PLoS One. 2020 May 12;15(5):e0232469. doi: 10.1371/journal.pone.0232469. eCollection 2020.

Functional magnetic resonance imaging of the trail-

making test in older adults
Natasha Talwar  1 , Nathan W Churchill  1 , Megan A Hird  1 , Fred Tam  2 , Simon J Graham  2   3 , 
Tom A Schweizer  1   4

Affiliations
PMID: 32396540 PMCID: PMC7217471 DOI: 10.1371/journal.pone.0232469
Free PMC article

Abstract
The trail-making test (TMT) is a popular neuropsychological test, which is used extensively to measure
cognitive impairment associated with neurodegenerative disorders in older adults. Behavioural
performance on the TMT has been investigated in older populations, but there is limited research on
task-related brain activity in older adults. The current study administered a naturalistic version of the
TMT to a healthy older-aged population in an MRI environment using a novel, MRI-compatible tablet.
Functional MRI was conducted during task completion, allowing characterization of the brain activity
associated with the TMT. Performance on the TMT was evaluated using number of errors and seconds
per completion of each link. Results are reported for 36 cognitively healthy older adults between the
ages of 52 and 85. Task-related activation was observed in extensive regions of the bilateral frontal,
parietal, temporal and occipital lobes as well as key motor areas. Increased age was associated with
reduced brain activity and worse task performance. Specifically, older age was correlated with
decreased task-related activity in the bilateral occipital, temporal and parietal lobes. These results
suggest that healthy older aging significantly affects brain function during the TMT, which
consequently may result in performance decrements. The current study reveals the brain activation
patterns underlying TMT performance in a healthy older aging population, which functions as an
important, clinically-relevant control to compare to pathological aging in future investigations.

Figures
 Fig 1. Images of the Fig 2. Task design for Fig 3. Brain activation
tablet system… one run… maps during task…

Fig 4. Brain activation

maps covaried with…

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