Exploring Heterogeneity on the Wisconsin Card Sorting Test in Schizophrenia Spectrum Disorders: A Cluster Analytical Investigation.

Wisconsin Card Sorting Test performance before and after temporal lobectomy

Wisconsin Card Sorting Test performance in obsessive-compulsive disorder: no evidence for involvement of dorsolateral prefrontal cortex

This study examined the persistent effects of traumatic brain injury (TBI) on Wisconsin Card Sorting Test (WCST) performance. Since poor effort can contaminate results in populations with incentive to perform poorly, performance validity was explicitly assessed and controlled for using multiple well-validated cognitive malingering indicators. Participants were 109 patients with mild TBI and 67 patients with moderate-to-severe TBI seen for neuropsychological evaluation at least one year post injury. Patients with diffuse neurological impairment and healthy controls were included for comparison. Results suggested a dose–response effect of TBI severity on WCST performance in patients providing good effort; the mild TBI group did not differ from controls while increased levels of impairment were observed in the moderate-to-severe TBI group. Effort during testing had a larger impact on WCST performance than mild or moderate-to-severe TBI. Clinical implications of these findings are discussed.

The relationship between psychopathology and Wisconsin Card Sorting Test (WCST) performance was evaluated in 25 unmedicated young acute schizophrenic female patients (14 neuroleptic-naive and 11 neuroleptic-free) and 15 female controls. The schizophrenic patients (especially the neuroleptic-free) performed more poorly than controls in the WCST. In addition, WCST impairment correlated with both negative and positive symptoms. The results suggest that the neuropsychological dysfunction in schizophrenia is present at the onset of the illness, and is neither secondary to previous neuroleptic treatment nor to chronicity of the illness.

The aims of this study were to assess developmental trends in performance on the Wisconsin Card Sorting Test (WCST) among 817 randomly selected adolescents aged 13-15 years, and to explore WCST performance factor structure and relationship to schizotypy. The results showed that of the nine WCST indexes, only the Categories Achieved and Failure to Maintain Set scores were associated with age, and only the Learning to Learn scores reached adult levels. Factor analysis of WCST performance scores yielded a three-factor structure. Psychometrically defined schizotypic subjects did not perform significantly worse than control subjects on any WCST indexes. These findings suggest that performance on various WCST indexes might indicate developmental changes at different ages, and deficits in WCST performance might not be sensitive indicators of vulnerability to schizophrenia in adolescence.

Wisconsin Card Sorting Test Performance in Above Average and Superior School Children: Relationship to Intelligence and Age

Neuropsychological differences between schizophrenic patients with heterogeneous Wisconsin Card Sorting Test performance

This study examined performance on the Wisconsin Card Sorting Test (WCST) by 23 schizotypic subjects and 28 normal control subjects. Schizotypy was measured on the Perceptual Aberration Scale (PAS). Overall, schizotypic (high PAS) subjects performed more poorly than control (low PAS) subjects on the WCST; specifically, schizotypic subjects showed deficits on the failure-to-maintain-set and number-of-categories indexes. Consistent with expectations based on research with high-risk subjects, schizotypic subjects were nearly 10 times more likely than controls to be included in a subgroup of deviant WCST performers identified by a composite performance index. WCST performance was not associated with current levels of anxiety or depression. Our results provide evidence for subtle WCST performance deficits in subjects hypothesized to be at risk for psychosis--perhaps schizophrenia--and are broadly consistent with current speculation about dorsolateral prefrontal cortex functioning in schizophrenia as well as recent speculation concerning spatial working memory and schizophrenia. The heuristic potential of our results is discussed and we encourage replication of the present study. Viewed in this context, our results are hypothesis-generating and do not provide definitive confirmation of specific hypotheses.

The specificity of the Wisconsin Card Sorting Test (WCST) for assessing frontal lobe pathology remains controversial, although lesion and cerebral blood flow studies continue to suggest a role for the dorsolateral prefrontal cortex in WCST performance. Inconsistencies might derive from the extended use of various WCST scores as equivalent indicators of frontal pathology. In this study, event-related potentials (ERPs) were recorded from 32 normal subjects who committed perseverative and non-perseverative errors. Both types of WCST errors evoked anomalous but distinct ERP patterns over frontal lobe regions. Perseverative errors were also associated with a dysfunctional extrastriate response to stimulation. This evidence suggests that perseverative and non-perseverative errors result from disruptions in two different prefrontal neural networks engaged during card sorting.

Background: Although studies have indicated that the frontal lobe plays an important role in performance on the Wisconsin Card Sorting Test (WCST) and that basal ganglia play a specific role in frontal lobe function, the role of striatal dopamine (DA) activity in performance on the WCST remains unclear. Methods: We assessed the relation between the availability of striatal dopamine transporters (DATs) and performance on the WCST as a measure of executive function in healthy individuals. We approximated the availability of DATs in 53 healthy volunteers aged 19–61 years by use of single photon emission computed tomography with technetium-99m (99mTc)-TRODAT-1 as the ligand. The WCST was administered to all participants. Results: The availability of DAT was significantly negatively correlated with perseverative errors on the WCST, both before and after adjustment for body mass index ( rbefore = −0.39, p = 0.004; rafter = −0.39, p = 0.005). Limitations: This was an association study; thus, a causal relation between DAT availability and performance cannot be confirmed. Conclusion: Our results suggest that striatal DAT availability may play a role in executive function as measured by the WCST.

Phonemic and semantic fluency tasks are frequently used to differentiate executive control roles and the integrity of lexical-semantic representation. The main goal of this study is to determine the influence of basic executive components on phonemic and semantic productivity in children with mild intellectual disability. The sample consisted of 95 children with unspecified mild intellectual disability (MID), ages 10-13.11. Phonemic fluency was assessed by the Controlled Oral Word Association Test (COWAT), while semantic fluency was assessed by the Category Naming Test (CNT). Cognitive flexibility was assessed by Wisconsin Card Sorting Test (WCST) and Trail Making Test (TMT). Number Manipulation Task (NMT) was used for the verbal working memory assessment, while Day/Night Stroop Task was used for the assessment of inhibitory control. The results analysis showed that all of the assessed EF components significantly affect phonemic productivity. Semantic productivity significantly depends on WCST and TMT performance. Verbal working memory and inhibitory control do not significantly contribute to semantic productivity. The results of our study indicate that the discrepancy between phonemic and semantic productivity in children with MID could be directly associated with the basic executive functions components.

Attentional set shifting modulates the target P3b Response in the Wisconsin card sorting test

Neuroimaging studies have demonstrated reduced prefrontal cortical blood flow and metabolism in depression, but the neurobehavioral significance of these observations is not yet established. The Wisconsin Card Sorting Test, a widely used neuropsychological index of prefrontal cortical function, was administered to 79 patients with major depression who had been unmedicated for at least 28 days, to 47 patients with schizophrenia who had never received antipsychotic medication, and to 61 healthy comparison subjects. Depressed patients demonstrated significant deficits on multiple Wisconsin Card Sorting Test measures compared with healthy individuals. These deficits were correlated with the severity of depression and were less severe than those demonstrated by patients with schizophrenia. These results provide neuropsychological evidence for significant prefrontal cortical dysfunction in depression.

PurposeThe Wisconsin Card Sorting Test (WCST) is the most common measure of cognitive flexibility in anorexia nervosa (AN), but task-switching paradigms are beginning to be utilized. The current study directly compared performance on a cued task-switching measure and the WCST to evaluate their association in participants with a lifetime diagnosis of AN, and to assess which measure is more strongly associated with clinical symptoms.MethodsForty-five women with a lifetime diagnosis of AN completed the WCST, cued color-shape task-switching paradigm, Anti-saccade Keyboard Task, Running Memory Span, Eating Disorder Examination Questionnaire, Depression Anxiety Stress Scales short form and Eating Disorder Flexibility Index.ResultsThere was no evidence of a significant association between WCST perseverative errors and cued task-switching switch costs. Results suggest lower working memory capacity is a determinant of higher perseverative error rate. When controlling for mood variables, neither cognitive flexibility measure was a significant independent predictor of symptom severity.ConclusionsResults provide support for previous suggestions that WCST perseverative errors could occur due to difficulties with working memory, sensitivity to feedback, and issues with concept formation. Cued task-switching paradigms may provide a useful measure of cognitive flexibility for future eating disorders research by reducing task-specific confounds.Level of evidenceLevel III Case–control analytic study.

Background: Basic neurocognitive functions such as attention and executive cognitive control represent promising endophenotypes that may improve understanding of the development and expression of borderline personality disorders (BPD). We evaluated the association between performance on the Attention Network Task (ANT) and the Wisconsin Card Sorting Test (WCST), two neurocognitive laboratory instruments, and the extent of BPD psychopathology. Sampling and Methods: We studied 22 BPD-diagnosed individuals who were independently administered these two laboratory assays. Performance on these tests was used as a predictor of the extent of BPD psychopathology. Results: Indexes of the ANT and the WCST were correlated with one another in this sample. Further, the extent of impairment in attention networks, specifically the orienting network, was associated with a greater spectrum of BPD psychopathology, independent of the effects of age and medication status. Finally, ANT and WCST performance were uncorrelated with general psychosocial functioning in this sample, implicating relative specificity to the extent, as contrasted with functional severity, of BPD psychopathology. Conclusions: Attentional and executive functions are promising endophenotypic markers of BPD psychopathology. The implications of these findings are considered from developmental, experimental, and clinical perspectives.