发育性协调运动障碍儿童执行功能的横断面研究(英文)

背景发育性协调运动障碍(developmental coordination disorder,DCD)患儿存在明显的运动能力、学习和日常生活能力的下降。国外研究表明,患儿的这些能力下降与其认知功能尤其是执行功能的受损有关,但国内尚无此类研究来证实这些结果。目的比较发育性协调运动障碍患儿与正常儿童的执行功能。方法对2008年3月至2010年3月在杭州市第七人民医院就诊并符合DSM-IV发育性协调运动障碍诊断的39例患儿采用威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)进行评估。另外,在杭州某小学随机抽取39名健康儿童作为对照组,同样对他们进行WCST评估。结果两组在WCST的总应答数及非持续错误数相似,但是研究组的错误应答数、持续性应答数和持续性错误数均显著高于对照组。另外,研究组患儿完成分类数低于对照组,完成第一个分类所需的应答数也高于对照组。结论本研究证实了先前一些研究的结果,即发育性协调运动障碍患儿存在明显的执行功能缺陷。所有这些研究均提示,患儿的执行功能缺陷显著影响了其智能和社会功能的发展。     

Executive functions and P300 latency in elderly depressed patients and control subjects.

The authors asked whether impaired executive functioning and long P300 latency are related dysfunctions and whether they are associated with geriatric depression. A group of 25 elderly depressed patients without dementia and 20 control subjects were assessed on tasks of fluency, initiation and perseveration, the Stroop task, the Wisconsin Card Sorting Test (WCST) perseverative error score, and P300 latency. The groups' performance differed significantly on these tasks and in P300 latency. Longer latency was associated with poorer performance in both groups on all measures except WCST perseverative errors. Regardless of patients' depression status, increased P300 latency predicts poorer performance on executive function tasks requiring speeded performance.     

A process approach to verbal memory assessment: Exploratory evidence of inefficient learning in women remitted from anorexia nervosa

Introduction: Anorexia nervosa (AN) is associated with deficits in set-shifting and cognitive flexibility, yet less is known about the persistence of these deficits after recovery and how they might contribute to reported difficulties organizing and learning new information. To address this question, the current study applied a process-focused approach, that accounts for errors and strategies by which a score is achieved, to investigate the relationship between verbal memory and executive function in women remitted from AN.

Method: Twenty-six women remitted from anorexia nervosa (RAN) and 25 control women (CW) aged 19–45 completed the California Verbal Learning Test, Second edition (CVLT-II) and the Wisconsin Card Sorting Test (WCST). Groups were compared on overall achievement scores, and on repetition, intrusion, and perseverative errors on both tests. Associations between learning and memory performance and WCST errors were also examined.

Results: RAN and CW groups did not differ on overall CVLT-II learning and memory performance or errors on the WCST, though the RAN group trended towards greater WCST non-perseverative and total errors. On the CVLT-II, the RAN group made significantly more repetition errors than CW (p = 0.010), and within-trial perseveration (WTP) errors (p = 0.044). For the CW group, CVLT-II learning and memory performance were negatively associated with errors on the WCST, whereas among RAN, primarily delayed memory was negatively correlated with WCST errors. Notably, for RAN, greater WCST perseverative responses were correlated with greater CVLT-II repetition and WTP errors, showing the convergence of perseverative responding across tasks.

Conclusions: Despite similar overall learning and memory performance, difficulties with executive control seem to persist even after symptom remission in patients with AN. Results indicate an inefficient learning process in the cognitive phenotype of AN and support the use of process approaches to refine neuropsychological assessment of AN by accounting for strategy use.     

Neuropsychologic profile of college students with schizotypal traits

Background

This study investigated the neuropsychologic functioning in nonclinical individuals with schizotypal traits using a comprehensive battery of neuropsychologic tests.

Method

We measured the neuropsychologic functioning of individuals with psychometrically defined nonclinical schizotypy (n = 28) and healthy controls (n = 31) for verbal memory (the Korean version of the California Verbal Learning Test), nonverbal memory (the Rey-Osterrieth Complex Figure Test), executive function (the Wisconsin Card Sorting Test), and attention (the d2 Test, Trail Making Test, and Controlled Oral Word Association Test).

Results

The schizotypal trait group committed significantly more total and perseverative errors and completed fewer categories on the Wisconsin Card Sorting Test than the control group. Performance on the other neuropsychologic tests did not differ between groups.

Conclusions

The nonclinical individuals with schizotypal traits demonstrated executive dysfunction, showing decreased ability in conceptualization, use of cues, and mental flexibility. Furthermore, these results indicate that the cognitive deficits observed in schizophrenia are also a characteristic of nonclinical individuals with schizotypal traits.     

Genetic influences on frontal brain function: WCST performance in twins

The Wisconsin Card Sorting Test (WCST) is one of the most widely used assessments of executive functioning related to prefrontal cortex. However, little is known about genetic and environmental determinants of individual differences in WCST performance. This study assessed heritability of standard WCST scores in a sample of 168 young female twins including 58 monozygotic and 25 dizygotic pairs. Several WSCT indices, including the number and percentage of errors, the number of perseverative responses, and the number and percent of perseverative errors, showed significant heritability ranging from 37 to 46%. The results suggest that selected aspects of frontal executive functioning measured by the WCST are moderately influenced by genetic factors.     

Wisconsin Card Sorting Test deficits in schizotypic individuals

The present study investigates executive functioning in schizotypic college students and control subjects using the Wisconsin Card Sorting Test (WCST). Inhibitory control and working memory, two aspects of executive functioning, were examined in deviantly high scorers on the Perceptual Aberration and Magical Ideation Scales (n=97), high scorers on the revised Social Anhedonia Scale (n=58), and in control subjects (n=104). The schizotypic groups displayed significantly more perseverative errors and achieved fewer categories than the control group. The two schizotypic groups did not differ from each other. We identified a subset of schizotypic individuals who also produced clinically deviant WCST profiles. The findings support the hypothesis that executive function deficits may precede the onset of schizophrenia and related illnesses.     

奥氮平对精神分裂症患者执行功能障碍的影响

目的:探讨奥氮平对精神分裂症患者执行功能障碍的长期疗效。方法:对29例服用奥氮平维持治疗与24例服用氯丙嗪维持治疗的精神分裂症患者进行2年随访,采用威斯康星卡片分类测验(WCST)评估执行功能。结果:维持治疗2年末奥氮平组和氯丙嗪组的WCST测验中的总测验次数、持续错误数、随机错误数均显著下降(P<0.05或P<0.01),但奥氮平组的总测验次数、持续错误数、随机错误数减分率均显著高于氯丙嗪组(P均<0.01)。结论:奥氮平长期维持治疗能显著改善精神分裂症患者的执行功能。     

Computerized version of the Wisconsin card sorting test in children with high-functioning autistic disorder or attention-deficit/hyperactivity disorder

To determine executive dysfunctions in children with autistic disorder or attention-deficit/hyperactivity disorder (ADHD), we investigated high-functioning autistic (full scale IQ score >or==70), ADHD, and control children using the computerized version of the Wisconsin Card Sorting Test. Data were obtained from 17 autistic children (16 boys and 1 girl, mean age+/-SD: 12.5+/-4.3), 22 ADHD children (20 boys and 2 girls, mean age+/-SD 11.3+/-2.6), and 25 control children (13 boys and 12 girls, mean age+/-SD: 12.7+/-3.1). Performances, indicated by mean number of categories achieved (5.4 in autistic, 6.5 in ADHD, and 8.8 in control group), total errors (38.2, 38.4, and 25.6, respectively), perseverative errors (11.4, 13.5, and 5.7), nonperseverative errors (27.1, 25.0, and 19.9), and Nelson type perseverative errors (8.9, 8.4, and 2.3), were significantly poorer in both autistic and ADHD groups than control group (P<0.01). Comparing the autistic group to the ADHD group, there were no significant differences in age, gender, scores of full-scale intelligent quotient (IQ), verbal or performance IQ, number of categories achieved or errors. The ADHD group, however, showed more frequent Milner type perseverative errors than the autistic group (P<0.05). The present study suggests that some kinds of executive function are more impaired in children with ADHD than in those with high-functioning autism, and that Milner type perseverative errors is useful parameter to differentiate the executive dysfunctions between autistic and ADHD children.     

Dissociation of ketamine effects on rule acquisition and rule implementation: possible relevance to NMDA receptor contributions to executive cognitive functions.

BACKGROUND: The demands of the Wisconsin Card Sorting Test (WCST) change with experience. This report contains two studies designed to examine N-methyl-D-aspartate (NMDA) receptor contributions to the executive components of WCST performance. These aspects of WCST performance figure more prominently in the initial completion of this task than in subsequent task repetitions in healthy populations. METHODS: In the first study, healthy subjects (n = 15) completed the WCST on two occasions separated by 1 week. In the second study, healthy subjects (n = 22) completed two test days spaced by approximately 1 week, during which, they completed the WCST and other assessments after administration of the NMDA antagonist ketamine (intravenous bolus 0.26 mg/kg followed by infusion of 0.65 mg/kg/hour) or matched placebo. RESULTS: In the first study, subjects reduced the number of total and perseverative errors with a single repetition of the WCST. In the second study, ketamine significantly increased the number of total errors and the number and percent of perseverative errors on the first, but not the second test day. Similarly, it reduced the number of category criteria met on the first, but not second test day. Ketamine also increased distractibility, impaired recall, produced psychosis, altered perception, and had effects resembling the negative symptoms of schizophrenia. However, only WCST performance showed order dependency. CONCLUSIONS: This order dependency further implicates NMDA receptors in executive cognitive functions associated with the frontal cortex.     

‘Autistic’ Traits in Non-Autistic Japanese Populations: Relationships with Personality Traits and Cognitive Ability

We explored the relationships between 'autistic' traits as measured by the AQ (Autism-Spectrum Quotient; Baron-Cohen et al., J. Autism Develop. Disord. (2001b) 31 5) and various personality traits or cognitive ability, which usually coincide with autistic symptoms, for general populations. Results showed the AQ was associated with tendencies toward an obsessional personality as defined by the TCI (Temperament and Character Inventory), higher depression and anxiety, and higher frequency of experience of being bullied. These results parallel the patterns in autism and corroborate the validity of the AQ for general populations. Contrary to our prediction, however, there was no relationship between the AQ and cognitive ability, such as theory of mind, executive functioning, and central coherence, suggesting the AQ does not reflect autism-specific cognitive patterns in general populations.     

Executive deficits in chronic PTSD related to political violence

Twenty-two subjects with chronic PTSD were compared to 23 subjects with no diagnoses (NPD) on tests of executive functioning (EF) that are assumed to have clinical significance after exposure to political violence. METHOD: The three cognitive components of EF, intentionality, inhibition and executive memory [Burgess, P. W., Alderman, N., Evans, J., Emslie, H., Wilson, B. A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4, 547-58], were measured using the Tower of London, Stroop Color-Word Test and Wisconsin Card Sorting Test (WCST), respectively. RESULTS: The PTSD group was impaired on tasks measuring automatic processing and executive memory. Executive memory problems were related to elevated posttraumatic symptoms, but the executive components intentionality and inhibition did not differentiate the groups. Arousal and intrusive symptoms had no impact on intentionality. CONCLUSION: Posttraumatic symptoms are related to automatic processing problems and impairment in executive memory. Observed dysfunctions in mental flexibility could have a negative impact on the cognitive processing of traumatic memory, thus preventing from recovery.     

Caudate atrophy and impaired frontostriatal connections are linked to executive dysfunction in temporal lobe epilepsy

This study tested the hypothesis that executive dysfunction, common in temporal lobe epilepsy (TLE), is associated with an abnormal frontostriatal network. Structural and diffusion tensor MR scans, the Wisconsin Card Sorting Test (WCST) targeting cognitive flexibility, and the Trail Making Test B examining parallel sequencing were obtained from 9 patients with left TLE and 17 healthy controls. The five major findings were: (1) Caudate volume is reduced on the left side in TLE. (2) The atrophy involves the dorsal and ventral head of the caudate. (3) These atrophic caudate regions have a corresponding high probability of connections to dorsal prefrontal, anterior cingulate, and orbitofrontal cortex. (4) Smaller caudate volumes are linked to greater numbers of WCST perseverative errors. (5) Reduced connections between caudate and dorsal prefrontal cortex correlated with poorer scores on the Trail Making Test B. The results suggest that atrophy in the dorsal head of the caudate might disrupt frontostriatal networks that are critical for executive functioning in TLE.     

Cognitive flexibility in autism spectrum disorder: Explaining the inconsistencies?

The Wisconsin Card Sorting Task (WCST) is the only cognitive flexibility task that has consistently shown deficits in individuals with an autism spectrum disorder (ASD). As this is the only task characterized by limited explicit task instructions and a high degree of disengagement required to perform the switch, we hypothesized that cognitive flexibility deficits of individuals with ASD might only become apparent in situations fulfilling these requirements. However, the WCST involves various additional cognitive processes besides switching, making it uncertain whether difficulties are indeed due to cognitive flexibility impairments. The aim of this study was to investigate whether individuals with ASD show cognitive flexibility impairments on a more controlled task-switching variant of the WCST, still fulfilling both requirements. We therefore developed such a task and administered it to 40 high-functioning children with ASD and 40 age- and IQ- matched typically developing controls. As predicted, individuals with ASD made more perseveration errors and had a significantly higher switch cost than typically developing controls, but they performed equally well on the control measures.     

Spatial working memory performance in patients with schizoaffective psychosis versus schizophrenia: a tale of two disorders?

We explored the relationship between schizophrenia and schizoaffective disorder by comparing the two patient groups in terms of their performance on measures of executive functioning (spatial working memory and Wisconsin Card Sorting Test). Patients with schizophrenia (N=34) and those with schizoaffective disorder (N=23) performed significantly poorer than community controls (N=30). However, the schizoaffective and schizophrenia groups did not differ from each other in terms of working memory accuracy or mean response latencies. Similarly, the two patient groups did not differ in terms of the number of categories achieved or number of perseverative errors on the Wisconsin Card Sorting Test. Among the patients, working memory accuracy was associated with number of WCST perseverative errors and number of categories achieved, though working memory performance was not associated with number of WCST nonperseverative errors. These findings indicate that both schizophrenia and schizoaffective disorder are associated with executive functioning deficits. The findings are discussed in the context of the ongoing debate regarding the conceptualization of schizoaffective disorder.     

Do schizophrenia patients make more perseverative than non-perseverative errors on the Wisconsin Card Sorting Test? A meta-analytic study

The Wisconsin Card Sorting Test (WCST) is widely used to explore executive functions in patients with schizophrenia. Among other findings, a higher number of perseverative errors has been suggested to implicate a deficit in task switching and inhibitory functions in schizophrenia. Many studies of patients with schizophrenia have focused on perseverative errors as the primary performance index in the WCST. However, do schizophrenia patients characteristically make more perseverative than non-perseverative errors compared with healthy controls? We reviewed the literature where schizophrenia patients were engaged in the WCST irrespective of the primary goal of the study. The results showed that while both schizophrenia patients and healthy participants made more perseverative than non-perseverative errors, the contrast between perseverative and non-perseverative errors is higher in schizophrenia patients only at a marginal level of significance. This result suggests that schizophrenia patients do make a comparable number of non-perseverative errors and cautions against simplistic interpretation of poor performance of schizophrenia patients in WCST as entirely resulting from impairment in set-shifting or inhibitory functions.     

Set shifting deficit in anorexia nervosa.

Anorexia nervosa (AN) is a severe mental illness characterized in part by rigid thinking and ritualized behaviors involving eating and weight. Cognitive rigidity may play a role in the perpetuation of symptoms, and may provide information as to important brain-based abnormalities. Neuropsychological studies of patients with AN have shown cognitive dysfunction, but few have focused on cognitive flexibility. This study assessed set shifting in patients with AN, as a measure of cognitive flexibility. In this study, 15 patients with AN were compared with 11 healthy controls using a neuropsychological battery including the Wisconsin Card Sort Test (WCST). While patients with AN did not differ from controls on 5 measures of neuropsychological function, they made significantly more perseverative errors on the WCST, indicating a problem in set shifting. This finding suggests that patients with AN have a specific neurocognitive abnormality that may play a role in the development and persistence of this disorder.     

精神分裂症认知障碍与精神症状的关系

目的：探索精神分裂症认知障碍特点及其与阴性、阳性症状间的关系。方法：比较32例未用过抗精神病药的精神分裂症患者及15例正常受试者的事件相关电位(ERPs)和威斯康星卡片分类测验(WCST)成绩，并进行相关分析。结果：精神分裂症患者多个位点N2和P3波潜伏期延长，P3波幅降低。WCST中分类完成数偏少，持续错误数和总错误数增加。N2潜伏期和波幅与阳性症状与阴性症状量表(PANSS)阳性症状分呈负相关，而WCST总错误数与PANSS总分和阴性症状分正相关。结论：精神分裂症病人存在中枢信息处理障碍、认知障碍，与阴性、阳性症状之间具有一定的内在联系。     

Cognitive inflexibility in Japanese adolescents and adults with autism spectrum disorders

AIM: To investigate executive function in Japanese adolescents and adults with autism spectrum disorders(ASD) compared to Japanese controls.METHODS: Thirty-three individuals with ASD and 33 controls participated. The ASD and control groups' demographic variables were matched for gender(male/female: 20/13 vs 20/13), age(26.1 ± 11.5 vs 26.8 ± 9.6), years of education(13.2 ± 2.9 vs 14.2 ± 1.9), full-scale intelligence quotient(IQ)(103.0 ± 16.7 vs 103.7 ± 14.7), performance IQ(96.2 ± 16.1 vs 97.8 ± 15.0), and verbal IQ(107.9 ± 16.3 vs 107.7 ± 14.4). Participants performed the Wisconsin Card Sorting Test(WCST), which assesses the executive processes involved in problem solving and cognitive flexibility, and the Continuous Performance Test(CPT), which assesses attention and impulsivity. Symptoms were assessed by the Autism-Spectrum Quotient Japanese version(AQ-J). First, we compared the scores of the WCST between the groups using a Mann-Whitney U-test and conducted an analysis of covariance for the variables with the scores of category archives and CPT scores as covariates. Second, we analyzed the correlation between the scores of the WCST and the AQ-J in the ASD group using Pearson's r.RESULTS: The total errors(TE) and the percentages of perseverative errors of the Milner type(%PEM) and Nelson type(%PEN) among the TE in the ASD group were significantly worse compared with the control group(ASD vs Control, respectively: TE: 16.0 ± 6.2 vs 12.6 ± 3.5, P = 0.012; %PEM: 11.7 ± 10.7 vs 6.6 ± 8.9, P = 0.037; %PEN: 20.1 ± 14.5 vs 8.7 ± 10.4, P = 0.0011). In contrast, no significant difference was observed between the two groups in the scores of categories achieved on the WCST or the CPT. An analysis of covariance revealed significant differences between the groups in the %PEN scores(P = 0.0062) but not in the TE or the %PEM scores. These results suggest that Japanese adolescents and adults with ASD have cognitive inflexibility. Furthermore, our results suggest that Japanese adolescents and adults with ASD may have difficulties using negative feedback because perseverative errors of the Nelson type indicate persistence in choosing the incorrect reaction. By contrast, there was no significant correlation between the WCST and AQ-J scores.CONCLUSION: We confirmed the presence of cognitive inflexibility in Japanese adolescents and adults with ASD. Our results also indicated that subjects with ASD may not use negative feedback effectively.     

Is a perseveration a perseveration? An evaluation of cognitive error types in patients with subcortical pathology

This study investigated several constructs of executive functioning in a group of 77 patients with subcortical pathology. Specifically, we examined the validity of categorizing perseverative errors as "recurrent," "stuck-in-set," or "continuous," as proposed by Sandson and Albert (1984). A principal components analysis of 2 measures of recurrent perseveration, 2 measures of stuck-in-set perseveration, and 2 measures of intrusive errors yielded a 2 component solution with stuck-in-set perseverations and intrusive errors loading on Component 1, and recurrent perseverations loading on Component 2. Presence of a continuous perseveration on a graphomotor test was significantly associated with higher factor scores on Component 1, but not Component 2. The stuck-in-set perseveration and intrusion component was associated with the majority of the other neuropsychological tests administered, including tests of executive function and memory. The recurrent perseveration component was not associated with the other measures of cognitive functioning. Presence of a continuous perseveration was associated with executive function but not memory measures. This study provides evidence that recurrent perseverations are distinct from the other types of perseverative and intrusive errors, and that stuck-in-set and intrusive errors are good indicators of general cognitive functioning in patients with subcortical pathology.     

精神分裂症认知障碍及其与阴性阳性症状的关系

目的 探索精神分裂症认知障碍特点及其与阴性阳性症状之间的关系。方法 比较32例从未用过抗精神病药或停药2周以上的精神分裂症患者以及15例健康受试者的事件相关电位(ERPs)和威斯康星卡片分类测验成绩(WCST),并进行相关分析。结果 与正常受试者比较,多个位点N2和P3波潜伏期延长,P3波幅降低。WCST中分类完成数偏少,持续错误数和总错误数增加。N2潜伏期和波幅与PANSS阳性症状分呈负相关,而WCST总错误数与PANSS总分和阴性症状总分正相关。结论精神分裂症病人存在中枢信息处理障碍,认知障碍与阴性阳性症状之间具有一定的内在联系。