Indonesian Trail Making Test: Analysis of Psychometric Properties, Effects of Demographic Variables, and Norms for Javanese Adults
Trail Making Test (TMT) has been widely used in Indonesia as an Executive Function (EF) test, however, no studies reported validity and reliability of the test. In this study, we analyzed TMT’s psychometric properties, including reliability and validity, effect of demographic variables such as education, age, and sex on the TMT, and propose norm scores for the urban population of Java Island. Four hundred ninety persons (aged 16-80 years) with varying education levels participated in the study. Four additional EF tests (Digit Span, Five Point, phonemic Verbal Fluency, and Stroop) were administered. Principal Component Analysis was used to test whether the structure of TMT supported theoretical foundations of EF. The test-retest reliability was estimated in different samples (N = 50). Results suggest that education increased and age decreased the performance, however there were no differences between high school graduates and undergraduates in the age range 16-39 years. The intraclass correlation as a reliability measure showed good results (TMTA, rs=0.76; TMT B, rs= 0.86; TMT B-A, rs=0.74). The PCA revealed that the TMT, Digit Span, and Five Point scores loaded highly on one construct, while Stroop, phonemic Verbal Fluency, and errors on Five Point test loaded highly on other. It can be concluded that TMT is a valid neuropsychological instrument measuring EF with high reliability score and has high sensitivity for education, and age effects. The study also provides TMT Norms and cut-off scores for Javanese population between 16 and 39 years old with senior high school and undergraduate level of education.
Abe, M., Suzuki, K., Okada, K., Miura, R., Fujii, T., Etsurou, M., Yamadori, A. (2004). Normative data on tests for frontal lobe functions: Trail Making Test, Verbal ﬂuency, Wisconsin Card Sorting Test (Keio version).Brain and Nerve, 56(7), 567–574.
Ashendorf, L., Jefferson, A. L., Connor, M. K., Chaisson, C., Green, R. C., & Stern, R. A. (2008). Trail Making Test errors in normal aging, mild cognitive impairment, and dementia. Archives of Clinical Neuropsychology, 23, 129 – 137.
Arbuthnott, K., & Frank J. (2000). Trail Making Test, Part B as a Measure of Executive Control: Validation Using a Set-Switching Paradigm. Journal of Clinical and Experimental Neuropsychology, 22 (4), 518-528.
Berrigan, L. I., Fisk, J. D., Walker, L. A. S., Wojtowicz, M., Rees, L. M., Freedman, M. S., & Marrie, R. A. (2014). Reliability of Regression-Based Normative Data for the Oral Symbol Digit Modalities Test: An Evaluation of Demographic Influences, Construct Validity, and Impairment Classification Rates in Multiple Sclerosis Samples. The Clinical Neuropsychologist, 28(2), 281–299.doi.org/10.1080/13854046.2013.871337
Bezdicek, O., Motak, L., Axelrod, B. N., Preiss, M., Nikolai, T., Vyhnalek, M., Poreh, A., & Ruzicka, E. (2012). Czech version of the Trail Making Test: Normative data and clinical utility. Archives of Clinical Neuropsychology, 27, 906 – 914.
Bouattour, N., Farhat, N., Hadjkacem, H., Hdiji, O., Dammak, M., & Mhiri, C. (2017). Trail Making Test (TMT): Tunisian normative values from 339 normal adult controls. Journal of the Neurological Sciences, 381, 846.https://doi.org/10.1016/j.jns.2017.08.2381
Bowie, C. R., & Harvey, P.D. (2008). Administration and interpretation of the Trail Making Test. Nature Protocols, 1(5), 2277 – 2281.
Bridges AJ & Holler KA. (2007). How Many is Enough? Determining Optimal Sample Sizes for Normative Studies in Pediatric Neuropsychology. https://doi.org/10.1080/09297040701233875
Burggraaff, J., Knol, D. L., & Uitdehaag, B. M. (2017). Regression-based norms for the symbol digit modalities test in the Dutch population: Improving detection of cognitive impairment in multiple sclerosis. European Neurology, 77, 246–252.
Cavaco S., Gonçalves A., Pinto C., Almeida E., Gomes F., Moreira I., Fernandes J., Teixeira-Pinto A. (2013). Trail Making Test: Regression-based Norms for the Portuguese Population, Archives of Clinical Neuropsychology, 28, 2, 189–198,https://doi.org/10.1093/arclin/acs115
Crawford J.R, & Garthwaite P.H. (2008) On the “Optimal” Size for Normative Samples in Neuropsychology: Capturing the Uncertainty When Normative Data Are Used to Quantify the Standing of a Neuropsychological Test Score. Child Neuropsychology. 14:2, 99-117, DOI:10.1080/09297040801894709
Demakis, G. J. (2004). Frontal lobe damage and tests of executive processing: A meta-analysis of the Category Test, Stroop test, and Trail-Making Test. Journal of Clinical and Experimental Neuropsychol. 26(3), 441–450. doi:10.1080/13803390490510149
Fellows R.P. & Schmitter E.M. (2020). Symbol Digit Modalities Test: Regression-Based Normative Data and Clinical Utility, Archives of Clinical Neuropsychology, 35 (1) 105–115,https://doi.org/10.1093/arclin/acz020
Fernandez, A. L., & Marcopulos, B. A. (2008). A comparison of normative data for Trail Making Test from several countries: Equivalence of norms and considerations for interpretation. Cognition and Neuroscience, 49, 239 – 246.
Henrich, J., Hein, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences,33, 61–135.
Hester RL, Kinsella GH., Ong B., McGregor J. (2005). Demographic influences on baseline and derived scores from the trail making test in healthy older Australian adults. Clin. Neuropsychol 19; 45-54.
Hicks, S.L., Sharma, R., Khan, A.N., Berna, C.M., Waldecker, A., Talbot, K., Turner, M.R. (2013). An Eye-Tracking Version of the Trail-Making Test. PLoS ONE, 8(12), e84061. https://doi.org/10.1371/journal.pone.0084061
Ivnik, R.J., Malec, J.F., Smith, G.E., Tangalos, E.G., & Petersen, R.C. (1996) Neuropsychological tests' norms above age 55: COWAT, BNT, MAE token, WRAT-R reading, AMNART, STROOP, TMT, and JLO, The Clinical Neuropsychologist, 10:3, 262-278, DOI:10.1080/13854049608406689
Jaros R. B., Salum, G. A., da Silva, C. T., Tozza, R., Becker, N., Agranonik, M., da Salles, J. F., & Manfro, G. G. (2017). Attention, Memory, Visuoconstructure, and executive task performance in adolescents with anxiety disorders: A case-control community study. Trend in Psychiatry and Psychotherapy, 39 (1), 5 – 11.
Koo, T. K., & Li, M. Y. (2016). A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of chiropractic medicine, 15(2), 155–163. https://doi.org/10.1016/j.jcm.2016.02.012
Lee, N. R., Wallace, G. L., Raznahan, A., Clasen, L. S., & Giedd, J. N. (2014). Trail making test performance in youth varies as a function of anatomical coupling between the prefrontal cortex and distributed cortical regions. Frontiers in Psychology. 5. https://doi.org/10.3389/fpsyg.2014.00496
Lezak, M. D. (1995). Neuropsychological Assessment. New York: Oxford University Press
Lezak, M. D., Howieson, D. N., & Loring, D. W. (2004). Neuropsychological Assessment, 4th Edn. New York, NY: Oxford University Press.
Matarazzo, J. D., Wiens, A. N., Matarazzo, R. G., & Goldstein, S. G. (1974). Psychometric and clinical test-retest reliability of the Halstead Impairment Index in a sample of healthy, young, normal men. Journal of Nervous and Mental Disease, 158(1), 37–49.https://doi.org/10.1097/00005053-197401000-00006
Mitrushina, M. N., Boone, K. L., & D’Elia, L. (1999). Handbook of normative data for neuropsychological assessment. New York: Oxford University Press.
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., & Howerter, A. (2000). The Unity and Diversity of Executive Functions and Their Contributions to Complex ‘‘Frontal Lobe’’ Tasks: A Latent Variable Analysis. Cognitive Psychology 41, 49–100. doi:10.1006/cogp.1999.0734
O’Bryant, S. E., Edwards, M., Johnson, L., Hall, J., Gamboa, A., & O’jile, J. (2018). Texas Mexican American adult normative studies: Normative data for commonly used clinical neuropsychological measures for English-and Spanish-speakers. Developmental Neuropsychology, 43 (1), 1 – 26.
Ojeda N, Aretouli E, Peña J, Schretlen DJ. (2016). Age differences in cognitive performance: A study of cultural differences in Historical Context. J of Neuropsychology., 10, 104–115.
Oosterhuis, H. E. M., van der Ark, L. A., & Sijtsma, K. (2016). Sample Size Requirements for Traditional and Regression-Based Norms. Assessment, 23(2), 191-202.
Parmenter, B. A., Testa, S. M., Schretlen, D. J., Weinstock-Guttman, B., & Benedict, R. H. (2010). The utility of regression-based norms in interpreting the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). Journal of the International Neuropsychological Society, 16, 6–16.
Periáñez JA, Ríos-Lago M, Rodríguez-Sánchez JM, Adrover-Roig D, Sánchez-Cubillo I, Crespo-Facorro B, Quemada JI & Barceló F. (2007). Trail Making Test in traumatic brain injury, schizophrenia, and normal ageing: sample comparisons and normative data. Arch Clin Neuropsychol. 22:433-47. doi: 10.1016/j.acn.2007.01.022. Epub 2007 Mar 1. PMID: 17336493.
Rabin, L.A., Paolillo, E., & Barr, W.B. (2016) Stability in Test-Usage Practices of Clinical Neuropsychologists in the United States and Canada Over a 10-Year Period: A Follow-Up Survey of INS and NAN Members, Archives of Clinical Neuropsychology, 31; 206–230, 216.https://doi.org/10.1093/arclin/acw007
Reitan, R. M., & Wolfson, D. (2004). The Trail Making Test as an initial screening procedure for neuropsychological impairment in older children. Archives of Clinical Neuropsychology, 19, 281 – 288.
Reitan, R. M., & Wolfson, D. (1985). The Halstead-Reitan Neuro- psychological Test Battery: Theory and clinical interpretation. Tucson, AZ: Neuropsychology Press.
Reitan, R. M. (1958). Validity of the Trail Making Test to organic brain damage. Perceptual and Motor Skills, 8, 271 – 276.
Richardson, J.T.E. (2011). Eta squared and partial eta squared as measures of effect size in educational research. Educational Research Review, 6(2), 135-147. https://doi.org/10.1016/j.edurev.2010.12.001.
Rivera, D., & Arango-Lasprilla, J. C. (2017). Methodology for the development of normative data for Spanish-speaking pediatric populations. NeuroRehabilitation, 41, 581 – 592.
Seo, E. H., Lee, D. Y., Kim, K. W., Lee, J. H., Jhoo, J. H., Youn, J. C., Choo, I. H., Ha., J., & Woo., J. I. (2006). A normative study of the Trail Making Test in Korean Elders. International Journal of Geriatric Psychiatry, 21, 844 – 862.
Siciliano, M., Chiorri, C., Battini, V., Sant’Elia, V., Altieri, M., Trojano, L., & Santangelo, G. (2019). Regression-based normative data and equivalent scores for Trail-Making Test (TMT): An updated Italian normative study. Neurological Sciences, 40, 469 – 477.
Spreen, O., & Strauss, E .(1998). A compendium of neuropsychological tests: administration, norms, and commentary, 3rd edn. Oxford University Press, New York.
Stanczak, D. E., Lynch, M. D., McNeil, C. K., & Brown, B. (1998). The Expanded Trail Making Test: Rationale, development, and psychometric properties. Archives of Clinical Neuropsychology, 13(5), 473–487. https://doi.org/10.1016/S0887-6177(97)00041-3
Tombaugh, T. N. (2004). Trail Making Test A and B: Normative data stratified by age and education. Archives of Clinical Neuropsychology, 19, 203 – 214.
Varjacic, A., Mantini, D., Demeyere, N., & Gillebert, C. R. (2018). Neuropsychologia Neural signatures of Trail-Making Test performance: Evidence from lesion-mapping and neuroimaging studies. Neuropsychologia, 115(March), 78–87. https://doi.org/10.1016/j.neuropsychologia.2018.03.031.
van de Vijver, F., & Tanzer, N.K. (2004). Bias and equivalence in cross-cultural assessment: an overview, European Review of Applied Psychology, 54(2), 119-135.https://doi.org/10.1016/j.erap.2003.12.004
Williams, L.M., Mathersul, D., Palmer, D.M., Gur, R.C., Gur, R.E., & Gordon, E. (2009) Explicit identification and implicit recognition of facial emotions: I. Age effects in males and females across 10 decades, Journal of Clinical and Experimental Neuropsychology, 31(3), 257-277, DOI:10.1080/13803390802255635
Wong, T.M., Strickland, T.L., Fletcher-Janzen, E., Ardila, A., & Reynolds, C.R. (2000) Theoretical and Practical Issues in the Neuropsychological Assessment and Treatment of Culturally Dissimilar Patients. Handbook of Cross-Cultural Neuropsychology. Critical Issues in Neuropsychology. Springer, Boston, MA.https://doi.org/10.1007/978-1-4615-4219-3_1
Zalonis, I., Karanzou, E., Triantafyllou, N. I., Kapakin, E., Papageorgiou, S., Sgouropoulos, P., & Vassilopoulos. (2008). A normative study of the Trail Making Test A and B in Greek adults. The Clinical Neuropsychologist, 22 (5), 842 – 850. doi: 10.1080/13854040701629301
- There are currently no refbacks.
Copyright (c) 2022 Jurnal Psikologi
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.