Effect of age and education on the Trail Making Test and determination of normative data for Japanese elderly people: The Tajiri Project

Abstract

The Trail Making Test (TMT) is a common two-part neuropsychological test, in which visuospatial ability (TMT-A) and executive function (TMT-B) are evaluated. Normative data for this test have not been reported for Japanese subjects; therefore, the purpose of the present paper was to investigate the effect of age and education on the TMT in 155 healthy elderly adults with clinical dementia rating 0 (healthy). The participants were classified into three groups based on age (70-74 years, 75-84 years and ≥85 years), and also into three groups based on educational level (6 years, 8 years and ≥10 years). The time to complete TMT-A and TMT-B were measured, and the difference in score between TMT-A and TMT-B (B-A) and the ratio of the score (B/A) were calculated as indices of executive function. The time for completion of both parts of the TMT increased markedly in the ≥85-years group. For TMT-A, there was a significant difference between the 6-years and 8-years groups, and between the 6-years and ≥10-years groups, and for TMT-B, there was a significant difference between the 6-years and ≥10-years groups, and between the 8-years and ≥10-years groups. The difference and ratio scores increased in the ≥85-years group, but the educational level did not significantly influence these scores. Our data suggest that cognitive functions evaluated by TMT-A and TMT-B are not affected by aging until the subjects are ≥85 years old. For TMT-A, an educational effect becomes apparent when the population includes poorly educated subjects, but this part of the test is not affected by educational level provided that the subjects have some education (>6 years). The time to complete TMT-B is affected by educational level, consistent with previous reports. However, when adjusted using the results for TMT-A [(B-A) or (B/A)], the educational effect on executive function disappeared. Thus, the effect of educational level on executive function was unclear in normal elderly subjects.

Relationship between Executive Function and Dual Task Physical Performance among Older Adults-A Cross Sectional Study

“…Hashimoto R et al (2006) tried to investigate the effect of age and education on the TMT in 155 healthy elderly adults with clinical dementia rating 0 (healthy) [16]. They suggested in their study that the time to complete TMT-B is affected by educational level.…”

“…A systematic review and meta-analysis of 27 prospective cohort studies with at least one year of follow-up among healthy communitydwelling older adults found that executive dysfunction, a subtle cognitive deficit, was associated with an increased risk for any fall and falls associated with serious injury [16][17][18]. Similarly, early mobility decline, assessed as slowing of gait, has been found to co-exist or even precede the onset of clinically demonstrable cognitive decline in older adults [19].…”

Low educational level effects on the performance of healthy adults on a Neuropsychological Protocol suggested by the Commission on Neuropsychology of the Liga Brasileira de Epilepsia

“…Hamdan and Hamdan 24 examining the influence of age and EL on Trail (A and B) test performance in 318 healthy adults aged between 18 and 81 years, divided according to education, reported that the less educated group needed more time to complete the task suggesting that at least more than two years of formal education would be necessary for the test completion. Hashimoto et al 25 study with older people concluded that there is a need for at least six years of schooling to the test set. Also, Elst et al 26 evaluated the influence of age, gender and EL in the Stroop test in adults, divided into groups according to education, observing that the lower the EL, the worse the performance.…”

The Trail Making Test in Morocco: Normative Data Stratified by Age and Level of Education

“…They were adapted to different cultures and languages: Arabic [10] [11], Chinese [12], Hebrew [13], Japanese [14], Italian [15], Indian [16].…”