Note on scoring perseveration on the Wisconsin card sorting test

Considerable confusion exists regarding the scoring rules of the Wisconsin Card Sorting Test. The purpose of this brief communication is to provide a supplement to the rules for scoring perseveration found in the Wisconsin Card Sorting Test manual (Heaton, 1981). These rules are to be used in conjunction with the manual, and are intended to clarify the existing rules, without modifying them or adding new rules.     

Wisconsin card sorting test in children with temporal lobe epilepsy

To search for the origin of frontal lobe dysfunction identified by the Wisconsin card sorting test (WCST) in temporal lobe epilepsy (TLE) patients, we investigated the WCST performance among 19 children with TLE (with hippocampal atrophy (HA group N=12), without structural lesions (NSL group N=7)), 15 patients with frontal lobe epilepsy (FLE group), and age-matched normal controls (N group). The paired verbal association learning test (PVALT) and Benton visual retention test (BVRT) were also performed. HA group and FLE groups achieved significantly fewer categories and demonstrated more perseverative errors on the WCST than NSL and N groups. In addition, category achievement in WCST showed significant inverse correlation to age at the initial status convulsivus in the HA group (P<0.05). The achievement on PVALT and BVRT did not show any significant differences between HA and FLE groups (P>0.05). Thus, the frontal lobe dysfunction in the HA group is found to exist as early as 7 years old, when they seem to have only a short seizure history or to receive a little electrical interference from the temporal lobe focus to the frontal region. These facts would underscore the importance of prefrontal dysfunction persisting from the early insults and only becoming apparent after maturation of the prefrontal region in patients with mesial TLE.     

Analysis of an abbreviated form of the Wisconsin card sorting test

The Wisconsin Card Sorting Test (WCST) was administered to 120 subjects in the standardized 128-card format. The standard scoring measures of the traditional administration were compared to those obtained using only the first 64 cards. Rank ordered correlations for all of the measures were significant. T-test comparisons revealed no differences on the measures between the test versions. These results provide preliminary support for an abbreviated administration of the WCST. Suggestions regarding further research are discussed.     

Wisconsin card sorting test as a measure of frontal pathology: A review

We reviewed studies of the Wisconsin Card Sorting Test (WCST) in which the test was administered to subjects with and without evidence of focal frontal-lobe dysfunction. This review indicated that few studies had investigated the differential performance of normals and those with frontal dysfunction. The evidence that frontal patients perform more poorly than nonfrontal patients is weak. There is insubstantial evidence to conclude that the WCST is a measure of dorsolateral-frontal dysfunction. The clinical utility of the test as a measure of frontal-lobe dysfunction is not supported nor is the use of the test as a marker of frontal dysfunction for research purposes.     

脑肿瘤病人的威斯康星分类作业测试指标(WCST)特点分析

目的分析脑肿瘤病人的威斯康星分类作业测试指标特点,寻找其规律性。方法对97例各类脑肿瘤病人进行威斯康星分类作业指标(Wisconsin Card Sorting Test,WCST)测试,并与79例相同年龄和性别的正常人进行比较。结果脑肿瘤病人WCST测试中的错误应答数(Re,47.1±16.4),持续错误数(Rpe,25.7±12.3),持续错误百分数(Rpe%,18.9±8.0),持续性应答(Rp,35.6±14.5),非持续性应答(Nrpe,24.8±8.6)和完成第一个分类所需应答(Rlst,33.4±14.5)均显著性高于对照组;但分类数(Cc,3.2±1.1)和概念化水平(CI,38.2±16.7)等指标明显低于对照组(t为2.291～3.345,P<0.05)。不同半球的脑肿瘤病人WCST测试指标中,除左半球组Nrpe指标显著性高于右半球组外(t=2.504,P<0.05),余各项WCST测试指标均无明显区别(t为0.971～1.415,P>0.05)。不同位置脑肿瘤病人WCST测试指标中,额叶组病人的Cc和CI测试值显著性低于非额叶组,而Re、Rpe、Rpe%和Rlst等指标明显高于非额叶组病(t=2.137～3.372,P<0.05),两组间Nrpe测试指标分布接近,无显著性差别(P>0.05)。按病灶体积大小,36例大病灶组(直径≥5 cm)Cc和CI测试值明显低于61例小病灶组(直径<5 cm),而Re、Rpe和Rpe%等指标显著性高于小病灶组(t为2.261～3.064,P<0.05);且两组间Rp、Nrpe和Rlst等测试指标分布接近,无显著区别(P>0.05)。结论脑肿瘤病人有明显的WCST测试指标障碍特点,为研究脑损伤病人认知功能表现提供了新渠道;干预措施可能减少认知功能损伤的发生。     

Effects of asthma on stability of Wisconsin card sorting test measures*☆ A twin study

BACKGROUND： The four measures used to assess the stability of the Wisconsin card sorting test （WCST）, that is, the number of preservative errors, percentage of preservative errors, number of categories completed, and the number of trials to complete the first category, reflect the function of the frontal lobe.
OBJECTIVE： This study was designed to investigate the effects of asthma on the stability of WCST measurements through the use of a twin study, and to analyze whether egg-type difference exists.
DESIGN： A cohort study.
SETTING： Mental Health Center, the First Affiliated Hospital of Chongqing Medical University.
PARTICIPANTS： Fifty-nine pairs of twins, aged 6-16 years, were primarily selected from schools between August 2005 and February 2007 and the WCST and Zygosity identification test was applied. Twins with achromatopsia, severe upper limb diseases, somatic diseases, or mental disorders were excluded. According to disease history of asthmatic attack, children were assigned into asthma （n = 16） and non-asthma （n = 43） groups.
METHODS： Four WCST measurements were determined in the 59 pairs of twins, and egg-type differences were identified in conjunction.
RESULTS： All 59 pairs of twins were included in the final analysis. Among the pairs of twins, 28 （48.5 %） were monozygotic twins, and 31 （52%） were dizygotic twins. Among the monozygotic and dizygotic twins, the number of preservative errors and percentage of preservative errors were significantly higher in the asthma group than in the non-asthma group （P 〈 0.05）. However, there was no significant difference of each corresponding measure between the monozygotic and dizygotic twins （P 〉 0.05）.
CONCLUSION： Asthma may affect the stability of WCST measures, but egg-type differences do not exist.     

Effects of asthma on stability of Wisconsin card sorting test measures A twin study

BACKGROUND:The four measures used to assess the stability of the Wisconsin card sorting test (WEST),that is,the number of preservative errors,percentage of preservative errors,number of categories completed,and the number of trials to complete the first category,reflect the function of the frontal lobe.OBJECTIVE:This study was designed to investigate the effects of asthma on the stability of WCST measurements through the use of a twin study,and to analyze whether egg-type difference exists.DESIGN:A cohort study.SETTING:Mental Health Center,the First Affiliated Hospital of Chongqing Medical University.PARTICIPANTS:Fifty-nine pairs of twins,aged 6-16 years,were primarily selected from schools between August 2005 and February 2007 and the WeST and Zygosity identification test was applied.Twins with achromatopsia,severe upper limb diseases,somatic diseases,or mental disorders were excluded.According to disease history of asthmatic attack,children were assigned into asthma(n=16)and non-asthma(n=43)groups.METHODS:Four WCST measurements were determined in the 59 pairs of twins,and egg-type differences were identified in conjunction.RESULTS:All 59 pairs of twins were included in the final analysis.Among the pairs of twins,28 (48.5%)were monozygotic twins,and 31(52%)were dizygotic twins.Among the monozygotic and dizygotic twins,the number of preservative errors and percentage of preservative errors were significantly higher in the asthma group than in the non-asthma group(P<0.05).However,there was no significant difference of each corresponding measure between the monozygotic and dizygotic twins (P>0.05).CONCLUSION:Asthma may affect the stability of WCST measures,but egg-type differences do not exist.     

Performance of adults ages 20 to 90 on the abbreviated Wisconsin card sorting test

Studies of the potential effect of aging on Wisconsin Card Sorting Test (WCST) performance have found older adults to perform at an impaired level relative to younger adults. This study examined the sensitivity of the 64-card version of the WCST to age-related changes in 140 healthy adults, ages 20 to 90 years. Results revealed significant linear trends for age, demonstrating decreased competence on variables of accuracy (e.g., Total Errors, Categories) and perseveration.     

Wisconsin card sorting test: a new global score, with Italian norms, and its relationship with the Weigl sorting test

The Wisconsin card sorting test and the Weigl test are two neuropsychological tools widely used in clinical practice to assess frontal lobe functions. In this study we present norms useful for Italian subjects aged from 15 to 85 years, within 5–17 years of education. Concerning the Wisconsin card sorting test, a new measure of global efficiency (global score) is proposed as well as norms for some well known, qualitative aspects of the performance, i. e. perseverative responses, failure to maintain the set and non-perseverative errors. In setting normative values, we followed a statistical methodology (equivalent scores) employed in Italy for other neuropsychological tests, in order to favour the possibility of comparison among these tests. A correlation study between the global score of the Wisconsin card sorting test and the score on the Weigl test was carried out and it emerges that some cognitive aspects are not overlapping in these two measures. Received: 15 June 2000 / Accepted in revised form: 10 November 2000     

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

For years the Wisconsin card sorting test (WCST) has been used as a test of frontal lobe function. Recent event-related potential (ERP) research has shown large differences in the amplitude of P3b responses evoked by early and late trials within each WCST series ([8]: Barceló F., Sanz M., Molina V., Rubia FJ. The Wisconsin Card Sorting Test and the assessment of frontal function: A validation study with event-related potentials. Neuropsychologia 1997;35:399-408). In this study, 16 normal subjects performed a WCST adaptation to investigate the role of attentional set shifting in these WCST P3b effects. Two control tasks were designed to examine whether early-late WCST P3b changes reflect category selection (attention) or category storage (memory) operations. Results suggest both a sharp P3b attenuation during shift WCST trials, followed by a gradual P3b build-up during post-shift trials. This P3b modulation could not be attributed to selection or storage of simple sensory stimulus dimensions, nor was it observed when the new rule was externally prompted by the first card in the WCST series. Instead, WCST P3b changes seem related to the endogenously generated shift in the perceptual rule used to sort the cards (i.e., the shift in set). The gradual build-up in P3b amplitude paralleled a progressive improvement in sorting efficiency over several post-shift WCST trials. A model based on formal theories of visual attention and attentional set shifting is proposed to account for these effects. The model offers firm grounds for prediction and bridges the gap between related clinical and experimental evidence.     

Utility of a Wisconsin card sorting test short form in persons with Alzheimer's and Parkinson's disease

Abstract

A diagnostic index, based on WAIS-R subtests, to identify patients with Dementia of the Alzheimer Type (DAT) and differentiate them from normal or depressed elderly was investigated. In a sample of 82 geriatric outpatient clinic patients who complained of memory loss, 22% of patients with probable DAT and 13% of nondemented patients obtained a positive profile. The occurrence of the profile in the two groups was not significantly different, nor were differences in education or severity of dementia found between subjects who did or did not obtain the profile. In a second sample of 173 elderly research volunteers, the profile occurred in 7% of DAT subjects, 10% of subjects complaining of memory loss who did not meet diagnostic criteria for DAT, 7% of nondemented major depressed subjects, and 7% of normal control subjects. Thus, the current investigation did not find the profile useful in differentiating DAT from other common disorders among elderly subjects. The authors conclude that a more comprehensive test battery remains the diagnostic tool of choice for differentiating DAT from other disorders.     

Age-related changes in the Wisconsin card sorting test performances of 8- to 11-year-old Turkish children

The leading aim of the present study was to examine developmental trends in performance on a computerized version of the Wisconsin Card Sorting Test (WCST) in Turkish children. Participants were 449 children aged between 8 and 11. Findings suggested that children's WCST scores improve with age, and developmental changes in executive functions follow distinct processes as assessed by different components of the WCST. The most striking improvement was noted in perseverative tendencies around age 10. This study also explored the effects of parental education on WCST performances of children, and maternal education emerged as the most important predictor.     

Detecting malingered performance with the Wisconsin card sorting test: a preliminary investigation in traumatic brain injury

The present study examined the classification accuracy of four potential Wisconsin Card Sorting Test malingering indicators (Bernard and Suhr formulas and two types of Unique responses). Participants were 89 traumatic brain-injury (TBI) patients assigned to malingering and nonmalingering groups on the basis of the Slick, Sherman, and Iversion (1999) criteria. Individual Sensitivities were greater than .33 with acceptable Specificity. Combined Sensitivity for two of the indicators was greater than.60. Overall, this study demonstrated three distinct approaches to the WCST used by probable malingerers. The clinical relevance of these findings and directions for future research are discussed.     

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.     

Administration accuracy of the wisconsin card sorting test

This investigation explored the types of examiner errors encountered during the administration of the Wisconsin Card Sorting Test (WCST). Seven novice and 7 experienced examiners contributed a total of 70 WCST protocols (35 novice and 35 experienced). Only 28.6% of the protocols were error free and novices made 50% more mistakes than experts. Although no differences emerged between the groups in terms of the type of errors committed, examiners did differ when recording card attributes. Specifically, novices had more problems than experts recording the attribute of “form”, while experts had greater difficulty accurately recording “number”. Response cards that matched a given stimulus card on two attributes were most prone to error. Finally, the recording errors changed test scores and, therefore, may influence test interpretation.     

Standard versus computerized administration of the wisconsin card sorting test

Abstract

Performance on the Psychological Assessment Resources computerized version of the Wisconsin Card Sorting Test (WCST)(PAR) was compared to that on the standard version of the WCST using 119 neurologically normal subjects from Spain. Subjects were randomly assigned to test versions and were administered either the standard or computerized WCST. The data indicate that these two test versions yield similar results in normals. Further, age- and education-corrected standard scores based on the North American standardization sample described in the WCST manual indicate that performance by Spanish subjects on measures of the WCST approximates that of North American subjects.     

Using the Wisconsin card sorting test to detect malingering: an analysis of the specificity of two methods in nonmalingering normal and patient samples

This study sought to examine the specificity of two sets of equations designed to differentiate honest from malingered performance on the WCST. Data were provided by several samples of nonmalingering normal college students and neurological patients. High false positive error rates were observed in most samples. It was argued that these equations performed poorly because they reflect valid WCST response profiles. The importance of learning to identify malingering on standard neuropsychological tests is recognized, and an alternative approach to identifying such patterns of malingered performance is proposed.