ABSTRACT
The aim of the present experiment was to assess attention and executive functioning, using Color-Trail Test and Behavioral Regulation index of Executive Functioning Adult version. For this purpose, two subjects-one young adult (female) and one female elderly (female) were taken of the age 22 years and 77 years respectively. In the first phase BRIEF-A self report form was administered to both subjects followed by CTT. The result showed that the performance of the elderly confirmed results from the BRIEF-A self- report, that there was a significant impairment in executive functions and divided attention in the elderly’s performance on the two tests as compared to the young adult whose abilities seem intact.
INTRODUCTION
The cerebral cortex can be divided into four sections, which are known as lobes, named for the bones of the skull that cover them. The frontal lobe refers to the anterior portion of the cerebral cortex and includes everything in front of the central sulcus.
The frontal lobe contains most of the dopamine-sensitive neurons in the cerebral cortex. The dopamine system is associated with reward, attention, short-term memory tasks, planning, and drive. Dopamine tends to limit and select sensory information arriving from the thalamus to the fore-brain.
Recent advances have uncovered important roles for the frontal lobes in a multitude of cognitive processes, such as executive function, attention, memory, and language. The importance of the frontal lobes in processes underlying affect, mood, personality, self-awareness, as well as social and moral reasoning, is also a renewed area for research.The prefrontal cortex makes it possible to perceive, even anticipate the consequences of brain's behaviour. The frontal lobes are considered as the emotional control centre and home to personality.
Posner presents a model of attention that proposes that attention can be defined by three major functions
1. Orienting to events, particularly to locations in visual space.
2. Achieving and maintaining a vigilant or alert state
3. Orchestrating voluntary actions.
The visual orienting system is termed as the posterior attention system since, visually orienting to an event involves the parietal, midbrain and thalamic region. This system plays a role in conscious attention to portions of your visuospatial field and directs the attention of your eyes to a point in space.
The vigilance attention system mobilizes and sustains alertness for processing high-priority targets and is important to attentional functioning. The neural network supporting the vigilance system includes the right frontal and parietal regions of the brain.
The executive attention system controls and coordinates other brain regions in the execution of voluntary attention. A hierarchy exists for attentional processing, with the anterior system passing control to the posterior system as needed. The executive attention system orchestrates higher order cognitive functions such as task switching, inhibitory control, conflict resolution, error detection, attentional resource allocation, planning and the processing of novel stimuli.
One of the other important functions performed by frontal lobe is the central executive functioning. The executive functions of the frontal lobes involve the ability to recognize future consequences resulting from current actions, to choose between good and bad actions (or better and best), override and suppress unacceptable social responses, and determine similarities and differences between things or events. Therefore, it is involved in higher mental functions. The executive system is a theorized cognitive system in psychology that controls and manages other cognitive processes. It is responsible for processes that are sometimes referred to as the supervisory attentional system, or cognitive control. However, executive function and cognitive control are not synonymous with an executive system with the former potentially carried out by specific brain areas or networks (e.g., anterior cingulate cortex and prefrontal cortex in attention, cf. Botvinick et al., 2001; Verguts & Notebaert, 2009).
Frontal Lobe and Executive Functioning
The frontal lobes are considered our emotional control center and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms (Kolb & Wishaw, 1990). The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. There are important asymmetrical differences in the frontal lobes. The left frontal lobe is involved in controlling language related movement, whereas the right frontal lobe plays a role in non-verbal abilities. Some researchers emphasize that this rule is not absolute and that with many people, both lobes are involved in nearly all behavior.
The terms frontal lobe functioning and executive functioning are often used interchangeably. Although the terms overlap, the former suggest that presented behaviours are directly linked to the frontal lobes, whereas the latter connotes a class of behavioural manifestations that maybe directly or indirectly related to frontal lobe functioning.
The following are the central executive functions:
Processing Speed
Processing Speed is one of the measures of cognitive efficiency or cognitive proficiency. It involves the ability to automatically and fluently perform relatively easy or over-learned cognitive tasks, especially when high mental efficiency is required. That is, for simple tasks requiring attention and focused concentration. It relates to the ability to process information automatically and therefore speedily, without intentional thinking through.

Cognitive flexibility
Cognitive flexibility is the term used to describe one of the executive functions; a function which is an important component of human behavior; the ability to switch behavioral response according to the context of the situation. This ability of a person to see different aspects of an object, idea or situation and switch their "attentional set" is measured by such neuropsychological tests as the Wisconsin Card Sorting Test, and the Stroop test.
Research has been conducted on the neural mechanisms underlying cognitive flexibility via the use of fMRI during test subjects completing a variety of set-shifting tests. Various distinct regions of the brain from which flexibility could be predicted reliably included the prefrontal cortex, basal ganglia, anterior cingulate cortex, and posterior parietal cortex.
Selective Attention:
Selective attention is the focusing of one’s conscious awareness on a particular stimulus. The senses take in billions of bits of information every second, but only about 40 are processed by the brain. One example of selective attention is the “Cocktail Party Effect” where a person is able to focus on a certain voice in a noisy room. Selective attention is also a factor in car accidents, drivers focusing on talking on a phone or holding a conversation with a passenger are more likely to be in an accident because they are more focused on the conversation than on the driving.
The inability of children to resolve conflict is generally because they lack executive control of their attention. Executive function is developed in early childhood and becomes useful to adults when resolving conflicts and planning new actions. It is developed differently among individuals and this natural development is one reason why people differ in their behavior as well as their emotional control. The ability to resolve conflicts is minimal as an infant, for example, an infant’s ability to reach for a toy differs at ages 9 months and 1 year. Context sensitive learning of sequences is a form of learning which allows adults to acquire higher level attention than children, and therefore resolve larger conflicts. The capability to learn this way begins at around 18 months and is practiced throughout the life span.
Switching attention:
Attention switching is the term used to describe any process whereby the person sets off to increase the amount of Free Attention they have. This involves focusing away from Distress in some fashion. This can be done by paying attention to a neutral but demanding stimulus, or by focusing on positive stimuli. Which technique you select at any one moment will depend on how much Free Attention you have available and how much you need to gain--enough to permit Discharge or enough to carry on with a task.Rogers and Monsell(1995) demonstrated that the time taken to switch attention between two different tasks was disproportionately increased when interfering information was present, suggesting that the processes of attention-switching and interference-resolution interact with each other, and are not independent. However, using a confirmatory factor analysis, Miyake et al(1996) concluded that the latent constructs of attention-shifting and interference resolution were only modestly related to one another, proposing that these processes may in fact be separable. Thus, the behavioral data suggest that attention-switching and interference resolution may share some common mechanisms, but may involve separable mechanisms as well.

Conflict-resolution:
Cognitive tasks involving conflicting stimuli and responses are associated with an early age-related decline in performance. Conflict and conflict-induced interference can be stimulus- or response-related. In classical stimulus-response compatibility tasks, such as the Stroop task, the event-related potential (ERP) usually reveals a greater negativity on incongruent versus congruent trials which has often been linked with conflict processing.

Conflict resolution is one major role of executive function, and is critical in keeping adequate performance in the complex situation with significant interference between two or more sources of information. Functional neuroimaging studies have confirmed that the PFC, especially the dorso-lateral PFC, is involved in resolving conflict. The PFC reallocates and maintains the attention on the task-relevant stimulus dimensions and processes, while inhibits the task-irrelevant information and responses. The Stroop paradigm is a classical method to study the conflict resolution mechanisms, introduced by John Ridley Stroop in 1935 . The main feature of the Stroop paradigm is selecting to respond to a certain dimension of the stimulus over other dimensions. In the color-word Stroop task,the subject is usually instructed to respond to the color of the stimulus while ignoring to read the word.Since reading the word is a more prepotent response than naming the color, lexical and hue conflict with each other when the presented color of the stimulus is incongruent with its meaning. In addition,the color-word Stroop task has been widely used to investigate the abnormal brain function of conflict resolution in many neurological and psychiatric disorders.

Neuropsychological assessment data, particularly from measures of executive functions, have long been used to understand the impact of deficits resulting from frontal lobe damage or injury. Many neurological disorders show executive dysfunctions. Among executive dysfunctions reported in the literature are difficulties with changing mental sets, maintaining mental sets, and temporal structuring. The inability to switch mental set in response to environmental demands, or, perseveration, shows most clearly on neuropsychological testing through measures that require strategy shifts to solve problems (such as the Behavior Rating Inventory of Executive Function) or an alternating response between two different types of stimuli (such as the Trail Making Test B, Color Trails Test, or the Stroop Test).
With the increased understanding of what constitutes the brain basis of executive function difficulties, there has also been greater attention to and incremental development of standardized assessments and ecological measures of these executive function capacities. Within the last decade, standardized instruments, such as the NEPSY and NEPSY-2 (Korkman, Kirk, & Kemp, 1998; 2007), the Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001), and indirect measures, such as the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000), have been developed.

BRIEF-A:
The BRIEF-A, self- report form include 75items in nine non-overlapping clinical scales and two validity scales. These theoretically and statistically derived scales form two indexes: a) Behavioral Regulation (three scales) and b) Metacognition (five scales), as well as a Global Executive Composite score which takes into account all of the clinical scales and represents the child's overall executive function.
The Behavior Rating Inventory of Executive Function (BRIEF), developed by Drs. Gerard Gioia, Peter Isquith, Steven Guy, and Lauren Kenworthy, is an assessment of executive functions or self regulation in their everyday environment, for children and adolescents ages 5–18. The questionnaire is administered to parent- and teacher- informants and takes 10–15 minutes to administer, and 15–20 minutes to score. Other versions of the BRIEF measuring executive function in preschool children (BRIEF Preschool 3–5 years), school-age children using self-report (BRIEF Self-Report 13–18 years), and adults (BRIEF Adult 18–90 years) are also available. The BRIEF was developed in 2000 to address limitations in available rating scales of executive function to examine person’s qualitative behavioral expression of executive function competence in real-world settings. The BRIEF provides a standardized way of asking multiple raters about executive functions in daily life in a manner that is not disease specific. Because it is not disease specific, the BRIEF may be used to assess executive function with an array of difficulties including learning disabilities, attention difficulties, brain injuries, developmental disorders, psychiatric conditions, and medical issues.
In the present study we are using adult version of this test which is designed to be completed by adults between ages of 18 and 90 years with a minimum fifth grade reading level. The BRIEF-A is composed of 75 items within non overlapping theoretically and empirically derived clinical scales that measures different aspects of executive functioning: Inhibit, Shift, Emotional control, Self monitor, Initiate, Working memory, Plan/Organize, Task monitor and Organization of Materials. It also includes three validity scales: Negativity, Infrequency and Inconsistency.
The Color Trails Test (CTT; D’Elia, Satz, Uchiyama, & White, 1996) measures remote divided attention and sustained attention, abilities that are considered to reflect frontal lobe perceptual tracking function (i.e., ability to locate different elements within a predetermined time), sequenciation (i.e., ability to achieve numeric order according to the required task), and motographic ability (i.e., ability to achieve fine motor coordination suitable to the task). The CTT has been used as a neuropsychological test in clinical practice, hospitals, and academia, with regard to the importance of instruments that assess sustained attention and divided attention.

CTT consists of two distinct parts – Color Trails 1 and Color Trails 2. The first part is primarily a test of sustained visual attention involving perceptual tracking and simple sequencing, whereas The second part, because of the alternating sequence pattern, more directly assesses frontal systems functioning (Boucugnani & Jones, 1989; Shute & Huertas, 1990). Color Trails 2 is, therefore, thought to be a more sensitive indicator of cerebral dysfunction than color Trails 2 (Horton, 1979). However, both the parts measure sustained visual attention, visual scanning, and graphomotor skills; therefore, both trials provide information regarding speed of eye-hand coordination and information processing.
It is hypothesized that the alternating shift between number and color sequences on Color Trails 2 would require more effortful executive processing than the shift between numbers and letters, which involves highly overlearned verbal sequences. In addition, an association between color naming and right-hemisphere function has long been reported in the literature (DeRenzi & Spinnler, 1967), prompting the possibility that the CTT may be particularly sensitive to right hemisphere dysfunction.
Research using CTT with other variables has been found in the literature. Regarding the evaluation of individuals with acquired brain damage who sought to obtain a driver’s license, Hartman-Maeir, Erez, Ratzon, Mattatia and Weiss (2008) tested 30 subjects using the CTT 1 and CTT 2. The subjects also underwent traffic evaluation with a driving rehabilitation specialist and an instructor. The approved participants on the traffic test completed the CTT 1 and CTT 2 more quickly than those who failed the test, although the difference between groups was significant only for the CTT 1.

The relationship between substance use and impulsive personality traces was studied by Dolan, Bechara and Nathan (2008) in 38 patients with a history of substance abuse compared with a control group comprising 30 participants. The study used the Wisconsin Card Sorting Test, CTT, Stroop test, Wechsler Adult Intelligence Scale -WAIS-II (Digit Span), and Iowa Gambling Task. Individuals with a history of substance abuse and impulsive personality traces exhibited lower performance on the tasks involving executive function, attention, and memory compared with control subjects.

METHOD
(a)Participants: The sample for BRIEF and CTT consisted of two subjects, one subject belonging to age group (18-25 years) and the other one must be 80+
(b) Assessment Measures: The present study included the use of two measures of frontal lobe and executive functioning. They are the Behavior Rating Inventory of Executive Function – Adult Version and the Color Trails Test. They are discussed below:

BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION-A
Design and Construct:
This Test has been deemed the most widely used of all the neuropsychological assessment tools for evaluating executive function capacities. The BRIEF was developed in 2000 to address limitations in available rating scales of executive function to examine person’s qualitative behavioral expression of executive function competence in real-world settings.
The BRIEF-A is composed of 75 items within non overlapping theoretically and empirically derived clinical scales that measures different aspects of executive functioning: Inhibit, Shift, Emotional control, Self monitor, Initiate, Working memory, Plan/Organize, Task monitor and Organization of Materials. It also includes three validity scales: Negativity, Infrequency and Inconsistency.
The clinical scales form two broader indexes- the Behavioral Regulation Index (BRI) and the Metacognition Index (MI) and an overall summary score, the Global Executive Composite (GEC).
BRIEF-A is designed to be completed by adults between the ages 18 and 90 years with a minimum fifth grade reading level. Thus, this test can be used with a wide age range of individuals.

Instructions:
Verbal instructions are given to the respondent that should emphasize the importance of responding to all the items on the form. These instructions are as follows-
“People often know a lot about their own behavior and how they solve problems they may face. Your help is important to me as I attempt to better understand you and your behavior. This questionnaire allows you to record your own observations about how you function at your home, work and school and at leisure. Please read the instructions carefully and respond to all of the items, even if some are difficult or do not seem to apply to you. As you will see, the instructions ask you to read a list of statements that describe people’s behavior and to indicate if you have had any problems with theses behaviors over the past month. If the specific behavior has ‘never’ been a problem for you in the past month, circle the letter N; if the behavior has ‘sometimes’ been problem for you, circle the letter S; if the behavior has ‘often’ been a problem for you, circle the letter O. If you have any questions or concerns, please don’t hesitate to ask for my help.”

Evaluated functions:
The BRIEF-A is an assessment of different aspects of executive functioning- Inhibiting, Shifting, Emotional control, Self Monitoring, Initiating, use of Working Memory, Planning/Organizing, Task monitoring and Organization of materials.
Procedure:
The present study involves the use of a self report form. The form contains a list of statements that describe people’s behavior. The subject is asked to indicate if they had any problem with these behaviors over the past month. If specific behavior has never been a problem, the subject is asked to mark ‘N’, if it is sometimes a problem, mark ‘S’ and if it is often a problem, the subject is asked to mark ‘O’.
The form contains total of 75 items. After giving response for all the 75 items, the data is scored. The respondent’s item responses are reproduced as circled item scores on the scoring sheet, with 1 corresponding to Never (N), 2 corresponding to Sometimes (S) and 3 corresponding to Often (O).Then the circled scores for each item are transferred to the box provided in that item row. The item scores in each column are added and the subtotal is entered in the box at the bottom of the column. Then subtotals for both the pages are added and total is entered in total raw score box. The raw scores for each dimension are converted into T scores and percentiles. Likewise, responses on clinical scales are scored. The clinical scales form two broader indexes- the Behavioral Regulation Index(BRI) consisting of inhibit, shift, emotional control and self monitor and Meta cognition Index (MI) consisting of initiate, working memory, plan/organize, task monitor, organization of materials. There is an overall summary score, the Global Executive Function (GEC) which is the sum of (BRI) and (MI).
There is the concept of missing responses as well, which are those items that are unanswered by the respondent. The test consists of 3 validity scales- Negativity scale, Infrequency scale and Inconsistency scale. The Negativity scale items are indicated by the letter N enclosed in a box in right margin of scoring sheet of the report form. If any of these item score boxes contain a 3 (that is, endorsed as often by the respondent), we circle each item number in boxed column that received an item score of 3 and obtain the negativity score.
The Infrequency scale items are indicated by bolded letter F. Responses of Often to items 10 and 38 and responses of never to items 28 48 and 59 are infrequent in clinical and normative population. Circle each item number in the boxed column that received an infrequent item score.
Scoring the inconsistency scale is a bit complex. Inconsistency scale consists items are indicated by the letter ‘I’ and consists of 10 pairs of items. For each item pair, the absolute value of the difference between item scores is calculated. Then, sum the difference values for the 10 pairs to obtain the inconsistency score.
Confidence Intervals (CIs) are also calculated which represent the band of measurement error that is associated with a clinical scale, index or GEC T score.
After calculating all the clinical scales, validity scales, T scores, percentiles , they are plotted on the self report profile form.

COLOUR TRAILS TEST
The CTT was originally created by D’Elia, Satz, Uchiyama and White (1996). The CTT is an adaptation of the Trail Making Test (or TMT) which is a component of the standard Halstead-Reitan Neuropsychological Battery (Reitan & Wolfson, 1993). CTT was developed such that it had the sensitivity and specificity of the standard TMT, but had broader application in cross-cultural contexts. In other words, CTT is an analogue of the TMT which retains the same psychometric properties as the standard TMT, but it substitutes the use of color for the use of English alphabet letters. In order to minimize the linguistic and cultural bias of the CTT, no letters of any alphabet are used. Thus, The CTT proved to be an alternative attention evaluation in several countries, because it uses numbered colored circles and universal language symbols and does not depend on knowledge of the English alphabet.

Description of the test:
The CTT consists of two distinct parts – Color Trails 1 and Color Trails 2. It is based on the use of numbered colored circles. CTT stimuli consist of circles (approximately ½ inch in diameter) with numbers printed inside. Each circle has either a vivid pink or a yellow background. Color Trails 1 is similar to TMT Part A, with the exception that all odd-numbered circles have a pink background, and all even-numbered circles have a yellow background. For Color Trails 2, each number is presented twice, once with a pink background and once with a yellow background.
Evaluated functions: The CTT 1 tests perception tracking and sustained attention and allows the observation of motographic ability. The CTT 2 evaluates the same functions and also divided attention and sequenciation because it demands sequential alternations of colors and numbers. The CTT 1 requires the examinee to follow a numeric sequence, and the CTT 2 requires the examinee to divide attention and simultaneously follow the alternating sequence of colors and numbers.

Procedure:
The CTT is administered to individuals over 18 years of age and consists of using a pencil to connect, in ascending order, 25 numbers (CTT 1) and alternate colors (CTT 2) in “the shortest time possible”. For the CTT 1, the examinee is instructed to quickly trace a line that unites circles numbered from 1 to 25 in the correct order. The fact that the color changes in each consecutive circle is not mentioned to the participant. The examinee must complete the training before beginning the test, the results of which are evaluated. In cases of errors, the examiner indicates the error and instructs the examinee to correct the error and continue with the task. The examinee has 10 seconds to link a circle to another circle, after which time the examiner must nonverbally indicate (e.g., pointing with a finger) the next correct circle position. The time needed for the examinee to accomplish the task is recorded in seconds. Error and near-error frequencies are recorded, in addition to the number of interventions made by the examiner (i.e., warnings). A near-error response occurs when the examinee incorrectly starts the path toward a circle, but then corrects it spontaneously before reaching the incorrect circle. No intervention is required in this type of response.
For the CTT 2, the examinee is instructed to quickly trace a line between numbered circles, obeying the number sequence but alternating between pink and yellow (i.e., the examinee must trace the line from pink circle 1 to yellow circle 2, not to pink circle 2, and then to pink circle 3, not to yellow circle 3), and so on. The examinee completes the training before proceeding with the test. The names of the colors (e.g., “pink” and “yellow”) must not be mentioned during the training instruction. The examiner must point and say “of that color.” The time needed for the examinee to complete the stage is recorded in seconds. Color error and near-error frequencies are recorded, in addition to the number of interventions by the examiner (i.e., warnings).

RESULTS:
Table 1:BRIEF-A scales and obtained raw scores, Tscores and Percentile Ranks of participant1 (Young Adult)
SCALE/INDEX Raw Score T score % ile
Inhibit 15 60 84
Shift 10 56 77
Emotional Control 12 43 31
Self-Monitor 12 63 92
BRI 49 54 63
Initiate 15 60 80
Working Memory 13 56 76
Plan/Organize 14 49 58
Task Monitor 13 68 98
Organization of Materials 17 61 85
MI 72 59 78
GEC (BRI+MI) 91 44 30

Table 2: BRIEF-A scales and their obtained raw score, T score and percentile rank of participant 2 (Elderly)
SCALE/INDEX Raw Score T score % ile
Inhibit 16 70 98
Shift 13 75 >99
Emotional Control 24 87 >99
Self-Monitor 11 62 88
BRI 64 82 99
Initiate 17 77 99
Working Memory 21 96 >99
Plan/Organize 25 92 >99
Task Monitor 15 83 >99
Organization of Materials 11 51 65
MI 89 114 >99
GEC (MI+BRI) 153 86 99

Table 3: CTT performance of participant 1 (Young Adult) Raw Score Percentile range Standard score T score Percentile
Score
Color Trails 1 (time in seconds) 32 112 58 79
Color Trails 1 errors 0 >16
Color Trails 1 near misses 0 >16
Color Trails 1 Prompts 1 >16
Color Trails (2 time in seconds) 73 109 56 73
Color Trails 2 Color Errors 0 >16
Color Trails 2 Number Errors 0 >16
Color Trails 2 Near- Misses 1 >16
Color Trails 2 Prompts 0 >16
Inference Index 1.28 >16

Table 4: CTT performance of Participant 2 (elderly) Raw Score Percentile range Standard score T score Percentile
Score
Color Trails 1 (time in seconds) 69 96 47 38
Color Trails 1 errors 0 >16
Color Trails 1 near misses 2 ≤1
Color Trails 1 Prompts 2 ≤1
Color Trails (2 time in seconds) 154 83 39 14
Color Trails 2 Color Errors 1 >16
Color Trails 2 Number Errors 0 >16
Color Trails 2 Near- Misses 1 >16
Color Trails 2 Prompts 1 >16
Inference Index 1.23 >16

INTERPRETATION AND DISCUSSION
The objective of our present study is to assess attention and executive functioning in young and older adults (75+) by using Color Trail Test (CTT) and Behavior Rating Inventory of Executive Function (BRIEF). The assessment of executive functions is a complex task with unique features. Firstly BRIEF was administered to both the subjects (young and older adult) and scores were obtained. The validity scales are interpreted first.
Negativity scale measures the extent to which the respondent answers selected BRIEF-A items in an unusually negative manner. The negative score is the total number of negativity items endorsed as Often. Participant 1 (young adult) obtained a score of 0 so her protocol classification came out to be acceptable and Participant 2(older adult) got a score of 6 which means that her protocol classification is elevated. An elevated score on this scale raises the possibility that the subject has an overly negative view.
Infrequency scale measures the extent to which adults endorse items in an atypical fashion. Both the participants had an infrequency score of 0. The protocol classification is acceptable here for the young as well as the older adult, which means respondents haven’t answered the items in a haphazard manner, have been biased towards endorsing in an extreme manner or haven’t tried to portray themselves in a more positive way than can actually be the case.
Score on the Inconsistency scale indicate the extent to which the respondent answers similar BRIEF-A items in an inconsistent manner. Participant1 (young adult) obtained a score of 0 which is classified as acceptable. Participant 2 (older adult) obtained a score of 2 which is also acceptable.
After evaluating the validity scales, clinical scales are interpreted. The BRIEF-A clinical scales measure the extent to which the respondent reports problems with different type of behaviour related to the domains of executive functioning encompassed by the BRIEF-A.
Inhibit scale measures the respondent’s inhibitory control (ability to resist, inhibit or not act on an impulse). As it can be seen from table 1 Participant 1 (young adult) obtained a raw score of 15, and corresponding T score of 60 and percentile rank 84 which indicates 84% of the cases lie below the raw score participant 1. Participant 2 (older adult) obtained a raw score of 16, T score of 70 and percentile 98 indicating 98% of the cases lie below her. This means that the older adult’s inhibitory control is dysfunctional as compared to the young adult.
The shift scale measures the respondent’s ability to move freely from one situation, activity or aspect of a problem to another as the circumstances demand. Participant1 (young adult) got a raw score of 10, T score of 56 and percentile 77 which indicates 77% of the cases lie below the score of the subject whereas Participant 2 (older adult) got a raw score of 13, T score 75 and percentile >99. Most of the people lie below Participant 2 on the scale of shift that is participant 2 is most dysfunctional in the ability to move freely from one situation, activity or aspect of a problem to another as the circumstance may demand.
Emotional control scale addresses the manifestation of executive functions within the emotional realm and measures an adult’s ability to modulate emotional responses. Participant 1 got a raw score of 12, T score of 43 and percentile 81 which indicates 81% of the cases lie below her in emotional control. Participant 2 (older adult) obtained a raw score of 24, T score of 87 and percentile >99 which shows that old adult has poor emotional control than the young participant. Also the participant’s profile endorses that she is emotionally labile and displays emotional explosiveness. Such individuals may have overblown emotional reactions to relatively minor events. Example, item 33 (“I overreact to small problems”) Often. The Self- Monitor scale measures a personal self- monitoring function- the extent to which the adult keeps track of his or her own behavior and the effect of his or her behavior on others. Participant1 (young adult) got a raw score of 12, T score of 43 and percentile 31 which indicates 31 percent of the cases lie below her. Participant 2 (older adult) got a raw score of 11, T score of 62 and percentile 88 which indicates only 88 percent of the cases lie below her score. This shows that older adult has a lower self- monitoring function than the young participant. High score on this scale for the older adult displays that she may be failing to appreciate or have an awareness of one’s own social behavior and the effect this may have on others. Items under this scale for example are like: item 69 (often) “I say things without thinking.” The initiate scale contains items rating to beginning a task or activity and to independently generating ideas, responses or problem solving strategies. Participant 1(young adult) obtained a raw score of 15, T score of 60 and percentile 80 which means 80 percent of the cases lie below her raw score. Participant 2 (older adult) obtained a raw score of 17, T score of 77 and percentile 99 which clearly indicates that the elderly adult can less easily get started with a task independently as compared to the young subject.
Items on the Working memory scale measures the respondent’s capacity to actively hold information in mind for the purpose of completing a task or generating a response. Participant1 (young) got a raw score of 13, T score of 56 and percentile 76 which means 76% of the cases lie below her raw score. Participant2( older adult) on the other hand, obtained a raw score of 21, T score of 96 and percentile >99 which means almost all of the cases lie below the participant’s raw score. This clearly shows that older adult’s capacity to actively hold information in mind is way more less than in a young adult. The older adult has trouble remembering things for delayed periods, lose track of what she is doing as she works, or forget what the participant is supposed to retrieve when instructed. Example of items under this scale is: item 11 (“I have trouble with jobs or tasks that have more than one step”). The Plan/ Organize scale measures the adult’s ability to manage current and future oriented task demands within the situational context. The plan component of this scale relates to the ability to anticipate future events, implement instructions and develop appropriate steps ahead of time to carry a task. The organize component of this scale relates to the adult’s ability to bring order to information, actions, or materials to achieve an objective. Participant1 (young adult) got a raw score of 14, T score of 49 and percentile 58 whereas subject2 (older adult) obtained a raw score of 25, T score of 92 and percentile >99 which means 25 percent of the cases lie below her raw score. This indicates Participant 2 poorly manages current and future oriented task demands within the situational context. The young adult on the other hand does well on the plan/ organize scale. Example of item that is associated with this scale is: item 21 “I start tasks without the right equipments.”
The Task Monitor scale measures a problem solving; task oriented monitoring function- the extent to which the individual keeps track of his or her own problem solving success or failure. Participant1 (young) got a raw score of 13, T score of 68 and percentile 98 which means 68% of the cases lie below her raw score. On the other hand, Participant2 got a raw score of 15, T score of 58 and percentile 99 which means almost all of the cases lie below her raw score. This indicates that both participants are significantly poor at task monitoring. The organization of materials scale measures organization in the adult’s everyday environment, with respect to orderliness of work, living and storage spaces such as desks, closets and bedrooms.
Organization of Material scale: Participant1 (young) obtained a raw score of 11, T score of 51 and percentile 65 which means 65 percent of the cases lie below her raw score whereas in case of Participant2 , raw score obtained is 17, T score 61 and percentile 85 which means 85% of the cases lie below his raw score. This clearly shows that Participant 2 (elderly adult) is poorer in organizing material than Participant1 (young) but still both are significantly poor at it.
After evaluating all the 9 clinical scales, the BRI, MI and GEC is interpreted. Behavioral Regulation Index (BRI) represents the adult’s ability to maintain appropriate regulatory control of his or her behavior and emotional responses. This Index includes Inhibit scale, Shift scale, Emotional control scale and Self Monitor scale. In BRI Participant1 (young) obtained a raw score of 49, T score of 54 and percentile 63, it means 63 percent of the cases lie below her raw score. Whereas, Participant2 obtained a raw score of 64 , T score of 82 and percentile 99 that indicates 99% of the cases lie below her raw score. Clearly the older participant is poorer on the behavioural regulation which includes appropriate inhibition of thoughts and actions, flexibility in shifting problem solving set, modulation of the emotional response, and monitoring of one’s actions. The Meta Cognition Index (MI) represents the individual’s ability to systematically solve problems via planning and organization while sustaining these task completion efforts in active working memory. This Index includes Initiate scale, Working Memory scale, Plan/ Organize scale, Task monitor scale, Organization of materials scale. Participant1 (young) obtained a raw score of 72, T score of 59 and percentile 78. Whereas, Participant 2 obtained a raw score of 89, T score of 114 and percentile >99 which means almost all of the cases lie below her raw score. The older participant has significant difficulty in managing attention and problem solving.
The Global Executive Composite (GEC) is a summary score that incorporates all of the clinical scales of the BRIEF-A. It is the sum of BRI and MI. Participant1 (young) got a raw score of 91, T score of 44 and percentile 30 which indicates 30 % of the cases lie below her raw score. On the other hand, Participant2 obtained a raw score of 153, T score of 86 and percentile 99 which indicates almost all of the cases lie below her raw score.
The overall evaluation shows that executive functioning is more intact in case of the young adult as compared to the older adult. This is expected as it is believed that executive functioning degenerates with aging. So validity of his scores can be questioned. As BRIEF-A is a subjective test, so one has to club this test with a performance test ( COLOR TRAILS TEST) to come out with authentic results.
The Colour Trails Test (CTT) is a culture-fair test of visual attention, graphomotor sequencing, and effortful executive processing abilities. CTT 1 is primarily a test of sustained visual attention involving perceptual tracking and simple sequencing whereas CTT 2, more directly assesses frontal system functioning.
The test was conducted on the same two participants. Participant 1 was a 21 year old female and Participant 2 was a 78 year old female. Both of them had completed 15 years of education.
As can be seen from Table 3, Participant 1 completed the CTT 1 in 32 seconds and the CTT 2 in 73 seconds. While he made no errors and did not require any prompts on CTT 1, she made 1 near miss on CTT 2, though no number errors. The participant’s raw score is converted into standard scores and T-score with the help of the data presented in Appendix B of the CTT Manual. Accordingly, Participant 1 has a standard score of 112 and a T-score of 58 on CTT 1 and a standard score of 109 and a T-score of 56 on CTT 2. His performance on CTT 1 falls in the 58th percentile and his performance on CTT 2 falls in the 73rd percentile. Thus, participant 1 performed better on CTT 2 than on CTT 1.
Further, the CTT manual is consulted for clinical interpretation of the standard score and T-score values. According to Table 10 of the manual, based on the participant’s CTT 1 performance he falls in the ‘above average’ group which implies that the subject’s performance suggests no neurological impairment. Based on the participant’s CTT 2 scores, he falls again in the ‘above average’ category, confirming a neurologically intact performance. Therefore, it can be concluded that Participant 1 shows signs of above average neurological functioning, with a normal capacity for divided attention and sequencing.
Interference Index represents the difference in performance between CTT 1 and CTT 2, expressed as a function of the level of performance for CTT 1. It can be seen from Table 1, that the Interference Index for Participant 1 was calculated to be 1.28. This means that Participant 1 took almost 1.3 times longer to complete CTT 2 than CTT 1. The CTT manual uses a cut-off interference score of 1.7 to 2.3 to define impairment. That is, it is normal for a respondent to take 2.7 to 3.3 times longer to complete CTT 2 than to complete CTT 1. Going by this cut-off score, it can be said, that Participant 1 performed better than average and can therefore be said to be cognitively intact with fine functioning attention processes, alternating and sequencing skills.
The scores for Participant 2 on CTT 1 & 2 can be seen from Table 3. She completed CTT 1 69 seconds and CTT 2 in 154 seconds. She made 1 error of colour, 0 error of number on either test and showed 1 near-miss and 1 required prompts. Her standard score and T-score on CTT 1 are 96 and 47 respectively, placing her in the 38th percentile. On CTT 2, her standard score is 83 and T-score is 39, placing her in the 14th percentile.
Consulting the CTT manual for clinical interpretation of the standard score and T-score, Participant 2 falls in the 'Average' category, suggesting that her performance on both CTT 1 was ‘average’ and on CTT2 ‘mildly impaired’ neurological functioning. Validity evidence has suggested that CTT 2 is a more sensitive indicator of neurological dysfunction than CTT 1. Therefore, it can be concluded that Participant 1 shows signs of mildly impaired neurological functioning, with a slightly reduced capacity for divided attention and sequencing.
As can be seen from Table 1, Participant 2 obtained an Interference Index of 0.811. This implies that she took almost 1.8 times longer to complete CTT 2 than CTT 1. However since this value is within the normal range (1.7-2.3), it means that Participant 2 shows no evidence of susceptibility to cognitive interference.
The performance of both the participants was also compared to locally developed norms as a part of the same study on a slightly larger scale. The study included conducting the Colour Trail Test and the Wisconsin Card Sorting Test on 96 individuals within the age range of 18 – 25 years. The mean and standard deviation of the raw scores on both the test for all the subjects was calculated.
According to this normative data, the mean time taken on CTT 1 is 48.94 seconds and on CTT2 is 84.74 seconds. Since Participant 1 took 32 seconds to complete CTT 1 and 73 seconds to complete CTT 2, it can be said that she performed average on CTT1 and on CTT2. whereas Participant 2, who completed CTT 1 in 69 seconds and CTT 2 in seconds, also did better than the average according to the local norms. Further, the mean interference index in these norms was calculated to be 0.789. Thus Participant 1 with an interference index of 0.395 did fairly well in comparison to the average; while Participant 2’s performance with an interference index of 0.811 was mildly impaired. The mildly impaired performance on CTT as well as reported executive functioning on BRIEF-A by participant 2 could be attributed to her old age and reduction in her executive skills and performance on divided attention tasks as a result of aging.

CONCLUSION:
The objective of the study was to assess executive functioning and attention in young adult and an elderly. For this purpose, BRIEF-A and CTT were used and results of both the participants on these two tests were compared. The results indicated that participant1’s (young) executive functioning as well as performance over divided attention is intact. Participant 1 has displayed normal functioning on both the tests. CTT as a performance test confirmed the results of the self- report measure used that is BRIEF.

REFERENCES
Zillmer, E. A., Spiers, M. V., Culbertson, W. C. (2008). Principles of Neuropsychology (2nd edition). Belmont, CA: Wadsworth.
Hartman-Maeir A, Erez AB, Ratzon N, Mattatia T, Weiss P., 2008. The validity of the Color Trail Test in the pre-driver assessment of individuals with acquired brain injury. Brain Inj, 22(13-14), 994-998
Color Trails Test Professional Manual: Louis Elia, Paul Satz, Craig Uchiyama and Travis White(1994): Psychological Assessment Resources, Inc.Florida