TEST

Color Trails Test (CTT)

Visual attention, speed, and set shifting without cultural bias

Culturally fair analogue of the Trail Making Test (D’Elia et al., 1996). It replaces number-letter alternation with color-based alternation, preserving the executive demand while reducing dependence on the Latin alphabet and literacy.

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2

PARTS (A AND B)

25

NUMBERS PER PART

49

STIMULI IN B

0

LINGUISTIC DEPENDENCE

WHAT THE TEST IS

The trail-making paradigm, without the alphabet barrier

Introduced by D’Elia, Satz, Uchiyama, and White (1996), the CTT maintains the logic of Trail Making —rapid execution of a sequential trail— but eliminates number-letter alternation and replaces it with color alternation. It is especially indicated in multicultural contexts, in people with low literacy, or those unfamiliar with the Latin alphabet.

Part 1 provides an index of visuomotor speed and sustained attention under a simple rule. Part 2 introduces alternation between two sets defined by color, assessing cognitive flexibility, inhibitory control, and rule updating in working memory (Tyburski et al., 2020; Strauss et al., 2006). Normative data are available in different populations, including the Spanish NEURONORMA-Plus project (García-Escobar et al., 2024).

HOW IT IS ADMINISTERED

Connect 25 numbers and then alternate between two colors

In Part A, the user connects 1 to 25 in ascending order; number 1 is identified with an arrow icon (start) and 25 with a hand icon (finish), with no text. In Part B, the 25 numbers are duplicated in two colors —yellow and blue— adding up to 49 stimuli; the user must follow the sequence 1-2-3… while obligatorily alternating color at each step.

Each part is preceded by a practice block with the first 8 elements. Correct press: the circle is highlighted and the black line is drawn to the previous one. Incorrect press: brief red outline, without advancing the sequence. The platform records times, exact sequence, errors, and latencies by quadrant.

WHAT THE TEST MEASURES

Indicators and their interpretation

The contrast between the two parts and the qualitative analysis of the sequence make it possible to separate general slowing from executive deficit and detect possible visuospatial biases.

Total time Part A

Seconds to complete the 1→25 sequence under a simple rule. Index of visuomotor processing speed and sustained attention.

High time: general slowing, fatigue, or visuoperceptual difficulty.
Low time: preserved visual scanning and psychomotor speed.

Total time Part B

Time in the task with color alternation. Measures cognitive flexibility, inhibitory control, and working memory under attentional demand.

High time: deficit in attentional alternation or set-shifting.
Low time: efficient rule switching.

Errors

Presses that break the sequence (omissions, sequence, non-alternated color, proximity). Measures accuracy and self-monitoring.

Color perseverations: difficulty in flexibility/inhibition.
Low errors: preserved attentional control.

B/A ratio

Quotient between time B and time A. Normalizes executive cost relative to the user’s baseline speed.

Ratio > 3: disproportionate deficit in alternation (TBI, schizophrenia).
Ratio close to 1: preserved cognitive flexibility.

B – A difference

Extra seconds required by alternation. Considered by some authors the most appropriate marker of “pure” executive control.

High difference: significant executive overcost.
Low difference: alternation with low cognitive cost.

Maximum latencies and quadrants

Five longest intervals between presses in each part, mapped by screen quadrant. Qualitative analysis only possible in the digital version.

Concentration on one side: suspected hemispatial neglect.
Latencies at the end: attentional fatigue.

REFERENCES

Bibliography

D’Elia, L. F., Satz, P., Uchiyama, C. L., & White, T. (1996). Color Trails Test. Odessa, FL: PAR.
Dugbartey, A. T., Townes, B. D., & Mahurin, R. K. (2000). Equivalence of the Color Trails Test and Trail Making Test in nonnative English-speakers. Archives of Clinical Neuropsychology, 15(5), 425–431.
Tyburski, E., Pełka-Wysiecka, J., Mak, M., et al. (2020). Color Trails Test: Cognitive components and clinical utility. (Review).
Ben Yair, N., Wilf, M., Bahat, Y., & Plotnik, M. (2023). Studying cognitive-motor interactions using a tablet-based application of the Color Trails Test. Experimental Brain Research, 241(4), 1065–1075.
García-Escobar, G., et al. (2024). Spanish normative studies (NEURONORMA-Plus): Norms for the Color Trails Test. Neurología, 39(2), 160–169.
Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A compendium of neuropsychological tests (3rd ed.). Oxford University Press.