Trail Making Task

HED Task ID: hedtsk_trail_making

Also known as: Trail Making Test, TMT, Trails A/B, Trail Making

Paper-and-pencil sequencing: connect numbered circles (Part A) or alternate numbers and letters (Part B) as fast as possible. B−A difference indexes set switching.

Description

The Trail Making Test is a widely used neuropsychological assessment consisting of two parts. In Part A, participants draw lines connecting consecutively numbered circles (1→2→3→…) as quickly as possible, measuring visual scanning and psychomotor speed. In Part B, participants alternate between numbers and letters (1→A→2→B→3→C→…), adding demands for cognitive flexibility and task-switching. The derived score (B–A) isolates the switching cost from baseline motor and visual search speed. The TMT is among the most sensitive measures of general brain dysfunction and is included in virtually every neuropsychological test battery. Digital tablet versions now capture rich kinematic data (velocity, pressure, pauses).

Inclusion test

Procedure

Participants connect numbered circles in order (Part A: 1-2-3…) or alternate between numbers and letters (Part B: 1-A-2-B-3-C…), drawing lines as quickly as possible.

Manipulation

Part A vs. Part B; number of targets; digital vs. paper administration.

Measurement

Completion time for Part A and Part B; B-minus-A difference (executive component); B/A ratio; errors.

Variations

Variation

Description

Justification

TMT-A (Number Sequencing)

Connect numbered circles in order; baseline speed measure.

Canonical: connect numbers in order; processing speed measure

TMT-B (Number-Letter Alternation)

Alternate numbers and letters in sequence; indexes switching.

Alternating numbers and letters; adds cognitive flexibility demand

Oral Trail Making Test

Verbal version for patients with motor impairments; say the sequence aloud.

Verbal response instead of pencil tracing; different response modality

Color Trails Test

Uses colored numbers instead of letters; suitable for cross-cultural/non-English speakers.

Color-coded circles instead of letters; tests same construct in different format

Comprehensive Trail Making Test (CTMT)

Five subtests of increasing complexity.

Extended standardized version with additional subtests; named published instrument

D-KEFS Trail Making

Part of the Delis-Kaplan Executive Function System with additional conditions (motor speed, visual scanning, number sequencing, letter sequencing, switching).

Delis-Kaplan version with additional conditions; named published instrument

Cognitive processes

This task engages the following cognitive processes:

Key references

  • {‘authors’: ‘Reitan, R. M.’, ‘year’: 1958, ‘title’: ‘Validity of the Trail Making Test as an Indicator of Organic Brain Damage’, ‘venue’: ‘Perceptual and Motor Skills’, ‘venue_type’: ‘journal’, ‘journal’: ‘Perceptual and Motor Skills’, ‘volume’: ‘8’, ‘issue’: ‘3’, ‘pages’: ‘271-276’, ‘doi’: ‘10.2466/pms.1958.8.3.271’, ‘openalex_id’: None, ‘pmid’: None, ‘citation_string’: ‘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.’, ‘url’: ‘https://doi.org/10.2466/pms.1958.8.3.271’, ‘source’: ‘crossref’, ‘confidence’: ‘high’, ‘verified_on’: ‘2026-04-20’}

  • {‘authors’: ‘Bowie, C. R., & Harvey, P. D.’, ‘year’: 2006, ‘title’: ‘Administration and interpretation of the Trail Making Test’, ‘venue’: ‘Nature Protocols’, ‘venue_type’: ‘journal’, ‘journal’: ‘Nature Protocols’, ‘volume’: ‘1’, ‘issue’: ‘5’, ‘pages’: ‘2277-2281’, ‘doi’: ‘10.1038/nprot.2006.390’, ‘openalex_id’: None, ‘pmid’: None, ‘citation_string’: ‘Bowie, C. R., & Harvey, P. D. (2006). Administration and interpretation of the Trail Making Test. Nature Protocols, 1(5), 2277–2281.’, ‘url’: ‘https://doi.org/10.1038/nprot.2006.390’, ‘source’: ‘crossref’, ‘confidence’: ‘high’, ‘verified_on’: ‘2026-04-20’}

Recent references

  • {‘authors’: ‘Salthouse, T. A.’, ‘year’: 2011, ‘title’: ‘What cognitive abilities are involved in trail-making performance?’, ‘venue’: ‘Intelligence’, ‘venue_type’: ‘journal’, ‘journal’: ‘Intelligence’, ‘volume’: ‘39’, ‘issue’: ‘4’, ‘pages’: ‘222-232’, ‘doi’: ‘10.1016/j.intell.2011.03.001’, ‘openalex_id’: None, ‘pmid’: None, ‘citation_string’: ‘Salthouse, T. A. (2011). What cognitive abilities are involved in trail-making performance? Intelligence, 39(4), 222–232.’, ‘url’: ‘https://doi.org/10.1016/j.intell.2011.03.001’, ‘source’: ‘crossref’, ‘confidence’: ‘high’, ‘verified_on’: ‘2026-04-20’}

  • {‘authors’: ‘SÁNCHEZ-CUBILLO, I., PERIÁÑEZ, J., ADROVER-ROIG, D., RODRÍGUEZ-SÁNCHEZ, J., RÍOS-LAGO, M., TIRAPU, J., & BARCELÓ, F.’, ‘year’: 2009, ‘title’: ‘Construct validity of the Trail Making Test: Role of task-switching, working memory, inhibition/interference control, and visuomotor abilities’, ‘venue’: ‘Journal of the International Neuropsychological Society’, ‘venue_type’: ‘journal’, ‘journal’: ‘Journal of the International Neuropsychological Society’, ‘volume’: ‘15’, ‘issue’: ‘3’, ‘pages’: ‘438-450’, ‘doi’: ‘10.1017/s1355617709090626’, ‘openalex_id’: None, ‘pmid’: None, ‘citation_string’: ‘Sánchez-Cubillo, I., Periáñez, J. A., Adrover-Roig, D., Rodríguez-Sánchez, J. M., Ríos-Lago, M., Tirapu, J., & Barceló, F. (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.’, ‘url’: ‘https://doi.org/10.1017/s1355617709090626’, ‘source’: ‘crossref’, ‘confidence’: ‘high’, ‘verified_on’: ‘2026-04-20’}

  • {‘authors’: ‘Cangoz, B., Karakoc, E., & Selekler, K.’, ‘year’: 2009, ‘title’: ‘Trail Making Test: Normative data for Turkish elderly population by age, sex and education’, ‘venue’: ‘Journal of the Neurological Sciences’, ‘venue_type’: ‘journal’, ‘journal’: ‘Journal of the Neurological Sciences’, ‘volume’: ‘283’, ‘issue’: ‘1-2’, ‘pages’: ‘73-78’, ‘doi’: ‘10.1016/j.jns.2009.02.313’, ‘openalex_id’: None, ‘pmid’: None, ‘citation_string’: ‘Cangoz, B., Karakoc, E., & Selekler, K. (2009). Trail Making Test: Normative data for Turkish elderly population by age, sex, and education. Journal of the Neurological Sciences, 283(1-2), 73–78.’, ‘url’: ‘https://doi.org/10.1016/j.jns.2009.02.313’, ‘source’: ‘crossref’, ‘confidence’: ‘high’, ‘verified_on’: ‘2026-04-20’}