Trail Making Test error analysis in classic motor neuron disease
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ORIGINAL ARTICLE
Trail Making Test error analysis in classic motor neuron disease Foteini Christidi • Evangelia Kararizou • Nikolaos I. Triantafyllou • George P. Paraskevas Ioannis Zalonis
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Received: 11 June 2012 / Accepted: 7 November 2012 / Published online: 18 November 2012 Ó Springer-Verlag Italia 2012
Abstract The use of non-traditional scores in neuropsychological assessment allows for pattern analysis of test performance, commonly referred to as Quantified Process Approach (QPA). In the present study, the QPA was taken to study error rates on the Trail Making Test (TMT) in 26 non-demented patients with classic motor neuron disease (cMND), who commonly present with impaired cognitive flexibility, and 26 matched healthy controls. Betweengroup comparisons revealed that cMND patients exhibited higher total error rates on the TMT Part B (TMT-B) relative to controls (p \ 0.001), though no significant associations were noted between TMT errors and measures of attention and executive function obtained using the Stroop Neuropsychological Screening Test, the Wechsler Adult Intelligence Scale Digit Symbol and Digit Span subtests and the Wisconsin Card Sorting Test. Moreover, the percentage of cMND patients with normal TMT-B time-tocompletion who committed at least one error (either sequential or perseverative errors) in TMT-B was significantly higher compared to controls (p = 0.005). These findings suggest that error analysis using the QPA may increase the clinical utility of TMT and should be considered in addition to time-to-completion scores, in the neuropsychological assessment of patients with cMND.
F. Christidi (&) I. Zalonis Neuropsychological Lab, A’ Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University, 72-74 Vas. Sofias Avenue, 115 28 Athens, Greece e-mail: [email protected] E. Kararizou N. I. Triantafyllou G. P. Paraskevas A’ Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University, Athens, Greece
Keywords Quantified Process Approach Trail Making Test Error analysis Cognitive flexibility Classic motor neuron disease
Introduction The Trail Making Test (TMT Part A and B; TMT-A and TMT-B) has found popular use in neuropsychological practice given its utility in assessing both attention and cognitive flexibility [1]. In particular, the TMT-B is most readily administered to evaluate executive function, and appears to be a measure of cognitive flexibility rather than a measure of the ability to maintain a cognitive set [2]. To optimally quantify the patient performance, numerous derived scores may be calculated, including the difference score between TMT-B and A, the ratio score TMT-(B/A), and the proportional score TMT-(B-A/A) [3, 4]. Furthermore, in addition to time-to-completion scores, it has been suggested that examination of error rates may yield equally valuable information [5]. The methodological framework that characterizes the development and the use of these TMT indices is the Quantified Proces
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