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Regression-based normative data and equivalent scores for Trail Making Test (TMT): an updated Italian normative study

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Abstract

Objectives

The Trail Making Test (TMT) is widely used to assess psychomotor speed and attentional set-shifting. Since the regression-based norms and equivalent scores (ESs) for the TMT Italian version trace back to more than 20 years ago, we aimed at providing updated normative data for basic (Part A and Part B) and derived (Score B-A and Score B/A) TMT scores collected in a larger sample with an extended age range.

Methods

Three hundred fifty-five Italian volunteers stratified for sex (166 men), age decades (age range 20–90 years), and educational level (from primary school to university) completed the TMT and the Montreal Cognitive Assessment (MoCA).

Results

Multiple linear regression analyses revealed that age and educational level significantly influenced performances on basic and derived TMT scores except for B/A, which was associated only with the educational level. From the derived linear equations, correction grids for basic and derived TMT raw scores were developed. Inferential cutoff scores, estimated using a non-parametric technique, and ES were computed. Basic and derived TMT scores showed a good test–retest reliability (all rs ≥ 0.50); Part B (rs = − 0.48, p < 0.001) and Score B-A (rs = − 0.49, p < 0.001) were moderately associated with MoCA total score.

Conclusions

This study confirms the association of basic and derived TMT raw scores with sociodemographic variables and provides updated correction grids and ES for assessing the attentional/executive functions in clinical and research fields.

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References

  1. US War Department AGsO (1944) The new Army Individual Test of General Mental Ability. Psychol Bull 41:532–538

    Article  Google Scholar 

  2. Lezak MD (1995) Neuropsychological assessment, 3rd edn. Oxford University Press, New York

    Google Scholar 

  3. Spreen O, Strauss E (1998) A compendium of neuropsychological tests: administration, norms, and commentary, 3rd edn. Oxford University Press, New York

    Google Scholar 

  4. Reitan R, Wolfson D (1993) The Halstead-Reitan neuropsychological test battery: theory and clinical interpretation. Neuropsychology Press, Tucson

    Google Scholar 

  5. Crowe SF (1998) 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

    Article  CAS  PubMed  Google Scholar 

  6. Sánchez-Cubillo I, Periáñez JA, Adrover-Roig D, Rodríguez-Sánchez JM, Ríos-Lago M, Tirapu J, Barceló F (2009) Construct validity of the Trail Making Test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. J Int Neuropsychol Soc 15:438–450. https://doi.org/10.1017/S1355617709090626

    Article  PubMed  Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. Bezdicek O, Motak L, Axelrod BN, Preiss M, Nikolai T, Vyhnalek M, Poreh A, Ruzicka E (2012) Czech version of the Trail Making Test: normative data and clinical utility. Arch Clin Neuropsychol 27:906–914. https://doi.org/10.1093/arclin/acs084

    Article  PubMed  Google Scholar 

  9. Moll J, de Oliveira-Souza R, Moll FT, Bramati IE, Andreiuolo PA (2002) The cerebral correlates of set-shifting: an fMRI study of the trail making test. Arq Neuropsiquiatr 60:900–905

    Article  PubMed  Google Scholar 

  10. Jacobson SC, Blanchard M, Connolly CC, Cannon M, Garavan H (2011) An fMRI investigation of a novel analogue to the Trail-Making Test. Brain Cogn 77:60–70. https://doi.org/10.1016/j.bandc.2011.06.001

    Article  PubMed  Google Scholar 

  11. Armitage SG (1946) An analysis of certain psychological tests used for the evaluation of brain damage. J Gerontol 60:30–34

    Google Scholar 

  12. Reitan RM (1958) Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 8:271–276

    Article  Google Scholar 

  13. Cangoz B, Karakoc E, Selekler K (2009) Trail Making Test: normative data for Turkish elderly population by age, sex and education. J Neurol Sci 283:73–78. https://doi.org/10.1016/j.jns.2009.02.313

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. Hester RL, Kinsella GJ, Ong B, McGregor J (2005) Demographic influences on baseline and derived scores from the trail making test in healthy older Australian adults. Clin Neuropsychol 19:45–54

    Article  PubMed  Google Scholar 

  16. Steinberg BA, Bieliauskas LA, Smith GE, Ivnik RJ (2005) Mayo’s older Americans normative studies: age- and IQ-adjusted norms for the Trail-Making Test, the Stroop Test, and MAE Controlled Oral Word Association Test. Clin Neuropsychol 19:329–377

    Article  PubMed  Google Scholar 

  17. Bornstein RA (1985) Normative data on selected neuropsychological measures from a nonclinical sample. J Clin Psychol 41:651–659

    Article  Google Scholar 

  18. Arango-Lasprilla JC, Rivera D, Aguayo A, Rodríguez W, Garza MT, Saracho CP, Rodríguez-Agudelo Y, Aliaga A, Weiler G, Luna M, Longoni M, Ocampo-Barba N, Galarza-Del-Angel J, Panyavin I, Guerra A, Esenarro L, García de la Cadena P, Martínez C, Perrin PB (2015) Trail Making Test: normative data for the Latin American Spanish speaking adult population. NeuroRehabilitation 37:639–661. https://doi.org/10.3233/NRE-151284

    Article  CAS  PubMed  Google Scholar 

  19. Ardila A, Moreno S (2001) Neuropsychological test performance in Aruaco Indians: an exploratory study. J Int Neuropsychol Soc 7:510–515

    Article  CAS  PubMed  Google Scholar 

  20. Fernández AL, Marcopulos BA (2008) A comparison of normative data for the Trail Making Test from several countries: equivalence of norms and considerations for interpretation. Scand J Psychol 49:239–246. https://doi.org/10.1111/j.14679450.2008.00637.x

    Article  PubMed  Google Scholar 

  21. Cavaco S, Gonçalves A, Pinto C, Almeida E, Gomes F, Moreira I, Fernandes J, Teixeira-Pinto A (2013) Trail Making Test: regression-based norms for the Portuguese population. Arch Clin Neuropsychol 28:189–198. https://doi.org/10.1093/arclin/acs115

    Article  PubMed  Google Scholar 

  22. Giovagnoli AR, Del Pesce M, Mascheroni S, Simoncelli M, Laiacona M, Capitani E (1996) Trail making test: normative values from 287 normal adult controls. Ital J Neurol Sci 17:305–309

    Article  CAS  Google Scholar 

  23. Amodio P, Wenin H, Del Piccolo F, Mapelli D, Montagnese S, Pellegrini A, Musto C, Gatta A, Umiltà C (2002) 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

    Article  PubMed  Google Scholar 

  24. Mondini S, Mapelli D, Vestri A, Bisiacchi P (2003) Esame neuropsicologico breve [Brief neuropsychological exam]. Raffaello Cortina Editore, Milano

    Google Scholar 

  25. Amodio P, Campagna F, Olianas S, Iannizzi P, Mapelli D, Penzo M, Angeli P, Gatta A (2008) Detection of minimal hepatic encephalopathy: normalization and optimization of the Psychometric Hepatic Encephalopathy Score. A neuropsychological and quantified EEG study. J Hepatol 49:346–353. https://doi.org/10.1016/j.jhep.2008.04.022

    Article  PubMed  Google Scholar 

  26. Bianchi A, Dai Prà M (2008) Twenty years after Spinnler and Tognoni: new instruments in the Italian neuropsychologist's toolbox. Neurol Sci 29:209–217. https://doi.org/10.1007/s10072-008-0970-x

    Article  PubMed  Google Scholar 

  27. Capitani E (1997) Normative data and neuropsychological assessment. common problems in clinical practice and research. Neuropsychol Rehabil 7:295–310. https://doi.org/10.1080/713755543

    Article  Google Scholar 

  28. Brugnolo A, De Carli F, Accardo J, Amore M, Bosia LE, Bruzzaniti C, Cappa SF, Cocito L, Colazzo G, Ferrara M, Ghio L, Magi E, Mancardi GL, Nobili F, Pardini M, Rissotto R, Serrati C, Girtler N (2016) An updated Italian normative dataset for the Stroop color word test (SCWT). Neurol Sci 37:365–372. https://doi.org/10.1007/s10072-015-2428-2

    Article  CAS  Google Scholar 

  29. Santangelo G, Siciliano M, Pedone R, Vitale C, Falco F, Bisogno R, Siano P, Barone P, Grossi D, Santangelo F, Trojano L (2015) Normative data for the Montreal Cognitive Assessment in an Italian population sample. Neurol Sci 36:585–591. https://doi.org/10.1007/s10072-014-1995-y

    Article  PubMed  Google Scholar 

  30. Reitan RM (1955) The relation of the Trail Making Test to organic brain damage. J Consult Psychol 19:393–394

    Article  CAS  PubMed  Google Scholar 

  31. Wilks SS (1941) Determination of samples size for setting tolerance limits. Ann Math Stat 12:91–96

    Article  Google Scholar 

  32. Ackermann H (1985) Mehrdimensionale nicht-parametrische Normbereiche. Methodologische und medizinische. Aspekte. Springer-Verlag, Berlin

    Book  Google Scholar 

  33. Spinnler H, Tognoni G (1987) Standardizzazione e taratura italiana di test neuropsicologici. [Italian standardization and adjustment of neuropsychological tests]. Ital J Neurol Sci 6:8–20

    Google Scholar 

  34. Cohen JW (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates Publishers, Hillsdale

    Google Scholar 

  35. Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B Stat Methodol 57:289–300. https://doi.org/10.2307/2346101

    Article  Google Scholar 

  36. Bezdicek O, Stepankova H, Axelrod BN, Nikolai T, Sulc Z, Jech R, Růžička E, Kopecek M (2017) Clinimetric validity of the Trail Making Test Czech version in Parkinson's disease and normative data for older adults. Clin Neuropsychol 31:42–60. https://doi.org/10.1080/13854046.2017.1324045

    Article  PubMed  Google Scholar 

  37. Knight RG, McMahon J, Green TJ, Skeaff CM (2006) Regression equations for predicting scores of persons over 65 on the rey auditory verbal learning test, the mini-mental state examination, the trail making test and semantic fluency measures. Br J Clin Psychol 45:393–402

    Article  PubMed  Google Scholar 

  38. Corrigan JD, Hinkeldey NS (1987) Relationships between parts A and B of the Trail Making Test. J Clin Psychol 43:402–409

    Article  CAS  Google Scholar 

  39. Lamberty GJP, Chatel SH, Bieliauskas DM, Linas A (1994) Derived Trail Making Test indices: a preliminary report. Neuropsy Neuropsy Behav 7:230–234

    Google Scholar 

  40. Strauss E, Sherman EMS, Spreen O (2006) A compendium of neuropsychological tests: administration, norms, and commentary, 3rd edn. Oxford University Press, New York

    Google Scholar 

  41. Caffarra P, Vezzadini G, Dieci F, Zonato F, Venneri A (2002) Rey-Osterrieth complex figure: normative values in an Italian population sample. Neurol Sci 22:443–447

    Article  CAS  Google Scholar 

  42. Pigliautile M, Chiesi F, Rossetti S, Conestabile Della Staffa M, Ricci M, Federici S, Chiloiro D, Primi C, Mecocci P (2015) Normative data for the ACE-R in an Italian population sample. Neurol Sci 36:2185–2190

    Article  PubMed  Google Scholar 

  43. Catricalà E, Gobbi E, Battista P, Miozzo A, Polito C, Boschi V, Esposito V, Cuoco S, Barone P, Sorbi S, Cappa SF, Garrard P (2017) SAND: a screening for aphasia in nurodegeneration. Development and normative data. Neurol Sci 38:1469–1483

    Article  PubMed  Google Scholar 

  44. Basagni B, Luzzatti C, Navarrete E, Caputo M, Scrocco G, Damora A, Giunchi L, Gemignani P, Caiazzo A, Gambini MG, Avesani R, Mancuso M, Trojano L, De Tanti A (2017) VRT (verbal reasoning test): a new test for assessment of verbal reasoning. Test realization and Italian normative data from a multicentric study. Neurol Sci 38:643–650

    Article  PubMed  Google Scholar 

  45. Appollonio I, Leone M, Isella V, Piamarta F, Consoli T, Villa ML, Forapani E, Russo A, Nichelli P (2005) The Frontal Assessment Battery (FAB): normative values in an Italian population sample. Neurol Sci 26:108–116

    Article  CAS  Google Scholar 

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Acknowledgments

The authors thank Dr. Paola Falanga, Dr. Ilaria Fornaro, Dr. Maria Rosaria Figliola, Dr. Domenico Vivarelli, Dr. Anita Sportiello, and UNITRE for their contribution in collecting data.

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Authors and Affiliations

  1. Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences - MRI Research Center SUN-FISM, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, 80138, Naples, Italy

    Mattia Siciliano

  2. Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico 31, 81100, Caserta, Italy

    Mattia Siciliano, Valeria Sant’Elia, Manuela Altieri, Luigi Trojano & Gabriella Santangelo

  3. Department of Educational Sciences, University of Genova, Genoa, Italy

    Carlo Chiorri & Valeria Battini

  4. ICS Maugeri, Scientific Institute of Telese, Via Bagni Vecchi 2, 82037, Telese, Italy

    Luigi Trojano

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  1. Mattia Siciliano
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  4. Valeria Sant’Elia
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Correspondence to Luigi Trojano.

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The study was carried out in accordance with the Declaration of Helsinki on Ethical Principles for Medical Research.

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Siciliano, M., Chiorri, C., Battini, V. et al. Regression-based normative data and equivalent scores for Trail Making Test (TMT): an updated Italian normative study. Neurol Sci 40, 469–477 (2019). https://doi.org/10.1007/s10072-018-3673-y

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