Exploring the association of the Comprehensive Trail Making Test with driving indexes in patients with Parkinson’s disease Ion N. Beratis a , Nikolaos Andronas a , Stella Fragkiadaki a , Dionysia Kontaxopoulou a , Dimosthenis Pavlou b , Panagiotis Papantoniou b , Maria Stamelou c,d , Leonidas Stefanis a,e , George Yannis b , Sokratis G. Papageorgiou a,⇑ a National & Kapodistrian University of Athens, 2nd Department of Neurology, ‘‘Attikon” University General Hospital, 1 Rimini Str, 12462 Athens, Greece b National Technical University of Athens, School of Civil Engineering, Department of Transportation Planning and Engineering, 9 Heroon Polytechniou Str, 15780 Zografou, Athens, Greece C HYGEIA Hospital, Parkinson’s disease and Movement Disorders Department, 4 Erythrou Stavrou Str, 15123 Marousi, Athens, Greece d National and Kapodistrian University of Athens, 1st Department of Neurology, Aiginiteion Hospital, 72 Vas. Sofias Str, 11528 Athens, Greece e Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou Str, 11527 Athens, Greece article info Article history: Received 30 December 2016 Received in revised form 8 June 2017 Accepted 15 October 2017 Available online xxxx Keywords: Comprehensive Trail Making Test Trail Making Test Parkinson’s disease Fitness-to-drive Driving simulator abstract The Trail Making test (TMT) has been identified as predictor of driving ability in patients with Parkinson’s disease (PD). However, previous research has not explored the effective- ness of an alternative version of the TMT, namely of the Comprehensive Trail Making Test (CTMT; Reynolds, 2002) to show associations with measures related to driving fitness. Main objective of the current work was to evaluate the capacity of the CTMT to detect asso- ciations with fitness to drive related measures in patients with PD. Inclusion criteria were the presence of a valid driver’s license, regular car driving, a CDR score  0.5, and a Hoehn & Yahr score between 1 and 3. Twelve individuals with PD (Age: Mean = 63.75, SD = 10.50) and 12 cognitively intact individuals (Age: Mean = 63.50, SD = 10.43) were introduced in the study. Collection of data included a comprehensive neurological/neuropsychological assessment and a driving simulation experiment. Certain subtests of the CTMT were more strongly associated with a variety of driving indexes in individuals with PD as compared to the original TMT. In addition, according to the stepwise regression models that were applied, the CTMT was recognized as a more effective predictor of driving behavior than the TMT. The pattern of findings that was observed supports the usefulness of CTMT on detecting associations with fitness to drive related-measures in patients with PD. Underlying factors that may explain the effectiveness of the CTMT could be related to the greater variety of set shifting and inhibition processes that this alternative option inte- grates as compared to the original TMT. Ó 2017 Elsevier Ltd. All rights reserved. 1. Introduction Parkinson’s disease (PD) is a slowly progressive, degenerative disease of the basal ganglia, with motor dysfunction as a cardinal feature (Fritsch et al., 2012; Gazewood, Richards, & Clebak, 2013). In addition to motor dysfunction, PD is related to cognitive (memory, visuo-spatial, and executive dysfunction), emotional (e.g. depression, apathy) and https://doi.org/10.1016/j.trf.2017.10.007 1369-8478/Ó 2017 Elsevier Ltd. All rights reserved. ⇑ Corresponding author at: 2nd University Department of Neurology, Behavioral Neurology and Neuropsychology Unit, University General Hospital ‘ATTIKON’, 1 Rimini Str, 12462 Haidari, Athens, Greece. E-mail address: sokpapa@med.uoa.gr (S.G. Papageorgiou). Transportation Research Part F xxx (2017) xxx–xxx Contents lists available at ScienceDirect Transportation Research Part F journal homepage: www.elsevier.com/locate/trf Please cite this article in press as: Beratis, I. N., et al. Exploring the association of the Comprehensive Trail Making Test with driving indexes in patients with Parkinson’s disease. Transportation Research Part F (2017), https://doi.org/10.1016/j.trf.2017.10.007