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

Wisconsin Card Sorting Test performance before and after temporal lobectomy

Introduction. Abnormalities in associative frontostriatal circuits are often associated with obsessive-compulsive disorder (OCD), leading many researchers to predict that executive dysfunction should be particularly pronounced. However, deficits on putative tests of this construct have not consistently been identified. Methods. The present study used quantitative techniques to integrate results from 32 studies that assessed OCD patients' performance on tests of phonemic fluency, semantic fluency, and/or the Wisconsin Card Sorting Test (WCST). Results. As has been found for patients with focal frontal (but not focal nonfrontal) cortical lesions, relative to healthy controls OCD patients were comparably impaired on tests of phonemic and semantic fluency (r s =.33 and.37, respectively). However, in contrast to patients with focal frontal lobe injuries, fluency deficits did not qualify as differential deficits relative to psychomotor speed. Moreover, although a prominent view in the literature is that set-shifting is particularly compromised, the WCST was less sensitive to the presence of OCD than phonemic and semantic fluency, and also failed to qualify as a differential deficit. Conclusions. For patients with OCD, deficits on tests of verbal fluency and the WCST do not appear to reflect executive dysfunction, but are instead consistent with a more generalised cognitive impairment.

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

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 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.

Evaluating the efficacy of thrombolytic therapy in ST-elevation myocardial infarction by using ischemia grade on the enrollment electrocardiogram

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.

Objective: The aim of this study is to examine the relationship between executive functions such as selective atten-tion, response inhibition and cognitive flexibility and social-cognitive and social-perceptual theory of mind (ToM) functions in obsessive-compulsive disorder (OCD) patients. Methods: The Demographic Information Form, Beck Anxiety Scale, Beck Depression Scale, Wisconsin Card Sorting Test (WCST), Stroop Test, Eyes Test, Hinting Test were applied to 48 patients with OCD diagnosis and 39 healthy subjects. The Yale Brown Obsessive Compulsive Scale was administered to the OCD group. Results: While there was no difference in selective attention and re-sponse inhibition between the groups, it was found that the OCD group performed poorly in terms of cognitive flexi-bility. Compared to groups ToM tests, The OCD group was found to score significantly lower than the control group in the Eyes Test. In the OCD group, there was no significant correlation between ToM tests and other continuous numerical variables. In the control group, there was a moderate negative correlation between the Hinting Test score and Stroop 5 duration. Conclusion: To our knowledge, our study is the second study in the literature to show that impairment in social-perceptual ToM functions that may be specific to OCD and that this condition is independent of impairment in cognitive functions. Further studies with greater samples are needed.

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.

There is indirect evidence from previous research that several executive disturbances in obsessive-compulsive disorder (OCD) are mediated by comorbid depressive symptoms. For the present study, the authors investigated whether OCD patients with elevated Hamilton Rating Scale for Depression (HRSD) scores would exhibit deficits in tasks sensitive to the medial and dorsolateral frontal cortex as well as other executive tasks. The 36 OCD patients were split along the median according to their HRSD scores and compared with matched control subjects. Patients with high HRSD scores performed significantly worse than control subjects and patients with low HRSD scores on the Wisconsin Card Sorting Test, the Trail-Making Test (TMT, Part B), and the TMT difference score. Moreover, patients with high HRSD scores exhibited deficits on a (creative) verbal fluency task. It is suggested that comorbid depressive symptoms may have artificially inflated some executive deficit scores in previous studies.

Ethical sensitivity in obsessive-compulsive disorder and generalized anxiety disorder: The role of reversal learning

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).

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

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.