Four boxes test

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The four boxes test is a computer-based test used to measure reaction times. In the test, a black circle appears in one of four boxes on the screen, and the patient presses the corresponding key on the keyboard as quickly as possible. The next circle appears after 500 ms, until 52 circles have been exposed. The computer measures the time the subject takes to complete the test and the number of errors they make.[1]

The test has been used to measure long-term cognitive dysfunction in elderly people who have undergone an operation.[2] When subjects had undergone anesthesia with different drugs, and were then tested using the Stroop Colour and Word Interference Test, the digit symbol substitution test and the four boxes test, recovery times varied both by anesthetic and by type of test.[3] Other studies have shown that there is an association between postoperative cognitive dysfunction (POCD) and impaired performance in the four boxes test, but that the test is not a good predictor of POCD.[4]


  1. ^ Houx P; Jolles J. (1993). "Age-related decline of psychomotor speed: effects of age, brain health, sex and education" (PDF). Percept Mot Skills. 76 (1): 195–211. doi:10.2466/pms.1993.76.1.195. PMID 8451129. Retrieved 2010-09-25.
  2. ^ J T Moller; P Cluitmans; L S Rasmussen; P Houx; H Rasmussen; J Canet; P Rabbitt; J Jolles; K Larsen; C D Hanning; O Langeron; T Johnson; P M Lauven; P A Kristensen; A Biedler; H van Beem; O Fraidakis; J H Silverstein; J E W Beneken; J S Gravenstein (March 21, 1998). "Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study". The Lancet. Retrieved 2010-09-25.
  3. ^ Biedler A; Juckenhöfel S; Feisel C; Wilhelm W; Larsen R. (Apr 2000). "Cognitive impairment in the early postoperative period after remifentanil-propofol and sevoflurane-fentanyl anesthesia". Anaesthesist. 49 (4): 286–90. PMID 10840538.
  4. ^ J. STEINMETZ; L. S. RASMUSSEN (January 2008). "Choice reaction time in patients with post-operative cognitive dysfunction†". Acta Anaesthesiologica Scandinavica. 52 (1): 95–98. doi:10.1111/j.1399-6576.2007.01463.x.