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An fMRI study of the Trail Making Test
Abstract
This study investigated the cerebral correlates of the Trail Making Test (TMT), used commonly as a measure of frontal lobe function. Such work sheds additional light on the known shortcomings of the TMT as a localizing instrument, as indicated, for example, by studies of patients with focal brain lesions. Functional magnetic resonance imaging (fMRI) was used to record brain activity while participants performed the TMT using a custom-built, fiber-optic fMRI-compatible writing device, the "virtual stylus". Unlike in a previous fMRI study that used a verbal adaptation of the TMT, the virtual stylus enabled a closer depiction of the brain regions engaged by the actual paper-and-pencil task. Twelve, right-handed healthy young adults participated. In Part A of the task, participants were required to link in ascending order numbers (1-2-3 ...) that were randomly distributed on a computer screen. In Part B, participants were required to link alternately between numbers and letters (1-A-2-B ...). Although behavioral performance was somewhat less than typically obtained with the TMT due to use of the virtual stylus, distinct left-sided dorsolateral and medial frontal activity was revealed when comparing Part B versus Part A. These findings agree with existing literature showing sensitivity of the TMT to frontal regions in the left hemisphere. However, other activity was also observed (left middle and superior temporal gyrus) reinforcing that the brain-behavior correlations for the TMT are multifaceted and not restricted to the frontal lobe.
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“these tests involve DLPFC (Owen et al. 2005, Zakzanis et al. 2005) and are sensitive to mTBI (Arciniega et al. 2021, Li et al. 2023).”
From Mild traumatic brain injury alters function in the dorsolateral prefrontal cortex: a TMS-EEG study (2025) · cites this paper as Zakzanis et al. 2005
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“As shown in Table 1 (in the main text), regions commonly activated during these tasks are related to fronto-parietal and fronto-striatal brain regions [59–65].”
From The paradox of cognitive flexibility in autism (2009) · cites this paper as [65]
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Metadata
- Authors
- Zakzanis, K. K., Mraz, R., & Graham, S. J.
- Affiliations
- University of Toronto (CA)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Mraz, Richard
- Venue
- Neuropsychologia
- Publisher
- Elsevier BV
- Published
- 2005-01
- Volume
- 43
- Issue
- 13
- Pages
- 1878-1886
- ISSN
- 0028-3932 (ISSN-L)
- OpenAlex
- W2051410142
- Cited by
- 408
- References
- 37
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 13 · 2023: 14 · 2022: 19 · 2021: 27 · 2020: 13 · 2019: 13 · 2018: 20 · 2017: 24 · 2016: 25 · 2015: 27 · 2014: 26 · 2013: 35 · 2012: 34
- FWCI
- 5.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuropsychologia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- Trail Making Test, frontal lobe function, brain-behavior relationship, dorsolateral prefrontal cortex, medial frontal cortex, left hemisphere, executive function, temporal lobe activation, neuropsychological assessment validity
- MeSH terms
- Adult, Brain Mapping, Cerebral Cortex, Dominance, Cerebral, Female, Frontal Lobe, Hand, Humans, Magnetic Resonance Imaging, Male, Movement, Psychomotor Performance, Reference Values, Serial Learning, Trail Making Test
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