Wisconsin Card Sorting Test performance before and after temporal lobectomy

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.

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

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.

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.

Executive functioning and risk for Alzheimer's disease in the cognitively intact: Family history predicts Wisconsin Card Sorting Test performance.

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.

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.

Objective: The cholinergic system is important in the search for the pathophysiology of schizophrenia due to its role in cognitive function, interaction with the dopamine system in brain regions relevant to schizophrenia, side effects of antipsychotic medication and potential antipsychotic effect of muscarinic receptor antagonists. This study investigated the association of type I muscarinic receptor (CHRM1) genetic polymorphisms with the clinical characteristics of chronic schizophrenic inpatients. Methods: We determined the genotype of CHRM1 genetic polymorphisms in 243 schizophrenic patients hospitalized in chronic care wards. Psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), and cognitive function was assessed using the Folstein Mini-Mental Status Examination (MMSE) test. Sixty of the 243 subjects also completed the Wisconsin Card Sorting Test (WCST). Results: There was a significant difference in the number of correct responses and the percentage of perseverative errors in the WCST in the CHRM1 C267A genotype group of schizophrenia patients. There was no significant association between age at onset, chlorpromazine equivalents, BPRS scores, MMSE or schizophrenia per se in patients with the CHRM1 C267A genotype. The full exon of the CHRM1 gene was screened out with single-strand conformation polymorphism, and 2 single nucleotide polymorphisms (C267A and C1353T) were identified in our patients and control subjects. These 2 single nucleotide polymorphisms were linked together without exception. Conclusion: This study demonstrated that in schizophrenic patients, the heterozygote group of CHRM1 C267A polymorphism (267C/A) had more correct responses and less perseverative errors on the WCST performance than the 267C/C homozygote group, implicating that this polymorphism may be related to prefrontal cortical function. Our results also suggested that the C267A polymorphism plays no major role in the susceptibility to and clinical manifestations of schizophrenia.

The Wisconsin Card Sorting Test (WCST) is a complex measure of executive function that is frequently employed to investigate the schizophrenia spectrum. The successful completion of the task requires the interaction of multiple intact executive processes, including attention, inhibition, cognitive flexibility, and concept formation. Considerable cognitive heterogeneity exists among the schizophrenia spectrum population, with substantive evidence to support the existence of distinct cognitive phenotypes. The within-group performance heterogeneity of individuals with schizophrenia spectrum disorder (SSD) on the WCST has yet to be investigated. A data-driven cluster analysis was performed to characterise WCST performance heterogeneity. Hierarchical cluster analysis with k-means optimisation was employed to identify homogenous subgroups in a sample of 210 schizophrenia spectrum participants. Emergent clusters were then compared to each other and a group of 194 healthy controls (HC) on WCST performance and demographic/clinical variables. Three clusters emerged and were validated via altered design iterations. Clusters were deemed to reflect a relatively intact patient subgroup, a moderately impaired patient subgroup, and a severely impaired patient subgroup. Considerable within-group heterogeneity exists on the WCST. Identification of subgroups of patients who exhibit homogenous performance on measures of executive functioning may assist in optimising cognitive interventions. Previous associations found using the WCST among schizophrenia spectrum participants should be reappraised. (JINS, 2019, 25, 750-760).

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

BackgroundA number of reports showed en encouraging remediation in some patients' executive deficits thanks to the use of 'information processing strategies'. Moreover the impact of antipsychotics on cognitive functions of the schizophrenics is an important issue, especially if an integrated psychosocial treatment is needed.The aim of this paper is to evaluate different executive performance and response to verbalization, a strategy of the Wisconsin Card Sorting Test (WCST) remediation, in subjects on classical vs atypical antipsychotic (AP) treatment.MethodsSixty-three schizophrenic subjects undertook the WCST under standard and modified (verbalization) administration. Subjects were stratified by the kind of WCST response (i.e. good, poor and remediable) and AP treatment (i.e. atypical vs. classical).ResultsSubjects on atypical APs showed a better performance than those on classical ones. More poor performers who did not remediate were seen in the sample with classical Aps while subjects who remediated the performance were seen in the subgroup with atypical APs only. An increase of perseverative and total errors was seen in poor performers subjects on classical APs.ConclusionSubjects on atypicals showed a better cognitive pattern in terms of WCST performance. Since the naturalistic assignment of medication we cannot draw conclusions about its effect on cognitive performance and its interaction with cognitive remediation potential. However the data lead us to hypothesize that subjects with potential room for remediation did so with the atypical APs.

Objective To evaluate the antidepressant efficacy, cognitive effect and safety of theta-burst transcranial magnetic stimulation (TBS) in treatment of first-episode depression. Methods 43 hospitalized patients with first-episode depression meeting with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) were randomly divided into theta-burst stimulation group(TBS group, n=21)and sham-stimulation group(sham group, n=22). All patients were treated at left dorsolateral prefrontal cortex (DLPFC) for 4 weeks, and were concomitantly taking venlafaxine (150-300)mg/d. Hamilton Depression Scale-24 was used to assess the severity of depression before treatment, at week 2 and week 4 in both groups. Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT) were used to estimate cognitive function of depression before and after treatment. Results There was no difference on HAMD score before treatment between two groups((38.2±7.1)vs.(37.5±6.8), t=0.314, P=0.754). The reduction of HAMD score in TBS group showed significantly faster than that in sham group at week 2 ((20.5±4.8)vs.(16.1±5.9), t=2.547, P=0.015) and week 4((30.3±5.2)vs.(26.0±6.3), t=2.318, P=0.026). After 2-week stimulation, the response rate was higher in TBS group than that in sham group (57.9%vs. 25%, χ2 =4.358, P=0.037). The response and remission rates were significantly higher in TBS group than those in sham group after 4-week stimulation period (94.7%vs.65%, χ2 =5.284, P=0.021; 78.9%vs.45%, χ2=4.744, P=0.029). The improvements on WCST and CPT after treatment in TBS group, such as categories completed, correct responses, error responses, perseverative responses errors, nonperseverative responses errors, CPT1, CPT2 and CPT3, were significant than those in sham group (P<0.05). Conclusions Theta-burst stimulation of the left dorsolateral prefrontal cortex is safe and well-tolerated, while offering the potential to enhance early effects and modulate cognition in first-episode depressive patients. Key words: Theta-burst stimulation; Transcranial magnetic stimulation; Depression

Conceptual reasoning deficits are common in patients with multiple sclerosis (MS) and are typically associated with focal lesions involving the frontal lobes. In this study, we predicted that MS patients with frontal white matter lesions (MS-F) would be more impaired on a standard conceptual reasoning task (Wisconsin Card Sorting Test; WCST) than patients with minimal frontal lesions (MS-NF), even if the total cerebral lesion area (TLA), measured from MRI, was equivalent across groups. We subdivided 43 definite MS patients into three groups based on MRI findings: seven in the MS-F group (mean TLA = 41.4 cm2) and seven in the MS-NF group (mean TLA = 50.0 cm2); 29 MS patients served as a low lesion burden control group (MS-C; mean TLA = 6.4 cm2). The groups did not differ with regard to demographic and illness characteristics. Although the three subgroups obtained comparable scores on a measure of global cognitive functioning (verbal intelligence), the MS-F group achieved significantly fewer categories and made more total errors on the WCST than did the MS-NF and MS-C groups. The MS-F group made significantly more perseverative responses than the MS-C group and nonsignificantly more than the MS-NF group. These results suggest that the pattern of cognitive decline in MS is a function of the location of demyelinating lesions within the cerebral hemispheric white matter. Finally, we supplement the group study results with a case report of an MS patient who was studied serially with MRI and cognitive testing.

Performance on the Wisconsin Card Sorting Test in schizophrenia: Perseveration in clinical subtypes

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