Trail Making Test
Also known as: TMT, Trails A, Trails B, Trail Making A, Trail Making B
The Trail Making Test (TMT) is a simple, brief neuropsychological test developed by Reitan in 1958 that measures visuomotor processing speed, attention, and executive function. The TMT comprises two forms: Part A, which assesses basic processing speed and visual scanning, and Part B, which assesses executive function, task-switching, and cognitive flexibility. Despite its simplicity, the TMT is highly sensitive to cognitive impairment across a wide range of neurological and psychiatric conditions and remains one of the most widely used screening tests in neuropsychology.
Key highlights
- Simplicity and speed — takes 5–10 minutes; requires only paper and pencil; easy to administer and score.
- Excellent sensitivity to cognitive impairment — detects executive dysfunction and slowing across diverse conditions (dementia, stroke, TBI, ADHD, depression).
- Two-part design isolates distinct processes — Part A–B difference differentiates processing speed from executive function.
- Extensive normative data — published norms available across age groups, education levels, and clinical populations globally.
Intuition
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How it works
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When to use it
The TMT is indicated for screening executive function and processing speed in any patient with suspected cognitive impairment, particularly those with frontal lobe or subcortical damage (e.g., stroke, TBI, Parkinson's disease, vascular dementia). It is sensitive to delirium, dementia, attention deficit disorders, and mild cognitive impairment. The TMT is NOT diagnostic alone and should be integrated with clinical assessment, imaging, and other neuropsychological tests. It is particularly useful in busy settings due to its brevity and minimal equipment needs.
Strengths & limitations
- Simplicity and speed — takes 5–10 minutes; requires only paper and pencil; easy to administer and score.
- Excellent sensitivity to cognitive impairment — detects executive dysfunction and slowing across diverse conditions (dementia, stroke, TBI, ADHD, depression).
- Two-part design isolates distinct processes — Part A–B difference differentiates processing speed from executive function.
- Extensive normative data — published norms available across age groups, education levels, and clinical populations globally.
- Limited specificity — prolonged TMT performance can reflect processing speed slowing, motor impairment, visual-motor dysfunction, attention problems, or executive dysfunction; the test does not specify which.
- Vulnerable to motor and visual limitations — arthritis, tremor, vision problems, or motor slowness unrelated to cognition inflate completion times.
- Age and education effects — substantial increases in completion time with advancing age and lower education; raw scores must be converted to age-adjusted norms for interpretation.
- Practice effects — significant improvement can occur with repeated testing (typically 10–20% reduction in time), limiting utility for frequent serial monitoring.
Common pitfalls
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Applications
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Frequently asked
What should I do if a patient makes errors on the TMT?
Common errors include skipping a number or letter, or connecting dots out of sequence. If errors are few and corrected immediately, scoring typically includes only completion time. If errors are frequent (>3) or uncorrected, document them separately; frequent errors suggest attention or instruction-following problems. Some clinicians use error count as an additional outcome; consult norms in your reference population.
How do I interpret a large difference between Part B and Part A (B-A > 60 seconds)?
A B-A difference of >60 seconds suggests executive dysfunction, task-switching difficulty, or cognitive flexibility impairment. However, always verify that Part A time is normal; a large B-A difference driven by extremely slow Part A may simply reflect processing speed slowing rather than executive dysfunction. Plot both Part A and Part B against age-adjusted norms separately.
Can I use the TMT remotely or digitally?
Digital versions exist but may not be directly comparable to paper-and-pencil norms. If digital administration is necessary, document the platform and consider whether norms for that version are published. Paper-and-pencil administration in person remains the standard; vision, motor ability, and attention can be more readily observed.
What does a normal TMT but slow processing on other tests mean?
The TMT is sensitive but not comprehensive. A patient may have normal TMT but impaired performance on other measures of processing speed or executive function (e.g., Digit Symbol Substitution Test, Wisconsin Card Sorting Test). TMT is a useful screening tool; abnormal results prompt further testing, but normal results do not exclude cognitive impairment.
Sources
- 1.Reitan, R. M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8(3), 271-276.
- 2.Sanchez-Cubillo, I., Perianez, J. A., Adrover-Roig, D., et al. (2009). Construct validity of the Trail Making Test: Role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. Journal of the International Neuropsychological Society, 15(3), 438-450.
- 3.Corrigan, J. D., & Hinkeldey, N. S. (1987). Relationships between parts A and B of the Trail Making Test. Journal of Clinical Psychology, 43(4), 402-409.
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Cite this page
ScholarGate. (2026, June 3). Trail Making Test. ScholarGate. https://scholargate.app/neuropsychology/trail-making-test