Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 27:14:1227578.
doi: 10.3389/fpsyg.2023.1227578. eCollection 2023.

Improving validity of the trail making test with alphabet support

Therese Händel Waggestad  1 , Bjørn Eivind Kirsebom  2   3 , Carsten Strobel  4 , Anders Wallin  5 , Marie Eckerström  5   6 , Tormod Fladby  7   8 , Jens Egeland  1   9
Affiliations

Improving validity of the trail making test with alphabet support

Therese Händel Waggestad et al. Front Psychol. .

Abstract

Objective: The Trail Making Test (TMT) is commonly used worldwide to evaluate cognitive decline and car driving ability. However, it has received critique for its dependence on the Latin alphabet and thus, the risk of misclassifying some participants. Alphabet support potentially increases test validity by avoiding misclassification of executive dysfunction in participants with dyslexia and those with insufficient automatization of the Latin alphabet. However, Alphabet support might render the test less sensitive to set-shifting, thus compromising the validity of the test. This study compares two versions of the TMT: with and without alphabet support.

Methods: We compared the TMT-A, TMT-B, and TMT-B:A ratios in two independent normative samples with (n = 220) and without (n = 64) alphabet support using multiple regression analysis adjusted for age and education. The sample comprised Scandinavians aged 70-84 years. Alphabet support was included by adding the Latin alphabet A-L on top of the page on the TMT-B. We hypothesized that alphabet support would not change the TMT-B:A ratio.

Results: After adjusting for age and years of education, there were no significant differences between the two samples in the TMT-A, TMT-B, or the ratio score (TMT-B:A).

Conclusion: Our results suggest that the inclusion of alphabet support does not alter TMT's ability to measure set-shifting in a sample of older Scandinavian adults.

Keywords: TMT ratio score; alphabet support; cultural fairness; dyslexia; fitness to drive; test-validity; trail making test.

PubMed Disclaimer

Conflict of interest statement

BK has served as a consultant for Biogen. ME works as independent reviewer for Medavante-Prophase. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparison of TMT-A (A), TMT-B (B) and TMT-B:A (C) between the DDI/G-MCI and NorFAST samples. Brackets illustrate non-significant (n.s.) group differences in performance at 𝛼=0.05.
See this image and copyright information in PMC

References

    1. Albinet C. T., Boucard G., Bouquet C. A., Audiffren M. (2012). Processing speed and executive functions in cognitive aging: how to disentangle their mutual relationship? Brain Cogn. 79, 1–11. doi: 10.1016/j.bandc.2012.02.001, PMID: - DOI - PubMed
    1. Arbuthnott K., Frank J. (2000). Trail making test, part B as a measure of executive control: validation using a set-switching paradigm. J. Clin. Exp. Neuropsychol. 22, 518–528. doi: 10.1076/1380-3395(200008)22:4;1-0;FT518 - DOI - PubMed
    1. Avila J. F., Verney S. P., Kauzor K., Flowers A., Mehradfar M., Razani J. (2019). Normative data for Farsi-speaking Iranians in the United States on measures of executive functioning. Appl. Neuropsychol. Adult 26, 229–235. doi: 10.1080/23279095.2017.1392963, PMID: - DOI - PMC - PubMed
    1. Burgess P. (1997). “Theory and methodology in executive function research. Burgess, P.W. (1997) theory and methodology in executive function research” in Theory and methodology of frontal and executive function. ed. Rabbitt P. (East Sussex, UK: Psychology Press; ), 81–116.
    1. Christidi F., Kararizou E., Triantafyllou N., Anagnostouli M., Zalonis I. (2015). Derived Trail making test indices: demographics and cognitive background variables across the adult life span. Aging Neuropsychol. Cognit. 22, 667–678. doi: 10.1080/13825585.2015.1027650 - DOI - PubMed

LinkOut - more resources