Improving validity of the trail making test with alphabet support

Area of Science:

• Neuroscience
• Cognitive Psychology
• Gerontology

Background:

• The Trail Making Test (TMT) is a widely used neuropsychological assessment for evaluating cognitive decline and driving ability.
• Concerns exist regarding TMT's reliance on the Latin alphabet, potentially leading to misclassification in individuals with dyslexia or unfamiliarity with the alphabet.
• Alphabet support may enhance test validity by reducing misclassification but could also impair its sensitivity to set-shifting abilities.

Purpose of the Study:

• To compare the validity and sensitivity of the TMT with and without alphabet support.
• To determine if alphabet support impacts the measurement of executive function, specifically set-shifting, in older adults.

Main Methods:

• Two independent normative samples of Scandinavian adults aged 70-84 years were compared.
• One sample (n=220) received the TMT with alphabet support (Latin alphabet A-L on TMT-B), while the other (n=64) received the standard TMT.
• Multiple regression analysis, adjusted for age and education, was used to compare TMT-A, TMT-B, and TMT-B:A ratios between the groups.

Main Results:

• No significant differences were found in TMT-A, TMT-B, or the TMT-B:A ratio between the groups after adjusting for age and education.
• The inclusion of alphabet support did not alter performance metrics on the TMT.

Conclusions:

• Alphabet support does not significantly change the TMT's performance metrics in older Scandinavian adults.
• The findings suggest that alphabet support can be incorporated into the TMT without compromising its ability to measure set-shifting, potentially improving its validity for diverse populations.