Assessing mental flexibility in the older population with low levels of education

ΑBSTRACTObjectives: The Trail Making Test (TMT) is widely used for the assessment of mental flexibility in older individuals, but those with limited education are often unable to perform Part B; thus, we explored its clinical utility in assessing an older cohort with low education. Moreover, we explored the clinical utility of speedy reciting of the months of the year (MY) backwards (MB) as an alternative. Methods: We administered the TMT and MY to a sample of cognitively healthy individuals >64 years old and individuals with dementia who participated in a population-based epidemiological study, the Hellenic Longitudinal Investigation of Aging and Diet. Results: Of those who completed TMT-Part A (n = 1270), 69.6% of the cognitively healthy and 34.6% of the dementia group also completed Part B, while of those who successfully recited the months of the year forward (MF, n = 701), 95.1% of the cognitively healthy and 62.1% of the dementia group recited the months backwards. Group differences emerged on all test variables (Cohen's ds: -1.922 to -0.475) except TMT-Part B. Correlations revealed better performance on all test variables with higher levels of education and lower age, respectively, but associations with sex were inconsistent. Diagnostic group was a predictor, along with education and age, on all test variables, but not sex. ROCs suggested better diagnostic value for the MB, compared to TMT-Part B. Normative data are provided for MY. Conclusions: Our findings support the use of MB, rather than TMT-Part B, for assessing mental flexibility in older individuals with low levels of education.