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Behavioural Neurology
Volume 2015, Article ID 309235, 10 pages
Research Article

Errors on the Trail Making Test Are Associated with Right Hemispheric Frontal Lobe Damage in Stroke Patients

1Cognitive Neurology, Technische Universität Braunschweig and Department of Neurology, Braunschweig Hospital, Salzdahlumer Street 90, 38126 Braunschweig, Germany
2Department of Neurology, Hannover Medical School, Carl-Neuberg Street 1, 30625 Hannover, Germany
3Klinik Niedersachsen, Haupt Street 59, 31542 Bad Nenndorf, Germany
4Division of Neuropsychology, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler Street 3, 72076 Tübingen, Germany
5Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC 29208, USA

Received 30 January 2015; Revised 20 March 2015; Accepted 15 April 2015

Academic Editor: Marjan Jahanshahi

Copyright © 2015 Bruno Kopp et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Measures of performance on the Trail Making Test (TMT) are among the most popular neuropsychological assessment techniques. Completion time on TMT-A is considered to provide a measure of processing speed, whereas completion time on TMT-B is considered to constitute a behavioral measure of the ability to shift between cognitive sets (cognitive flexibility), commonly attributed to the frontal lobes. However, empirical evidence linking performance on the TMT-B to localized frontal lesions is mostly lacking. Here, we examined the association of frontal lesions following stroke with TMT-B performance measures (i.e., completion time and completion accuracy measures) using voxel-based lesion-behavior mapping, with a focus on right hemispheric frontal lobe lesions. Our results suggest that the number of errors, but not completion time on the TMT-B, is associated with right hemispheric frontal lesions. This finding contradicts common clinical practice—the use of completion time on the TMT-B to measure cognitive flexibility, and it underscores the need for additional research on the association between cognitive flexibility and the frontal lobes. Further work in a larger sample, including left frontal lobe damage and with more power to detect effects of right posterior brain injury, is necessary to determine whether our observation is specific for right frontal lesions.