The trail less traveled: Analytical approach for creating shortened versions for virtual reality-based color trails test

The Color Trails Test (“CTT”) is among the most popular neuropsychological assessment tests of executive function, targeting sustained visual attention (Trails A), and divided attention (Trails B). During the pen-and-paper (P&amp;P) test, the participant traces 25 consecutive numbered targets marked on a page, and the completion time is recorded. In many cases, multiple assessments are performed on the same individual, either under varying experimental conditions or at several timepoints. However, repeated testing often results in learning and fatigue effects, which confound test outcomes. To mitigate these effects, we set the grounds for developing shorter versions of the CTT (&lt;25 targets), using virtual reality (VR) based CTT (VR-CTT). Our aim was to discover the minimal set of targets that is sufficient for maintaining concurrent validity with the CTT including differentiation between age groups, and the difference between Trails A and B. To this aim, healthy participants in three age groups (total <i>N</i> = 165; young, middle-aged, or older adults) performed both the P&amp;P CTT, and one type of VR-CTT (immersive head-mounted-device VR, large-scale 3D VR, or tablet). A subset of 13 targets was highly correlated with overall task completion times in all age groups and platforms (<i>r</i> &gt; 0.8). We tested construct validity and found that the shortened-CTT preserved differences between Trails A and B (<i>p</i> &lt; 0.001), showed concurrent validity relative to the P&amp;P scores (<i>r</i> &gt; 0.5; <i>p</i> &lt; 0.05), and differentiated between age groups (<i>p</i> &lt; 0.05). These findings open the possibility for shortened “CTT-versions”, to be used in repeated-measures experiments or longitudinal studies, with potential implications for shortening neurocognitive assessment protocols.

颜色追踪测验（Color Trails Test，CTT）是当前应用最为广泛的执行功能神经心理学评估工具之一，其包含两个子任务：分别针对持续性视觉注意力的追踪任务A（Trails A）与针对分配性注意力的追踪任务B（Trails B）。在纸笔版（Pen-and-paper，P&P）测验中，被试需依次连线页面上标注的25个带有序号的目标点，测试人员记录其完成全部任务的时长。在实际应用场景中，常需对同一被试开展多次评估，或在不同实验条件下、多个时间节点进行测试，但重复测试往往会引发学习效应与疲劳效应，干扰测验结果的有效性。为缓解此类问题，本研究以基于虚拟现实（Virtual Reality，VR）的CTT（VR-CTT）为基础，奠定了开发短版CTT（目标数量少于25个）的研究基础。本研究的核心目标是探索最少数量的目标点集合，使其仍能保持与原版CTT的同时效度，包括能够区分不同年龄群体的表现差异，以及区分追踪任务A与任务B的表现差异。为此，研究招募了总样本量N=165的健康被试，分为青年、中年、老年三个年龄组，所有被试均完成纸笔版CTT，以及一种VR-CTT测试形式：沉浸式头戴设备VR、大型3D VR或平板端VR。研究结果显示，包含13个目标点的短版测验，与所有年龄组、各测试平台下的总任务完成时长均呈高度相关（相关系数r>0.8）。进一步验证结构效度后发现，短版CTT仍能保留追踪任务A与任务B的表现差异（p<0.001），与纸笔版CTT得分具有良好的同时效度（r>0.5；p<0.05），且能够有效区分不同年龄群体的表现（p<0.05）。本研究成果为开发短版CTT提供了实证支持，此类短版测验可应用于重复测量实验或纵向研究，有望简化神经认知评估流程。