A Normative Study of the Trail Making Test-Black and White in the Korean Population

Objective Although the Trail Making Test (TMT) is widely used to identify cognitive dysfunction, it has limited utility in cross-cultural contexts due to the use of the English alphabet in a subset of the test. The TMT-Black and White (TMT-B&W) is a newly developed version of the TMT that uses only black and white circles to overcome performance biases among non-English-speaking and illiterate older individuals. The objective of this study was to provide initial normative data for the TMT-B&W from the Korean population and investigate the influence of age, sex, and education level on the time taken to complete the test. Methods We recruited 1012 participants (430 men and 582 women) aged 19 to 90 in the community settings including a Welfare Center for the Elderly. TMT-B&W tests were conducted, and the time to completion of the test was measured. Scaled scores (M = 10, SD = 3) were calculated and multiple regression analyses were conducted to establish regression based normative T-scores (M = 50, SD = 10) for the TMT-B&W part A and B. Results Age, education level, and sex significantly predicted TMT-B&W Part A and Part B performance. The regression models explained 52.6% of the variance for Part A and 69.6% for Part B. Demographically adjusted T-scores were developed, providing standardized normative data for clinical interpretation. Conclusion This study provided normative data for the TMT-B&W in the Korean population. This new version of the TMT has the potential to be employed in cross-cultural contexts without language barriers, although further validation across diverse populations is needed.