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13-05-2012 | Stroke | Article

Trail Making Tests sensitive for future stroke mortality


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MedWire News: Men's performance on the Trail Making Test (TMT)-A and -B is a sensitive indicator of their risk for dying should they suffer a stroke, report Swedish researchers.

By contrast, the men's results on the Mini-Mental State Examination (MMSE) did not predict stroke mortality.

This is because the men in the study had generally good cognitive performance at baseline, say Bernice Wiberg (Uppsala University) and co-workers. The 919 men, drawn from the Uppsala Longitudinal Study of Adult Men and aged about 70 years at baseline, had a median score of 29 on the MMSE, and none had a score below 21, which would indicate dementia.

The MMSE screens for cognitive impairment and dementia, whereas the TMT-A and -B specifically assess executive function. "Executive dysfunction in an elderly population may be a manifestation of clinically unrealised cerebrovascular disease," notes the team in BMJ Open.

A total of 155 men had an ischemic or hemorrhagic stroke or transient ischemic attack (TIA) during a median 11 years of follow up. Of these, 84 died.

The average times on the TMT-A were similar for men with and without stroke/TIA, at 48 and 47 seconds, respectively, whereas those who developed stroke/TIA took longer on the TMT-B than those who did not, at 127 versus 119 seconds.

Among men who had stroke or TIA, those in the third tertile of TMT-A times, ie, those who needed the most time to complete the task, were 2.9-fold more likely to die than those in the first tertile. Also, men in the third terile of TMT-B times were 3.5-fold more likely to die after stroke than those in the first tertile. These associations were independent of confounders including age, education, and stroke risk factors.

"The present study is unique in its kind since the cognitive function evaluation was performed up to 12?years before the stroke event," comment Wiberg et al.

They conclude: "Thus, TMT-A and -B, easily accessible cognitive tests for clinical use, may not only be used as tools for identifying risk of stroke but may also be considered important predictors of post-stroke mortality."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Eleanor McDermid