Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test

Campanholo, Kenia Repiso; Romão, Marcos Antunes; Machado, Melissa de Almeida Rodrigues; Serrao, Valéria Trunkl; Coutinho, Denise Gonçalves Cunha; Benute, Gláucia Rosana Guerra; Lucia, Mara Cristina Souza de

doi:10.1590/S1980-57642014DN81000005

ABSTRACT

Objective: The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C. Methods: We recruited 1447 healthy subjects aged ≥18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C. Results: Among the participants, mean intellectual efficiency was 103.20 (SD: 12.0), age 41.0 (SD: 16.4) years and education 11.9 (SD: 5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference. Conclusion: Gender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples.

Key words:
attention; Trail Making Test; Stroop test; demographic analysis

RESUMO

Objetivo: Os testes de atenção Trail Making Test (TMT) e Stroop Test (ST) são largamente usados na prática clínica e em pesquisas. O objetivo deste estudo foi fornecer informação normativa para a população brasileira de adultos e estudar a interferência de gênero, idade e educação no TMT parte A e B e no ST cartão A, B e C. Métodos: Recrutamos 1447 sujeitos saudáveis com idade ≥18 anos, nível educacional de 0-25 anos, falantes nativos do Português (Brasil). Os sujeitos foram avaliados pelos subtestes do Wechsler Adult Intelligence Scale-III Raciocínio Matricial e Vocabulários, além do TMTA, TMTB e ST A, B e C. Resultados: Entre os participantes a média de eficiência intelectual foi de 103,20 (SD: 12,0), de idade 41,0 (SD: 16,4) anos e de escolaridade 11,9 (SD: 5,6) anos. Houve diferenças significantes por gênero em TMTA (p=0,002), TMTB (p=0,017) e STC (p=0,024). Idade se correlacionou de modo positivo com todos os testes de atenção, enquanto a escolaridade correlacionou-se de modo negativo. Após o modelo de regressão linear múltipla o gênero não manteve correlação significativa, mas idade e escolaridade mantiveram sua interferência. Conclusão: O gênero não mostrou grande impacto nas tarefas atencionais como a idade e escolaridade que devem, portanto, ser consideradas na estratificação de amostras normativas.

Palavras-chave:
atenção; Trail Making Test; Stroop Test; análise demográfica

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REFERENCES

¹
Halligan PW, Kischka U, Marshall JC. Handbook of Clinical Neuropsychology. New York: Oxford University Press; 2004.
²
Gazzaniga MS, Ivry RB, Mangun GR. Neurociência cognitiva: a biologia da mente. Porto Alegre: Artmed; 2006.
³
Mesulam MM. Principles of Behavioral and Cognitive Neurology. New York: Oxford University Press; 2000.
⁴
Lima RF. Compreendendo os mecanismos atencionais. Ciências e Cognição 2005;6:113-121.
⁵
Nabas TR, Xavier GF. Neurobiologia da atenção visual. In: Andrade VM, Santos FH, Bueno OFA, editors. Neuropsicologia Hoje. São Paulo: Artes Médicas; 2004:101-124.
⁶
Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests. Administration, norms and commentary.3th ed. New York: mOxford University Press; 2006.
⁷
Miotto EC, Campanholo KR, Machado MAR, et al. Cognitive performance and mood in patients on the waiting list for liver transplantation and their relation to the model for end-stage liver disease. Arq Neuropsiquiatr 2010;68:62-66.
⁸
Duncan MT. Obtenção de dados normativos para desempenho no teste de stroop num grupo de estudantes do ensino fundamental em Niterói. J Bras Psiquiatr 2006;55:42-48.
⁹
Charchat-Fichman H, Oliveira RM. Performance of 119 Brazilian children on StrooP Paradigm - Victoria Version. Arq Neuropsiquiatr 2009; 67:445-449.
¹⁰
Pinho M, Cerqueira R, Peixoto B. Psychometric hepatic encephalopathy score normalization data for the Portuguese population. Acta Med Port 2011;24(Suppl 2):319-326.
¹¹
Ihle-Hansen H, Thommessen B, Fagerland MW, et al. Impact of White Matter Lesions on Cognition in Stroke Patients Free from Pre-Stroke Cognitive Impairment: A One-Year Follow-Up Study. Dement Geriatr Cog Desord 2012;2:38-47.
¹²
Lezak MD, Howieson DB, Bigler ED, Trane, D. Neuropsychological Assessment. New York: Oxford University Press; 2004.
¹³
Partington JE, Leiter RG. Partington's Pathway Test. Psychological Service Center Bulletin 1949;168:111-117.
¹⁴
Delis DC, Kaplan E, Kramer JH. D-KEFS Delis-Kaplan Executive Function System. San Antonio: Pearson; 2011.
¹⁵
Reynolds CR. Comprehensive Trail-Making Tes. Austin: PRO-ED; 2002.
¹⁶
Rabelo IS, Pacanaro SV, Rosseti MO, Leme IFAS. Teste de Trilhas Coloridas. São Paulo: Casa do Psicólogo; 2010.
¹⁷
JR Stroop. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643-662.
¹⁸
Regard M. Cognitive rigidity and flexibility: a neuropsychological study. [dissertation] Victoria: University of Victoria; 1981.
¹⁹
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003:61:777-781.
²⁰
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361-370.
²¹
Nascimento E. Escala de Inteligência Wechsler para Adultos: Manual David Weschsler; Adaptação e padronização de uma amostra brasileira. 1a. ed. São Paulo: Casa do Psicólogo; 2004.
²²
Ringe WK, Saine KC, Lacritz LH, Hynan LS, Cullum CM. Dyadic short forms of the Wechesler adult intelligence scale-III. Assessment. 2002;9: 254-260.
²³
Seo EH, Lee DY, Kim KW, et al. A normative study of the Trail Making Test in Korean elders. Int J Geriatr Psychiatry 2006;21:844-852.
²⁴
Pavão Martins I, Maruta C, Freitas V, Mares I. Executive Performance in Older Portuguese Adults with Low Education. Clin Neuropsychologist 2013;27:410-425.
²⁵
Messinis L, Malegiannaki AC, Christodoulou T, Panagiotopoulos V, Papathanasopoulos P. Color Trails Test: Normative data and criterion validity for the Greek adult population. Arch Clin Neurospychol 2011;26:
²⁶
Elst WV, Van Boxtel MPJ, Van Breukelen GJP, Jolles J. The Concept Shifting Test: Adult Normative Data. Psychol Assess 2006;18:424-432.
²⁷
Drane DL, Yuspeh RL, Huthwaite JS, Klingler, LK. Demografic characteristics and normative observations for derived-Trail Making Test Indices. Neuropsychiatry Neuropsychol Behav Neurol 2001;15:39-43.
²⁸
Bayard S, Erkes J, Moroni C. Victoria Stroop Test: Normative Data in a Sample Group of Older People and the Study of Their Clinical Applications in the Assessment of Inhibition in Alzheimer's Disease. Arch Clin Neuropsychol 2011;26:653-661.
²⁹
Rognoni T, Casals-Coll M, Sanchez-Benavides G, et al. Estudios Normativos españoles em poblacíon adulta joven (Proyecto NEURONORMA Jóvenes): normas para las pruebas Stroop Color - Word Interference Test y Tower of London - Drexel University, Neurología, 2013;28:73-80.
³⁰
Norman MA, Moore DJ, Taylor M, et al. Demographically Corrected Norms for African Americans and Caucasians on the Hopkins Verbal Learning Test-Revised, Brief Visuospatial Memory Test-Revised, Stroop Color and Word Test, and Wisconsin Card Sorting Test 64-Card Version. J Clin Exp Neuropsychol 2011;33:793-804.
³¹
Seo EH, Lee DY, Choo IH, et al. Normative study of the Stroop Color and Word Test in an educationally diverse elderly population. Int J Geriatr Psychiatry 2008;23:1020-1027.
³²
Albinet CT, Boucard G, Bouquet CA, Audiffren M. Processing speed and executive functions in cognitive aging: How to disentangle their mutual relationship? Brain Cogn 2012;79:1-11.
³³
Elst WV, Boxtel MPJV, Breukelen GJPV, Jolles J. The Stroop Color-Word Test Influence of Age, Sex, and Education; and Normative Data for a Large Sample Across the Adult Age Range. Assessment 2006;13:62-79.
³⁴
Cavaco S, Pinto C, Almeida E, et. al. Trail Making Test: Regression Based Norms for the Portuguese population. Arch Clin Neuropsychol 2013;28:189-198.
³⁵
Troyer AK, Leach L, Strauss E. Aging and response inibition normative data for the victoria stroop test. Aging Neuropshychol Cogn 2006; 13:20-35.
³⁶
Tamayo F, Casals-Col M, Sánchez-Beavides G, et. al., Estudios Normativos españoles em población adulta joven (Proyecto NEURONORMA Jóvenes): normas para las pruebas span verbal, span visuoespacial, Letter-number sequencing, Trail Making Test y Symbol Digit Modalities Test. Neurología 2012;27:319-329.
³⁷
Zahodne LB, Glymour MM, Sparks C, et. al. Education Does Not Slow Cognitive Decline with Aging: 12-Year Evidence from the Victoria Longitudinal Study. J Int Neuropsychol Soc 2011;17:1039-1046.
³⁸
Prince M, Acosta D, Ferri CP, et al. Dementia incidence and mortality inmiddle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study. Lancet 2012;380:50-58.

Publication Dates

Publication in this collection
Jan-Mar 2014

History

Received
24 Nov 2013
Accepted
26 Jan 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Halligan PW, Kischka U, Marshall JC. Handbook of Clinical Neuropsychology. New York: Oxford University Press; 2004.

[2] ²
Gazzaniga MS, Ivry RB, Mangun GR. Neurociência cognitiva: a biologia da mente. Porto Alegre: Artmed; 2006.

[3] ³
Mesulam MM. Principles of Behavioral and Cognitive Neurology. New York: Oxford University Press; 2000.

[4] ⁴
Lima RF. Compreendendo os mecanismos atencionais. Ciências e Cognição 2005;6:113-121.

[5] ⁵
Nabas TR, Xavier GF. Neurobiologia da atenção visual. In: Andrade VM, Santos FH, Bueno OFA, editors. Neuropsicologia Hoje. São Paulo: Artes Médicas; 2004:101-124.

[6] ⁶
Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests. Administration, norms and commentary.3th ed. New York: mOxford University Press; 2006.

[7] ⁷
Miotto EC, Campanholo KR, Machado MAR, et al. Cognitive performance and mood in patients on the waiting list for liver transplantation and their relation to the model for end-stage liver disease. Arq Neuropsiquiatr 2010;68:62-66.

[8] ⁸
Duncan MT. Obtenção de dados normativos para desempenho no teste de stroop num grupo de estudantes do ensino fundamental em Niterói. J Bras Psiquiatr 2006;55:42-48.

[9] ⁹
Charchat-Fichman H, Oliveira RM. Performance of 119 Brazilian children on StrooP Paradigm - Victoria Version. Arq Neuropsiquiatr 2009; 67:445-449.

[10] ¹⁰
Pinho M, Cerqueira R, Peixoto B. Psychometric hepatic encephalopathy score normalization data for the Portuguese population. Acta Med Port 2011;24(Suppl 2):319-326.

[11] ¹¹
Ihle-Hansen H, Thommessen B, Fagerland MW, et al. Impact of White Matter Lesions on Cognition in Stroke Patients Free from Pre-Stroke Cognitive Impairment: A One-Year Follow-Up Study. Dement Geriatr Cog Desord 2012;2:38-47.

[12] ¹²
Lezak MD, Howieson DB, Bigler ED, Trane, D. Neuropsychological Assessment. New York: Oxford University Press; 2004.

[13] ¹³
Partington JE, Leiter RG. Partington's Pathway Test. Psychological Service Center Bulletin 1949;168:111-117.

[14] ¹⁴
Delis DC, Kaplan E, Kramer JH. D-KEFS Delis-Kaplan Executive Function System. San Antonio: Pearson; 2011.

[15] ¹⁵
Reynolds CR. Comprehensive Trail-Making Tes. Austin: PRO-ED; 2002.

[16] ¹⁶
Rabelo IS, Pacanaro SV, Rosseti MO, Leme IFAS. Teste de Trilhas Coloridas. São Paulo: Casa do Psicólogo; 2010.

[17] ¹⁷
JR Stroop. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643-662.

[18] ¹⁸
Regard M. Cognitive rigidity and flexibility: a neuropsychological study. [dissertation] Victoria: University of Victoria; 1981.

[19] ¹⁹
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003:61:777-781.

[20] ²⁰
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361-370.

[21] ²¹
Nascimento E. Escala de Inteligência Wechsler para Adultos: Manual David Weschsler; Adaptação e padronização de uma amostra brasileira. 1a. ed. São Paulo: Casa do Psicólogo; 2004.

[22] ²²
Ringe WK, Saine KC, Lacritz LH, Hynan LS, Cullum CM. Dyadic short forms of the Wechesler adult intelligence scale-III. Assessment. 2002;9: 254-260.

[23] ²³
Seo EH, Lee DY, Kim KW, et al. A normative study of the Trail Making Test in Korean elders. Int J Geriatr Psychiatry 2006;21:844-852.

[24] ²⁴
Pavão Martins I, Maruta C, Freitas V, Mares I. Executive Performance in Older Portuguese Adults with Low Education. Clin Neuropsychologist 2013;27:410-425.

[25] ²⁵
Messinis L, Malegiannaki AC, Christodoulou T, Panagiotopoulos V, Papathanasopoulos P. Color Trails Test: Normative data and criterion validity for the Greek adult population. Arch Clin Neurospychol 2011;26:

[26] ²⁶
Elst WV, Van Boxtel MPJ, Van Breukelen GJP, Jolles J. The Concept Shifting Test: Adult Normative Data. Psychol Assess 2006;18:424-432.

[27] ²⁷
Drane DL, Yuspeh RL, Huthwaite JS, Klingler, LK. Demografic characteristics and normative observations for derived-Trail Making Test Indices. Neuropsychiatry Neuropsychol Behav Neurol 2001;15:39-43.

[28] ²⁸
Bayard S, Erkes J, Moroni C. Victoria Stroop Test: Normative Data in a Sample Group of Older People and the Study of Their Clinical Applications in the Assessment of Inhibition in Alzheimer's Disease. Arch Clin Neuropsychol 2011;26:653-661.

[29] ²⁹
Rognoni T, Casals-Coll M, Sanchez-Benavides G, et al. Estudios Normativos españoles em poblacíon adulta joven (Proyecto NEURONORMA Jóvenes): normas para las pruebas Stroop Color - Word Interference Test y Tower of London - Drexel University, Neurología, 2013;28:73-80.

[30] ³⁰
Norman MA, Moore DJ, Taylor M, et al. Demographically Corrected Norms for African Americans and Caucasians on the Hopkins Verbal Learning Test-Revised, Brief Visuospatial Memory Test-Revised, Stroop Color and Word Test, and Wisconsin Card Sorting Test 64-Card Version. J Clin Exp Neuropsychol 2011;33:793-804.

[31] ³¹
Seo EH, Lee DY, Choo IH, et al. Normative study of the Stroop Color and Word Test in an educationally diverse elderly population. Int J Geriatr Psychiatry 2008;23:1020-1027.

[32] ³²
Albinet CT, Boucard G, Bouquet CA, Audiffren M. Processing speed and executive functions in cognitive aging: How to disentangle their mutual relationship? Brain Cogn 2012;79:1-11.

[33] ³³
Elst WV, Boxtel MPJV, Breukelen GJPV, Jolles J. The Stroop Color-Word Test Influence of Age, Sex, and Education; and Normative Data for a Large Sample Across the Adult Age Range. Assessment 2006;13:62-79.

[34] ³⁴
Cavaco S, Pinto C, Almeida E, et. al. Trail Making Test: Regression Based Norms for the Portuguese population. Arch Clin Neuropsychol 2013;28:189-198.

[35] ³⁵
Troyer AK, Leach L, Strauss E. Aging and response inibition normative data for the victoria stroop test. Aging Neuropshychol Cogn 2006; 13:20-35.

[36] ³⁶
Tamayo F, Casals-Col M, Sánchez-Beavides G, et. al., Estudios Normativos españoles em población adulta joven (Proyecto NEURONORMA Jóvenes): normas para las pruebas span verbal, span visuoespacial, Letter-number sequencing, Trail Making Test y Symbol Digit Modalities Test. Neurología 2012;27:319-329.

[37] ³⁷
Zahodne LB, Glymour MM, Sparks C, et. al. Education Does Not Slow Cognitive Decline with Aging: 12-Year Evidence from the Victoria Longitudinal Study. J Int Neuropsychol Soc 2011;17:1039-1046.

[38] ³⁸
Prince M, Acosta D, Ferri CP, et al. Dementia incidence and mortality inmiddle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study. Lancet 2012;380:50-58.

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