Brief Description

The Trail Making Test consists of two parts: TMT-A and TMT-B. In Part A, the examinee is asked to connect 25 numbered circles in sequential order (1 to 25), randomly distributed across a page. In Part B, the circles contain both numbers (1–12) and letters (A–M), and the participant must alternate between them in sequence (e.g., 1, A, 2, B, 3, C). TMT-B is more difficult due to its demand for cognitive flexibility. The test is administered individually and timed with a stopwatch.

Purpose

The TMT assesses visuoperceptual and visuomotor tracking abilities, attention, psychomotor speed, task persistence, and especially cognitive flexibility. It is widely used in neuropsychological evaluation and in the diagnosis of neurodegenerative conditions and brain injuries.

Scoring Method

Scoring is based on the time taken to complete each part (TMT-A and TMT-B), recorded in seconds. Errors are also noted and corrected during the task and are considered in the final interpretation.

Validity

The TMT demonstrates strong validity, supported by correlations with other cognitive tests and measures of frontal lobe functioning. It is effective in detecting organic brain damage and in distinguishing between cognitively impaired and non-impaired populations.

Reliability

The tool’s reliability has been confirmed through retesting and statistical analysis. In assessments involving individuals with Mild Cognitive Impairment (MCI) and Alzheimer’s disease, the correct reclassification rate for TMT-B was 79.6%, with a sensitivity of 84% and specificity of 70%. Cutoff values were set at 75 seconds for TMT-A and 223 seconds for TMT-B.

Data Analysis and Usage

The test was administered to a sample of 49 individuals, including 15 cognitively healthy older adults, 19 with Alzheimer’s disease, and 15 with MCI. The average age was 66.8 years, with a range of 10.6 years. Factor analysis revealed statistically significant performance differences between the groups, particularly on TMT-B. The TMT is suitable for use in clinical practice, research studies, and early detection of cognitive decline.

Key References

Gaudino, A., Mark, W. G., & Squires, N. K. (1995). Construct Validity in the Trail Making Test: What Makes Part B Harder? Journal of Clinical and Experimental Neuropsychology, 17, 529–535.
Kay, G. (1984). Neuropsychological Investigation of the Processes Underlying Performance on the Extended Trail Making Test. Dissertation, Memphis State University.
Reitan, R. M. (1958). Validity of the trail making test as an indication of organic brain damage. Perceptual and Motor Skills, 8, 271–276.
Reitan, R. M., & Wolfson, D. (1995). Category Test and Trail Making Test as Measures of Frontal Lobe Functions. The Clinical Neuropsychologist, 9, 50–56.
Varasolis, S., Tsantali, E., & Tsolaki, M. (2005). The ability of the Trail Making Test to distinguish between healthy elderly, individuals with Mild Cognitive Impairment, and Alzheimer’s patients. Presented at the 2nd Panhellenic Interdisciplinary Conference on Alzheimer’s Disease and Related Disorders, Thessaloniki.