Identification of Three Factors Influencing Trail Making Test Performance Using Multichannel Near-Infrared Spectroscopy

Abstract

Recent advances in medical care have facilitated the survival of patients with stroke or traffic-related injuries. However, such patients may suffer from higher brain dysfunction; i.e., an impaired ability to plan and perform behaviors based on prior knowledge. The Trail Making Test (TMT) is a cognitive task that is used to evaluate higher brain dysfunction caused by frontal lobe injury. TMT consists of two tasks; TMT-A involves connecting consecutive numbers, and TMT-B involves connecting numbers and letters alternately. In this study, using near-infrared spectroscopy (NIRS) and the achievement value (TMT score), we investigated the effects of three factors on TMT performance: knowledge of the TMT, the order of TMT-A and TMT-B performance, and gender. The subjects were 48 healthy adults, consisting of college graduates and undergraduates (age: 22.8 ± 2.5 years, education: 16.0 ± 1.2 years, 24 males and 24 females). We measured the changes in oxygenated hemoglobin (oxy-Hb) levels using NIRS, showing that the increase in oxy-Hb was higher in subjects who had no knowledge of the TMT than those who had prior knowledge. In both TMT-A and TMT-B, the subjects who performed their first task displayed higher oxy-Hb levels. Moreover, the oxy-Hb level in males was higher than that in females. In contrast, only the order of TMT performance showed noticeable effect on the TMT score. In the present study, using NIRS we have shown that either knowledge of the TMT, the order of the TMT, or gender affects TMT performance, providing invaluable information for interpreting TMT results.

Evaluation of the Trail Making Test and interval timing as measures of cognition in healthy adults: Comparisons by age, education, and gender

“…The increase in oxy-Hb was higher in participants who had no knowledge of the TMT (with no influence on the performance time). TMT-A results were not affected by gender, but males had higher oxy-Hb [28]. Summarizing, our results on TMT seem to be in accordance with other studies.…”

The Effects of Task Order Administration on Test Scores from the Trail Making Test: Near-Infrared Spectroscopy Investigations

“…For the order in which the tasks of the TMT were administered, significant changes were detected in Channels 1,2,3,4,5,7,8,9,10,11,12,13,14,15 and 18 on the left side (Table 1) There were significant knowledge of the TMT influences on oxy-Hb changes in Channel 9 on the right side (Table 2), and oxy-Hb levels were significantly higher in uninformed group than in informed group. Prior gender had no influence on oxy-Hb changes.…”

“…TMT score indicates the number of TMT targets that can be reached in 30 seconds [8] [9]. To measure changes in B-A oxy-Hb levels, multiple regression analyses were performed on the three factors as independent variables: gender, prior knowledge of the TMT, and the order in which the parts of the TMT were administered.…”

“…Age, intelligence quotient (IQ), and education are believed to influence TMT performance [11] [12] [13] [14]. In a previous study of TMT performance in subjects who had no differences in age or education, three additional factors seemed to also influence brain activation: gender, knowledge of the TMT (whether a subject had prior knowledge of the task), and whether subjects performed Part A or Part B first [9].…”

“…The rationale for claiming that there are differences is because Part B differs qualitatively from Part A [15]. In a previous study, we identified the order of TMT task performance as an influential factor in performance by measuring changes in oxy-Hb before and after task performance [9]. However, we did not compare performance on Part A and B directly.…”