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Limitations of the Trail Making Test Part-B in Assessing Frontal Executive Dysfunction

Published online by Cambridge University Press:  20 February 2015

Edgar Chan ,
Sarah E. MacPherson ,
Gail Robinson ,
Martha Turner ,
Francesca Lecce ,
Tim Shallice  and
Lisa Cipolotti
Edgar Chan*
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom
Sarah E. MacPherson
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom Department of Psychology, University of Edinburgh, Scotland, United Kingdom
Gail Robinson
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom School of Psychology, University of Queensland, Brisbane, Australia
Martha Turner
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom Institute of Cognitive Neuroscience, University College, London, United Kingdom
Francesca Lecce
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom Institute of Cognitive Neuroscience, University College, London, United Kingdom
Tim Shallice
Affiliation:
Institute of Cognitive Neuroscience, University College, London, United Kingdom International School for Advanced Studies (SISSA), Trieste, Italy
Lisa Cipolotti
Affiliation:
National Hospital for Neurology and Neurosurgery, London, United Kingdom Dipartimento di Psicologia, University of Palermo, Italy
*
Correspondence and reprint requests to: Edgar Chan, Box 37, NHNN, Queen Square, London WC1N 3BG. E-mail edgar.chan@uclh.nhs.uk
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Abstract

Part B of the Trail Making Test (TMT-B) is one of the most widely used neuropsychological tests of “executive” function. A commonly held assumption is that the TMT-B can be used to detect frontal executive dysfunction. However, so far, research evidence has been limited and somewhat inconclusive. In this retrospective study, performance on the TMT-B of 55 patients with known focal frontal lesions, 27 patients with focal non-frontal lesions and 70 healthy controls was compared. Completion time and the number of errors made were examined. Patients with frontal and non-frontal lesions performed significantly worse than healthy controls for both completion time and the number of errors. However, there was no significant difference for both completion time and the number of errors when patients with frontal and non-frontal lesions were compared. Performance was also not significantly different between patients with focal lesions within different regions of the frontal lobe (orbital, left lateral, right lateral, medial). Our findings suggest that the TMT-B is a robust test for detection of brain dysfunction. However, its capacity for detecting frontal executive dysfunction appears rather limited. Clinicians should be cautious when drawing conclusions from performance on the TMT-B alone. (JINS, 2015, 21, 169–174)

Keywords

Frontal lobesFocal lesionsExecutive functionNeuropsychologyNeuropsychological testsBrain diseases
Type
Brief Communications
Information
Journal of the International Neuropsychological Society , Volume 21 , Issue 2 , February 2015 , pp. 169 - 174
Copyright
Copyright © The International Neuropsychological Society 2015 

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