to participate, please be aware that you are free to withdraw at any point throughout the duration of the experiment.
All information you provide will remain confidential and will not be associated with your name. If for any reason during this study you do not feel comfortable, you may leave the laboratory and your information will be discarded.
Your participation in this study will require approximately 5 minutes. When this study is complete you will be provided with the results of the experiment if you request them, and you will be free to ask any questions. Please indicate with your signature on the space below that you understand your rights and agree to participate in the experiment.
Your participation is solicited, yet strictly voluntary. All information will be kept confidential and your name will not be associated with any research findings.
SIGNATURE OF THE APPLICANT
A rapport was established before giving the instructions by giving him a brief detail of the study. It was also ensured that the details were explained to the participant in the language which was most agreeable to him.
All the arrangements regarding the experiment were arranged in an appropriate manner. The participant’s concerns if any were also managed for the smooth conduction of the experiment.
- NAME: abc
- AGE: 22
- GENDER: FEMALE
- DATE OF ADMINISTRATION OF THE TEST: 29TH NOVEMBER 2020.
Both parts of the Trail Making Test consist of 25 circles distributed over a sheet of paper. In Part A, the circles are numbered 1 – 25, and you’ll have to draw lines to connect the numbers in ascending order. In Part B, the circles include both numbers (1 – 13) and letters (A – L); as in Part A, you’ll draw lines to connect the circles in an ascending pattern, but with the added task of alternating between the numbers and letters (i.e., 1-A-2-B-3-C, etc.). You’ll have to connect the circles as quickly as possible, without lifting the pen or pencil from the paper. Time taken while connecting the “trail” will be noted down.
Step 1: The patient was provided with a copy of the Trail Making Test Part A worksheet and a pen or pencil.
Step 2: Demonstration of the test to the client was done using the sample sheet (Trail Making Part A – SAMPLE).
Step 3: Time was recorded as he or she followed the “trail” made by the numbers on the test.
Step 4: The client was made to correct the errors (if made).
Step 5: The same procedure for Trail Making Test Part B was repeated after this.
|Trail A||34.15 seconds|
|Trail B||44.30 seconds|
Table 1 represents the different trails taken by the participant with their time taken to complete the task.
INTERPRETATION AND DISCUSSION :
Performance on the TMT is considered a robust correlate of overall measures of intelligence and a particularly sensitive indicator of neurological impairment. Normal, healthy adults often show declines in cognitive performance across a number of cognitive domains with aging and the TMT follows a pattern similar to most tests that have a motor speed component. In an elderly sample, increased times to complete both parts A and B were found in the absence of motor or sensory deficits, which suggests that the TMT is sensitive to normal age-related declines in concentration, vigilance, and visuospatial ability that occur in later life. Age, education, and occupation are related to performance on the TMT, and separate norms have been presented with these sociodemographic factors in mind.
The time taken by the participant to complete Part A is 34.15 seconds i.e. the average time taken by an individual. It depicts no cognitive impairment. The time taken by the participant to complete Part B is 44.30 seconds, this part is more cognitively complex still the participant took the average time which means there is no cognitive impairment in her. This also means the client is not suffering from Dementia and doing well in her life.
The aim of this test was to assess whether the client is having dementia by assessing cognition. After the conduction of the test, the results concluded that the client shows absence of any motor, sensory or cognitive impairment.