Trail Making Test Elucidates Neural Substrates of Specific Poststroke Executive Dysfunctions

Abstract

Background and Purpose Post-stroke cognitive impairment (PSCI) is typified by prominent deficits in processing speed and executive function. However, the underlying neuroanatomical substrates of executive deficits are not well understood and further elucidation is needed. There may be utility in fractionating executive functions to delineate neural substrates. Methods One test amenable to fine delineation is the Trail Making Test (TMT), which emphasizes processing speed (TMT-A) and set-shifting (TMT-B-A difference, proportion, quotient scores and TMT-B set-shifting errors). The TMT was administered to two overt ischemic stroke cohorts from a multinational study: (i) a chronic stroke cohort (N=61) and (ii) an acute-sub-acute stroke cohort (N=45). Volumetric quantification of ischemic stroke and White Matter HyperIntensities (WMH) was done on MRI, along with ratings of involvement of cholinergic projections, using the previously published Cholinergic Hyperintensities Projections Scale (CHIPS). Damage to the superior longitudinal fasciculus (SLF), which co-localizes with some cholinergic projections, was also documented. Results Multiple linear regression analyses were completed. While larger infarcts (β=0.37, p<0.0001) were associated with slower processing speed, CHIPS severity (β=0.39, p<0.0001) was associated with all metrics of set shifting. Left SLF damage, however, was only associated with the difference score (β=0.17, p=0.03). These findings were replicated in both cohorts. Patients with ≥2 TMT-B set shifting errors also had greater CHIPS severity. Conclusions In this multinational stroke cohort study, damage to lateral cholinergic pathways and the SLF emerged as significant neuroanatomical correlates for executive deficits in set shifting.

Endovascular treatment improves cognition after stroke

“…13 Other relevant stroke outcome measures such as health-related quality of life and disability status were significantly and directly correlated with poor cognitive status.…”

Mapping Common Aphasia Assessments to Underlying Cognitive Processes and Their Neural Substrates

“…The results showed lesions extending into underlying parts of the superior longitudinal fasciculus and frontal subcortical white matter, consistent with studies showing impaired executive function associated with white matter damage 42–44 . A recent study using the Trail Making Test, which simultaneously measures processing speed, attention, visuospatial ability, and working memory, showed that lesions involving the superior longitudinal fasciculus are associated with executive deficits in set-shifting 45 . Some language tests in our battery loaded on the Executive factor to a surprising extent (eg.…”

Functional independence in resting-state connectivity facilitates higher-order cognition

“…The Trail Making Test has not been as thoroughly studied as the Stroop task, leading to less consistent neuroimaging findings. Functional neuroimaging studies have implicated bilateral superior parietal (Allen, Owens, Fong, & Richards, 2011; Moll, de Oliveira-Souza, Moll, Bramati, & Andreiuolo, 2002), while lesion and anatomic studies have implicated bilateral prefrontal cortex (Lee, Wallace, Raznahan, Clasen, & Giedd, 2014; Muir et al, 2015; Pa et al, 2010; Yochim, Baldo, Nelson, & Delis, 2007). However, a Trail Making Test optimized for the fMRI environment reported neither parietal nor frontal involvement (Jacobson, Blanchard, Connolly, Cannon, & Garavan, 2011).…”