{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T11:30:35Z","timestamp":1784460635075,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The Trail Making Test (TMT) is commonly used worldwide to evaluate cognitive decline and car driving ability. However, it has received critique for its dependence on the Latin alphabet and thus, the risk of misclassifying some participants. Alphabet support potentially increases test validity by avoiding misclassification of executive dysfunction in participants with dyslexia and those with insufficient automatization of the Latin alphabet. However, Alphabet support might render the test less sensitive to set-shifting, thus compromising the validity of the test. This study compares two versions of the TMT: with and without alphabet support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We compared the TMT-A, TMT-B, and TMT-B:A ratios in two independent normative samples with (<jats:italic>n<\/jats:italic>\u2009=\u2009220) and without (<jats:italic>n<\/jats:italic>\u2009=\u200964) alphabet support using multiple regression analysis adjusted for age and education. The sample comprised Scandinavians aged 70\u201384\u2009years. Alphabet support was included by adding the Latin alphabet A\u2013L on top of the page on the TMT-B. We hypothesized that alphabet support would not change the TMT-B:A ratio.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After adjusting for age and years of education, there were no significant differences between the two samples in the TMT-A, TMT-B, or the ratio score (TMT-B:A).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results suggest that the inclusion of alphabet support does not alter TMT\u2019s ability to measure set-shifting in a sample of older Scandinavian adults.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2023.1227578","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T07:34:09Z","timestamp":1690443249000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Improving validity of the trail making test with alphabet support"],"prefix":"10.3389","volume":"14","author":[{"given":"Therese H\u00e4ndel","family":"Waggestad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn Eivind","family":"Kirsebom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Strobel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Wallin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Eckerstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tormod","family":"Fladby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Egeland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.bandc.2012.02.001","article-title":"Processing speed and executive functions in cognitive aging: how to disentangle their mutual relationship?","volume":"79","author":"Albinet","year":"2012","journal-title":"Brain Cogn."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1076\/1380-3395(200008)22:4;1-0;FT518","article-title":"Trail making test, part B as a measure of executive control: validation using a set-switching paradigm","volume":"22","author":"Arbuthnott","year":"2000","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1080\/23279095.2017.1392963","article-title":"Normative data for Farsi-speaking Iranians in the United States on measures of executive functioning","volume":"26","author":"Avila","year":"2019","journal-title":"Appl. Neuropsychol. Adult"},{"key":"ref4","first-page":"81","article-title":"Theory and methodology in executive function research. Burgess, P.W. (1997) theory and methodology in executive function research","volume-title":"Theory and methodology of frontal and executive function","author":"Burgess","year":"1997"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1080\/13825585.2015.1027650","article-title":"Derived Trail making test indices: demographics and cognitive background variables across the adult life span","volume":"22","author":"Christidi","year":"2015","journal-title":"Aging Neuropsychol. Cognit."},{"key":"ref6","volume-title":"Color trails test. Professional manual","author":"D\u2019elia","year":"1996"},{"key":"ref7","volume-title":"D\u2010KEFS Executive Function System: Examiners manual","author":"Delis","year":"2001"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"795","DOI":"10.3389\/fpsyg.2018.00795","article-title":"Inhibition and updating, but not switching, predict developmental dyslexia and individual variation in Reading ability","volume":"9","author":"Doyle","year":"2018","journal-title":"Front. Psychol."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1093\/arclin\/15.5.425","article-title":"Equivalence of the color trails test and trail making test in nonnative English-speakers","volume":"15","author":"Dugbartey","year":"2000","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1080\/23279095.2020.1774377","article-title":"Offering alphabet support in the trail making test: increasing validity for participants with insufficient automatization of the alphabet","volume":"29","author":"Egeland","year":"2020","journal-title":"Appl. Neuropsychol. Adult"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1017\/S1355617719000456","article-title":"A systematic review and meta-analysis on the association between driving ability and neuropsychological test performances after moderate to severe traumatic brain injury","volume":"25","author":"Egeto","year":"2019","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1080\/13854046.2020.1829068","article-title":"Demographically adjusted trail making test norms in a Scandinavian sample from 41 to 84 years","volume":"34","author":"Espenes","year":"2020","journal-title":"Clin. Neuropsychol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1123\/jsep.31.4.469","article-title":"The effect of physical activity on executive function: a brief commentary on definitions, measurement issues, and the current state of the literature","volume":"31","author":"Etnier","year":"2009","journal-title":"J. Sport Exerc. Psychol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.13129\/2282-1619\/mjcp-3406","article-title":"Application to adolescents of a pure set-shifting measure for adults: identification of poor shifting skills in the group with developmental dyslexia","volume":"10","author":"Ferrara","year":"2022","journal-title":"Mediterr. J. Clin. Psychol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3233\/JAD-170231","article-title":"Detecting at-risk Alzheimer's disease cases","volume":"60","author":"Fladby","year":"2017","journal-title":"J. Alzheimers Dis."},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.12252","article-title":"Effects of candesartan vs Lisinopril on neurocognitive function in older adults with executive mild cognitive impairment: a randomized clinical trial","volume":"3","author":"Hajjar","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"7405205070p1","DOI":"10.5014\/ajot.119.040626","article-title":"Exploring the predictive ability of the motor-free visual perception test (Mvpt) and trail making test (Tmt) for on-road driving performance","volume":"74","author":"Holowaychuk","year":"2020","journal-title":"Am. J. Occup. Ther."},{"key":"ref18","first-page":"230","article-title":"Derived Trail making test indices: a preliminary report","volume":"7","author":"Lamberty","year":"1994","journal-title":"Neuropsychiatry Neuropsychol. Behav. Neurol."},{"key":"ref19","first-page":"685","article-title":"Attentional performance and executive functions in children with learning difficulties","volume":"24","author":"Lima","year":"2011","journal-title":"Psicologia"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1080\/13803390902881942","article-title":"The trail making test and its neurobehavioral components","volume":"32","author":"Misdraji","year":"2010","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref21","volume-title":"Handbook of normative data for neuropsychological assessment","author":"Mitrushina","year":"2005"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1080\/13854046.2014.964326","article-title":"Executive functioning in children with developmental dyslexia","volume":"28","author":"Moura","year":"2014","journal-title":"Clin. Neuropsychol."},{"key":"ref23","first-page":"11","article-title":"Partington's pathways test","volume":"1","author":"Partington","year":"1949","journal-title":"Psychol. Serv. Cen. J."},{"key":"ref24","volume-title":"Neuropsychological test battery: theory and clinical interpretation","author":"Reitan","year":"1985"},{"key":"ref25","first-page":"4","article-title":"Norwegian adolescent reference data for a cognitive screening battery with relevance to driving capacity","volume":"21","author":"Rike","year":"2019","journal-title":"J. Norw. Neuropsychol. Soc."},{"key":"ref33","volume-title":"Rstudio: integrated development environment for R","year":"2021"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/S0301-0511(00)00052-1","article-title":"Aging and measures of processing speed","volume":"54","author":"Salthouse","year":"2000","journal-title":"Biol. Psychol."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.intell.2011.03.001","article-title":"What cognitive abilities are involved in trail-making performance?","volume":"39","author":"Salthouse","year":"2011","journal-title":"Intelligence"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1037\/0096-3445.132.4.566","article-title":"Executive functioning as a potential mediator of age-related cognitive decline in Normal adults","volume":"132","author":"Salthouse","year":"2003","journal-title":"J. Exp. Psychol. Gen."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s10072-018-3673-y","article-title":"Regression-based normative data and equivalent scores for trail making test (Tmt): an updated Italian normative study","volume":"40","author":"Siciliano","year":"2019","journal-title":"Neurol. Sci."},{"key":"ref30","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.ridd.2016.03.001","article-title":"Executive functions in adults with developmental dyslexia","volume":"53","author":"Smith-Spark","year":"2016","journal-title":"Res. Dev. Disabil."},{"key":"ref31","volume-title":"A compendium of neuropsychological tests: administration, norms, and commentary","author":"Strauss","year":"2006"},{"key":"ref32","volume-title":"Manual Norsk Revidert trail making test (Tmt-Nr3) (Norwegian)","author":"Strobel","year":"2018"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0887-6177(03)00039-8","article-title":"Trail making test a and B: normative data stratified by age and education","volume":"19","author":"Tombaugh","year":"2004","journal-title":"Arch. Clin. 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