Trail Making Test Could Predict Impairment in Cognitive Domains in Patients with Multiple Sclerosis: A Study of Diagnostic Accuracy

Abstract

Objective Cognitive impairment (CI) and executive dysfunction (ED) are prevalent in patients with multiple sclerosis (PwMS). The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is the gold standard neuropsychological battery (NPB) for detecting CI. Delis-Kaplan Executive Function System (DKEFS) NPB evaluates ED. We aimed to find practical test(s) from DKEFS with acceptable diagnostic utility for early detection of impairment in cognitive and executive domains. Methods Cognitive and executive tasks, physical disability, and depression scores of 30 PwMS were assessed (17 women, age: 38.1). Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Controlled Oral Word Association Test (COWAT) from MACFIMS and Trail Making Test (TMT), Design Fluency Test (DFT), and Verbal Fluency Test (VFT) from DKEFS were selected. The association between patients' characteristics and performance in tests, and diagnostic accuracy of DKEFS tests in detecting impairment in cognitive tasks were evaluated, using Pearson correlation and receiver operator characteristic curve analyses, respectively. Results A significant correlation was found between disease duration and SDMT and TMT subtests. Expanded Disability Status Scale was significantly related to SDMT, VFT-switching, and TMT subtests. Beck Depression Inventory was significantly related to DFT. TMT-switching detected abnormalities in SDMT and PASAT with 100% sensitivity, 93.3% (for SDMT), and 85.7% specificity (for PASAT). TMT-letter showed 100% sensitivity and 90% specificity in identifying abnormalities in COWAT. Conclusions TMT, particularly the switching condition, is a practical paper-based test that could predict impairment in cognitive tasks. Clinicians may use TMT as a screening tool among PwMS.

Validation of trail making test part A for cognitive screening in multiple sclerosis

“…In our study, we found that TMT part A was as easy to use as a screening tool for assessment of information processing speed as SDMT. Previous studies of attention in PwMS found that the TMT test was impaired in RRMS 12,13 . Similar to our results, it was found previously in a cohort study in Indian people that TMT and other cognitive tests were correlated with EDSS and physical disability 14 .…”

“…Previous studies of attention in PwMS found that the TMT test was impaired in RRMS. 12,13 Similar to our results, it was found previously in a cohort study in Indian people that TMT and other cognitive tests were correlated with EDSS and physical disability. 14 Previous studies 15,16 also found that SDMT correlated with EDSS and the number of relapses and can be a predictor of progression and cognitive affection.…”

“…They found that SDMT is a simple measure for assessment as well as TMT as a screening tool in PwMS. 13,20 To the best of our knowledge, there have been no previous similar studies for use and comparison of these single tests, and both tests are applicable in people regardless of educational level. Nowadays oral versions of both SDMT and TMT are used, which makes the tests easier to conduct.…”

“…Other studies showed a significant correlation between SDMT and Paced Auditory Serial Addition Test (PASAT), which is used for auditory processing speed, and TMT for executive function assessment. They found that SDMT is a simple measure for assessment as well as TMT as a screening tool in PwMS 13,20 . To the best of our knowledge, there have been no previous similar studies for use and comparison of these single tests, and both tests are applicable in people regardless of educational level.…”

Comparing the Efficacy of Two Cognitive Screening Tools in Identifying Gray and White Matter Brain Damage among Older Adults

“…However, while the TMT provides valuable insights into the executive function, relying exclusively on it may overlook other critical facets of this multifaceted construct [ 83 ]. This exclusive reliance on the TMT may yield an incomplete understanding of the executive function, potentially leading to the misinterpretation of cognitive profiles [ 84 , 85 ]. Moreover, the TMT may lack sensitivity in detecting subtle deficits, particularly in individuals with mild cognitive impairment or early-stage neurodegenerative disorders [ 85 ].…”