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.     

伴轻度抑郁症状的双相障碍患者执行和注意功能对照研究

目的:探讨伴轻度抑郁症状的双相障碍患者执行功能、注意功能与健康对照者的差异。方法:40例伴轻度抑郁症状的双相障碍患者(研究组)和40名年龄、性别、受教育年限与研究组匹配的健康者(健康对照组)均采用威斯康星卡片分类测验(WCST)及持续操作测验(CPT)测试两组执行功能和注意功能。结果:两组WCST测试成绩除完成第1个分类所需应答数、非持续性错误数差异无统计学意义(P0.05)外,完成分类数、总应答数、正确应答数、错误应答数、持续性错误数、持续性错误率组间差异有统计学意义(t=-6.10~5.96,P均=0.000);CPT测验中正确数研究组明显低于健康对照组(t=-3.87,P=0.000);错误数明显高于健康对照组(t=5.21,P=0.000)。结论:伴轻度抑郁症状的双相障碍患者存在执行功能损害和注意功能损害。     

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.     

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.     

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。     

Right frontal event related EEG coherence (ERCoh) differentiates good from bad performers of the Wisconsin Card Sorting Test (WCST).

AIM: To investigate changes in Event-Related Coherence (ERCoh) associated to good and bad resolution of the Wisconsin Card Sorting Test (WCST). METHODS: Event-Related Potentials (ERPs) were recorded from a sample of 30 university students while they performed a computerized version of the WCST. ERCoh was calculated for frontal and parietal electrodes for two specific moments: immediately before the response and after the feedback cues. RESULTS: Bad performers presented significantly reduced ERCoh at the right frontal region (in alpha, beta-1 and beta-2 bands), while no consistent group differences emerged for parietal ERCoh. Furthermore, the strength of functional coupling (ERCoh) between midfrontal and right-frontal electrodes was a good predictor of WCST behavioural parameters, such as the percentage of perseverative errors or the number of categories achieved. CONCLUSIONS: The results suggest that the right prefrontal cortex is specifically involved in executive functions, such as planning and foresight, tapped by the WCST. Although the specificity of the WCST to explore frontal lesions has been recently questioned, the present findings support that prefrontal areas are specifically involved in the successful resolution of the test by healthy subjects.     

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.     

精神分裂症患者与其健康同胞的注意和执行功能障碍的对照研究

目的　探讨精神分裂症患者及其健康同胞的注意、工作记忆 /执行功能的特点。方法对 5 0例精神分裂症患者 (患者组 )及其健康同胞 5 0名 (同胞组 ) ,以及 4 5名正常对照者 (正常对照组 )采用威斯康星卡片分类测验 (WCST)和持续操作测验 (CPT) ,评估注意、工作记忆 /执行功能。结果　(1)在WCST中 ,患者组及其同胞组的总测验次数 (分别为 83 4± 2 3 2和 74 1± 2 4 6 )、持续错误数 (分别为 2 5 8± 11 7和 2 2 8± 10 7)、随机错误数 (33 4± 19 2和 2 5 9± 17 1)均高于正常对照组 (分别为6 0 0± 2 1 6、14 8± 8 3和 18 1± 16 0 ;P <0 0 1)。 (2 )在CPT中 ,患者组的评分 [(2 8 4± 4 0 )分 ]低于同胞组 [(30 4± 2 3)分 ]和正常对照组 [(30 9± 2 8)分 ],而同胞组与正常对照组的差异无显著性(P >0 0 5 )。(3)患者组及其同胞组发生执行功能障碍 (分别为 2 9例和 2 5例 )和注意缺陷 (分别为 2 2例和 7例 )的例数均多于正常对照组 (分别为 9例和 4例 ;P <0 0 1) ,其中有工作记忆 /执行功能缺陷的精神分裂症患者 ,其同胞出现这一缺陷的比率 (6 6 % )高于无缺陷的精神分裂症患者的同胞 (2 8% )。(4)WCST中的持续错误数与文化程度呈负相关 (r =- 0 32 ,P <0 0 1) ,CPT与性别 (r=- 0 2     

Wiscosin card sorting task in patients with schizophrenia and thier siblings]

OBJECTIVE: This study's first objective was to confirm that patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function when compared to healthy control subjects. The second objective was to study the relation between Wisconsin card sorting task (WCST) performance and the persistence and severity of clinical symptoms, as well as different clinical dimensions. METHOD: Ninety subjects were involved in this study, divided in 3 groups of 30 each: one group of patients with schizophrenia, one group of their siblings, and a control group. Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS), and social functioning was measured by the Global functioning scale (GFS). The WCST was administered to all 3 groups. RESULTS: Patients with schizophrenia and their siblings had a significantly lower WCST performance than control subjects. Statistical analysis showed that the patient group had a significantly greater impaired WCST performance than the 2 other groups. Siblings also had a significantly lower performance than the control subjects. Furthermore, no significant relation was found between WCST performance and other variables, including age, gender, education, illness duration, treatment, and different PANSS and GFS scores. CONCLUSION: Patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function. These findings suggest that WCST performance can be considered a schizophrenia vulnerability marker in siblings of patients with schizophrenia.     

Performance of patients with schizophrenia on the Wisconsin Card Sorting Test (WCST)

OBJECTIVE: To directly compare the performance of patients with schizophrenia and control subjects on the Wisconsin Card Sorting Test (WCST). Specifically, we sought to verify if there are significant differences on the "classical" WCST measurements (perseverative errors and number of categories), as well as on more rarely reported scores, and assess the extent to which patients with schizophrenia can improve their performance with card-by-card instructions and continuous verbal reinforcement. DESIGN: Prospective cross-sectional study. SETTING: Psychiatry department in a university-affiliated hospital. PARTICIPANTS: 30 patients with schizophrenia, diagnosed according to DSM-IV criteria, and 30 control subjects, matched to patients according to age and education. INTERVENTION: The WCST was administered according to the criteria of Heaton, and a subgroup of the patients with schizophrenia was given a retest after an explanation of the WCST and verbal reinforcements. RESULTS: Patients with schizophrenia succeeded on fewer categories (t = 23.3, p < 0.001), committed more perseverative errors (t = 15.6, p < 0.001), made more perseverative responses (t = 14.6, p < 0.001), needed more trials to succeed at the first category (t = 9.2, p < 0.003) and gave significantly lower conceptual level responses (t = 14.1, p < 0.001) than the controls. However, on retest, patients with schizophrenia committed significantly fewer perseverative errors (t = 5.1, p < 0.001) and showed higher conceptual level responses (t = -3.45, p < 0.003). CONCLUSION: Consistent with a hypothesis of frontal dysfunction in schizophrenia, patients with schizophrenia tend to show a perseverative deficit; however, some are able to partially overcome this deficit when given verbal reinforcement.     

What about inhibition in the Wisconsin Card Sorting Test?

The commercially available Wisconsin Card Sorting Test (WCST) is one of the most commonly used tests for assessing executive functions within clinical settings. Importantly, however, it remains relatively unclear exactly what processes are assessed by the test. Conceptually, increased perseverative errors in sorting cards are usually related to deficient inhibition processes. Empirically, evidence supporting this conclusion is limited. In a sample of 38 healthy adults we addressed the question to what extent inhibition mechanisms assessed by the go/no-go and the stop-signal paradigm are related to WCST performances. Inhibition-related scores were found to predict non-perseverative errors better than perseverative errors. Consequently we conclude that the non-perseverative errors score reflects processes that are partly dependent on inhibition functions.     

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。     

Wisconsin Card Sorting Test performance before and after temporal lobectomy

Wisconsin Card Sorting Test (WCST) performance was studied before and after patients underwent right (n = 34) or left (n = 34) temporal lobectomy. Patients had hemisphere language dominance judged on intracarotid amobarbital testing and were free of space-occupying lesional pathology by magnetic resonance imaging (MRI). Right and left lobectomy patients did not differ before or after surgery on WCST parameters: categories completed, perseverative errors, total correct responses, total errors, nonperseverative errors, and perseverative responses. There was no relationship between WCST performance and MRI-determined hippocampal volumes or age of recurrent seizure onset. These findings are contrary to previous reports, suggesting the presence of laterality effects on preoperative WCST performance, relationships between WCST performance and age of seizure onset, and association of WCST performance and degree of mesial temporal sclerosis. Data from this study are consistent with a report on a larger group of temporal lobectomy patients, which found no laterality effect on WCST performance. The WCST seems to be of no value when attempting to lateralize seizure onset in nonlesional temporal lobe epilepsy.     

What About Inhibition in the Wisconsin Card Sorting Test?

The commercially available Wisconsin Card Sorting Test (WCST) is one of the most commonly used tests for assessing executive functions within clinical settings. Importantly, however, it remains relatively unclear exactly what processes are assessed by the test. Conceptually, increased perseverative errors in sorting cards are usually related to deficient inhibition processes. Empirically, evidence supporting this conclusion is limited. In a sample of 38 healthy adults we addressed the question to what extent inhibition mechanisms assessed by the go/no-go and the stop-signal paradigm are related to WCST performances. Inhibition-related scores were found to predict non-perseverative errors better than perseverative errors. Consequently we conclude that the non-perseverative errors score reflects processes that are partly dependent on inhibition functions.     

Modified wisconsin sorting test in elderly normal,depressed and demented patients

Abstract

Patients with major depression, and normal controls completed a modified version of the Wisconsin Card Sorting Test (WCST). DAT patients completed fewer categories and made more total and more perseverative errors than normal elderly patients. Moderate by severe DAT patients completed fewer categories than mild DAT and depressed patients. Mild DAT and depressed patients performed in a similar manner. The modified WCST may be particularly applicable for an elderly population. It simplifies the procedure and reduces ambiguity in conveying feedback so that fewer subjects may be unwilling or unable to complete the task. Further research is needed to establish the comparability of the modified WCST with the original test.     

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.     

Perception of ambiguous figures after focal brain lesions

Forty patients with unilateral frontal or posterior brain damage and 20 normal control subjects were tested on an ambiguous figures task (AFT). For each figure they were asked to recognize both ambiguous images. Subjects failing to recognize the second aspect of an ambiguous figure were prompted with the name of the image not yet perceived. The Wisconsin Card Sorting Test (WCST) was also administered to all subjects. Frontal patients exhibited greater difficulty in shifting from one aspect of an ambiguous figure to the other than did patients with more posterior lesions and control subjects. In addition, frontal-posterior and control differences were highly significant for number of prompts given. For the frontal patients, significant correlations were found between the number of prompts on the AFT and the number of perseverative errors on the WCST. Poor performance on the AFT can be considered as a "frontal lobe sign" of perceptual persevation.     

Working memory and Wisconsin Card Sorting Test performance in schizotypic individuals: a replication and extension

The present study examined spatial working memory and Wisconsin Card Sorting Test (WCST) performance in psychosis-prone individuals, either those with extremely high scores on the Social Anhedonia Scale (SocAnh; n = 49) or deviant scores on the Perceptual Aberration-Magical Ideation Scales (Per-Mag; n = 66). Sixty-three individuals with normal scores on the Chapman Psychosis-Proneness Scales served as control subjects. In order to evaluate working memory performance, participants were administered three tasks, namely, sensorimotor, degraded stimulus, and delayed-response tasks. Although the SocAnh and Per-Mag groups displayed poorer performance than control subjects on the working memory task, they did not differ significantly from each other. The SocAnh group exhibited slower reaction times on the working memory task compared to the control group. The groups did not differ in their performance on sensorimotor or degraded stimulus control tasks. Both psychosis-prone groups differed significantly from control subjects in terms of their WCST performance. Working memory performance was inversely associated with the number of perseverative errors (r = -0.17) and the number of trials to complete the first category on the WCST (r= -0.15). These findings extend the literature by indicating that some psychosis-prone individuals with social-interpersonal schizotypal deficits also display subtle spatial working memory impairments.     

Executive function in parents of patients with familial versus sporadic bipolar disorder

ObjectiveStudies investigating the cognitive function of healthy relatives of patients with bipolar disorder are conflicting, and the neurocognitive profile of relatives of bipolar disorder probands is still unclear. We aimed to evaluate executive function in unaffected parents of familial and sporadic patients with bipolar disorder.MethodsThe study included 24 unaffected familial parents (FP) of patients with bipolar disorder, 26 unaffected sporadic parents (SP) of patients with bipolar disorder and 26 controls matched with the parents for gender, age and duration of education (76 subjects in total). All of the subjects were interviewed with the Structured Clinical Interview for DSM-IV-Axis I. Executive function was assessed using the California Verbal Learning Test (CVLT), the Trail Making Test (TMT), the Wisconsin Card Sorting Test (WCST) and the Stroop test.ResultsIn comparison to their respective matched controls, FP performed significantly worse on the CVLT, TMT, WCST and Stroop test, whereas SP performed significantly worse only on WCST perseverative errors and Stroop color test. FP performed significantly worse than SP on the CVLT, TMT, and WCST.ConclusionThe present study investigated relatives with and without a family history of bipolar disorder separately and found that executive function was impaired in parents with a positive family history of bipolar disorder. These findings bring more evidence suggesting that deficits in prefrontal executive function and verbal memory are associated with familial vulnerability to bipolar disorder and that executive function and verbal memory impairments may represent a potential endophenotype of bipolar disorder.     

海洛因依赖者认知功能损害的对照研究

目的　采用威斯康星 (Wisconsin)卡片分类测验评估海洛因依赖者与正常人群的认知差异。方法　对完成脱瘾治疗的 4 8例海洛因依赖者和 4 2例正常人进行Wisconsin卡片分类测验评定。结果　两组间总应答数、完成分类数、正确应答百分数、错误应答数、持续应答数、持续性错误数、概念化应答百分数和完成第一类所需应答数的比较显示 ,海洛因依赖组较正常人组差 (P <0 0 1)。相关因素分析显示 ,吸毒时间及日吸毒量与认知功能损害程度呈正相关 (r分别为 0 4 1～ 0 4 7和 0 35～ 0 4 2 ;P <0 0 5 )。结论　海洛因依赖者存在认知功能损害