抑郁症患者威斯康星卡片分类测验和连续操作测验的初步研究

目的 :通过与精神分裂症患者和正常对照的比较 ,探讨抑郁症患者的执行功能和注意功能。方法 :采用威斯康星卡片分类测验 (WCST)、连续操作测验 (CPT) ,对 66例精神分裂症患者、 42例抑郁症患者和 5 0名对照者的执行功能和注意功能进行评估。结果 :两组患者WCST中的总测验次数、持续错误数和随机错误数均明显多于对照组 (P <0 0 1) ;其中精神分裂症组WCST的三项成绩明显差于抑郁症组 (P <0 0 1) ;无干扰刺激时 ,精神分裂症组的认对数明显差于抑郁症组和对照组 (P <0 0 1) ,而抑郁症组与对照组之间的差异无显著性 (P >0 0 5 ) ;有干扰刺激时 ,精神分裂症组与对照组的差异有显著性 (P <0 0 1) ,抑郁症组与其它两组的差异均无显著性 (P >0 0 5 )。结论 :抑郁症组有执行功能障碍 ,介于精神分裂症组和对照组之间 ;在抑郁症组中没有发现有明显的注意障碍。     

Wisconsin卡片分类测验用于酒依赖者认知障碍的研究

目的 :了解酒依赖者认知功能状况。方法 :对完成脱酒治疗的 3 7例男性酒依赖者和 3 4例男性非依赖者进行Wisconsin卡片分类测验 (WCST)评定。结果 :两组间分类数 (t =5 44 )、正确应答百分数 (t=4 75 )、错误应答数 (t=5 96)、持续应答数 (t=4 78)、持续性错误数 (t =4 70 )、概念化应答百分数 (t=)的比较均显示 ,酒依赖组成绩较非依赖组差 (P <0 0 1)。相关因素分析提示 ,饮酒时间与认知功能受损程度呈正相关 (r=0 3 2～ 0 3 8,P <0 0 5 )。结论 :酒依赖者存在认知功能缺损     

Is the Wisconsin Card Sorting Test a useful neurocognitive endophenotype?

The Wisconsin Card Sorting Test (WCST) has been utilized extensively as a measure of executive function and working memory and as a neurocognitive probe of prefrontal brain function. In studies of psychiatric illness--particularly schizophrenia--it has also been considered to be a cognitive vulnerability marker or endophenotype. Heritability is an important criterion for an endophenotype, but the very few studies of the heritability of the WCST have yielded inconsistent results. The goal of this study was to investigate the extent to which genetic and environmental factors influence WCST performance in a large adult twin sample. A computerized WCST was administered to 660 middle-aged male twins (170 monozygotic pairs and 160 dizygotic pairs). Polychoric intrapair correlations for six WCST scores were compared between MZ and DZ twins in order to assess heritability. Correlations were relatively low and there were no significant MZ-DZ differences. To our knowledge, this is the largest twin study of the WCST to date. There was no evidence for heritability of the WCST in this midlife adult sample. The WCST remains a valuable research tool, and we do not think that one should conclude from these results that genetic influences on frontal-executive function are unimportant. Rather, we believe that our results suggest that some properties of this particular test make it undesirable for use as an endophenotype.     

Comparison of the Wisconsin Card Sorting Test and the Halstead Category Test

Correlational comparisons of the Wisconsin Card Sorting Test and the Halstead Category Test (Pendleton & Heaton, 1982) are criticized as inadequate to assess the degree to which these two tests call upon the same cognitive processes. Asking patients to "think aloud" while performing on the tests is recommended as a more direct approach to understanding the cognitive components of the tests. Some results of analysis of such think-aloud protocols are presented that suggest the differences and areas of overlap of the two tests.     

Latent structure of the Wisconsin Card Sorting Test in a clinical sample.

The aims of this study were to: (a) examine the consistency of the published Wisconsin Card Sorting Test (WCST) factor structures; (b) determine the factor structure of the WCST in a large, heterogeneous sample; and (c) compare the WCST factor analytically with other neuropsychological procedures. Two WCST factors (concept formation/perseveration and Failure-to-Maintain-Set [FMS]) were consistently reported in the literature. Our analysis of data from 473 clinical cases replicated the two factors previously reported and revealed a third on which nonperseverative errors (NPE) was the sole salient variable. This pattern was maintained in three of four diagnostically distinct subgroups. These factors are potentially clinically meaningful, with each seeming to reflect one of three qualitatively different performance styles. In the construct validation factor analysis, WCST scores loaded independently of other neuropsychological variables, indicating that the WCST contributes uniquely to neuropsychological evaluation. Nevertheless, despite the rational interpretation of the factors, the cognitive processes underlying WCST performance remain poorly understood. Future directions for the application of these factor analytic findings are discussed.     

威斯康星卡片分类测验常用指标的稳定性分析

目的 :分析威斯康星卡片分类测验 (WCST)在正常人、精神分裂症、神经症和酒依赖患者中常用指标的稳定性。方法 :分别对 45名正常人 ,76例精神分裂症患者 (阳性症状为主 3 9例 ,阴性症状为主3 7例 ) ,10例神经症和 9例酒依赖患者进行两次WCST测试 ,间隔 1周 ;对两次测查的各指标进行配对t -检验和相关分析。结果 :各疾病组的反应持续性及概念形成的指标的稳定性良好 ,t检验两次分值的差异无显著性 (P >0 0 5 ) ;正常组两次分值差异有显著性 (P <0 0 5 ) ,第二次成绩好于第一次 ,与学习效应有关。两次测验各指标的相关系数均值为 0 60 6。结论 :WCST在正常人和上述疾病人群使用时 ,持续性错误应答数和完成第一个分类所需应答数的稳定性良好 ,可考虑用作该测查的判定指标     

Major depressives' and dysthmics' performance on the Wisconsin Card Sorting Test

Despite awareness that depression may affect performance on commonly used neuropsychological tests, little research has been conducted on the relative impact of severity and type of depression on higher problem-solving ability. Major depressives (n = 13), dysthymics (n = 17), and non-psychiatric comparison subjects (n = 18) were administered the Wisconsin Card Sorting Test (WCST). Although diagnostic category was related only marginally to some WCST measures after controlling for intellectual function, depressive symptom severity emerged as an independent predictor of Total Errors, Perseverative Responses, and Failure to Maintain Set. These findings lend support to the suggestion that neuropsychological test batteries should include assessment for depression and suggest that even relatively mild depression may affect WCST scores.     

The role of attention in Wisconsin Card Sorting Test performance.

The present study sought to test the hypothesis that the second factor (consisting of Failure-to-Maintain-Set and other scores) found in two recent factor analyses of the Wisconsin Card Sorting Test reflects attentional function. The effect of color overlays (an experimental manipulation known to influence neural systems linked to attention) was examined in 17 normal control and 14 attention-disordered children (ages 8 to 12). Group and Color main effects were found for Factor 1 (which consists largely of measures of perseveration) and a Color main effect was observed for Factor 2. The Color effect for Factor 2 supported the contention that this factor reflects attentional processes. A hypothesis concerning the relationship between problem solving and attention on the WCST is offered and a means for testing it is discussed.     

Developmental and Neuropsychological Perspectives on the Wisconsin Card Sorting Test in Children

The purpose of this study was to advance our understanding of the Wisconsin Card Sorting Test (WCST) as a measure of a set-shifting component of neuropsychological executive function among children by investigating the level of difficulty posed by the order of administering number (vs. shape and color) as a sorting criterion in the test. A total of 196 participants at three different ages groups (6, 11–12, and 18–19 yrs.) were administered the standard or a modified version of the WCST. Results revealed several age-related trends: (a) increases in the number of categories completed, (b) increases in test efficiency, and (c) differences in task difficulty as a function of the order in which the number sorting criterion was administered in the test. Implications of these findings are discussed in terms of the construct validity of the WCST for young children.     

Developmental and neuropsychological perspectives on the Wisconsin Card Sorting Test in children

The purpose of this study was to advance our understanding of the Wisconsin Card Sorting Test (WCST) as a measure of a set-shifting component of neuropsychological executive function among children by investigating the level of difficulty posed by the order of administering number (vs. shape and color) as a sorting criterion in the test. A total of 196 participants at three different ages groups (6, 11-12, and 18-19 yrs.) were administered the standard or a modified version of the WCST. Results revealed several age-related trends: (a) increases in the number of categories completed, (b) increases in test efficiency, and (c) differences in task difficulty as a function of the order in which the number sorting criterion was administered in the test. Implications of these findings are discussed in terms of the construct validity of the WCST for young children.     

Comparison of two short forms of the Wisconsin Card Sorting Test.

Two short forms of the Wisconsin Card Sorting Test (WCST) were evaluated. The WCST-64 consists of one deck of 64 cards; derived measures are number of categories obtained and number of perseverative responses. The WCST-3 includes measures of the number of cards required to complete three categories and the number of perseverative responses. WCST protocols from 37 schizophrenics, 20 temporal lobe epileptics, 11 patients with probable SDAT, and 54 normal controls, were scored using the three methods. Pearson correlations between WCST and WCST-64 scores ranged from.70 to.91. while correlations between WCST and WCST-3 were somewhat lower (.36 to.82). The WCST-64 was superior to the WCST-3 in agreement with the full WCST. The WCST-3 tended to underestimate the number of perseverative responses on the full WCST. Although the use of a short form reduces reliability, the WCST-64 appears to be an acceptable alternative when administration of the full WCST is not possible.     

Modified Wisconsin Card Sorting Test: proposal of a supplementary scoring method.

To assess categorizing ability, we propose a new scoring criterion for the MCST, the "categorizing efficiency", taking into account the number of cards used by the subject to complete a maximum of six categories. The advantage of adding that parameter to traditional ones is evaluated in a small population of normal children and adults and those affected with pathologies.     

Order effects in the administration of the Booklet Category Test and Wisconsin Card Sorting Test.

In order to evaluate the possibility of significant order effects, the Booklet Category Test and Wisconsin Card Sorting Test were administered in counterbalanced order to 20 psychiatric patients, 36 neurological patients, and 30 healthy, elderly individuals. Administering the Booklet Category Test first improved scores on the Wisconsin Card Sorting Test, although not to a statistically significant degree. Unexpectedly administering the Wisconsin Card Sorting Test first resulted in poorer scores on the Booklet Category Test. The results are discussed in terms of future research and clinical implications.     

Latent structure of the Wisconsin Card Sorting Test: a confirmatory factor analytic study.

The present study represents the first large scale confirmatory factor analysis of the Wisconsin Card Sorting Test (WCST). The results generally support the three factor solutions reported in the exploratory factor analysis literature. However, only the first factor, which reflects general executive functioning, is statistically sound. The secondary factors, while likely reflecting meaningful cognitive abilities, are less stable except when all subjects complete all 128 cards. It is likely that having two discontinuation rules for the WCST has contributed to the varied factor analytic solutions reported in the literature and early discontinuation may result in some loss of useful information. Continued multivariate research will be necessary to better clarify the processes underlying WCST performance and their relationships to one another.     

Wisconsin Card Sorting Test with children: a meta-analytic study of sensitivity and specificity

More and more frequently the presence of executive function deficits appears in the research literature in conjunction with disabilities that affect children. Research has been most directed at the extent to which executive function deficits may be implicated in specific disorders such as attention deficit hyperactivity disorder (ADHD); however, deficits in executive function have been found to be typical of developmental disorders in general. The focus of this paper is to examine the extent to which one frequently used measure of executive function, the Wisconsin Card Sorting Test (WCST), demonstrates sensitivity and specificity for the identification of those executive function deficits associated with ADHD as well as its use with other developmental disorders through meta-analytic methods. Evidence of sensitivity of the WCST to dysfunction of the central nervous system is reviewed. Effect sizes calculated for all studies compared groups of children on differing variables of the WCST. The results of this meta-analysis suggest that across all of the studies, individuals with ADHD fairly consistently exhibit poorer performance as compared to individuals without clinical diagnoses on the WCST as measured by Percent Correct, Number of Categories, Total Errors, and Perseverative Errors. Notably, other various clinical groups performed more poorly than the ADHD groups in a number of studies. Thus, while impaired performance on the WCST may be indicative of an underlying neurological disorder, most likely related to frontal lobe function, poor performance is not sufficient for a diagnosis of ADHD. Implications for further research are presented.     

Use of Wisconsin Card Sorting Test short forms with school-age children.

Short forms of the Wisconsin Card Sorting Test (WCST) have been developed and studied in adult populations, however studies addressing their use in children are lacking. This study compared the full WCST to two short forms in a sample of 174 school-age children who were referred for neuropsychological evaluation. Multiple regression was used to predict standard scores (SSs) on the full WCST. Percent scores were obtained, and normative data from the WCST manual was then used to obtain SSs. We found that scores from the short forms were significantly correlated with corresponding scores on the full WCST, however a high proportion of children obtained short form SSs, which differed significantly from the SSs obtained on the full WCST. It is recommended that clinicians use the full WCST with children, unless at least four categories are reached in the first deck.     

Polymorphisms of the Fyn kinase gene and a performance on the Wisconsin Card Sorting Test in schizophrenia

The glutamatergic system has been implicated in the pathogenesis and prefrontal cortex dysfunctions in schizophrenia. The Src-family tyrosine kinase Fyn plays a key role in the interaction between brain-derived neurotrophic factor and glutamatergic receptor N-methyl-D-aspartate, in prefrontal cortex. We estimated an association between three polymorphisms of Fyn gene and performance on the Wisconsin Card Sorting Test, measuring prefrontal cortex functions, in 188 schizophrenic patients. Patients with T/T genotype of IVS10+T/C polymorphism and T/T genotype of Ex12+894T/G polymorphism made significantly less perseverative errors in the Wisconsin Card Sorting Test compared with patients with remaining genotypes, and obtained numerically better results in other Wisconsin Card Sorting Test domains. No significant differences in Wisconsin Card Sorting Test performance were found as to -93 A/G polymorphism. The main finding of the study is showing a relationship between polymorphisms of the Fyn gene, related to the function of glutamatergic system, and a performance on neuropsychological test of prefrontal cortex activity in schizophrenic patients.     

精神分裂症症状与威斯康星卡片分类测验成绩的相关性

目的:探讨发作期的精神分裂症患者症状与威斯康星卡片分类测验成绩的相关性.方法:对新近发作、一月内未服用精神药物的精神分裂症40例住院患者和32例正常人进行了威斯康星卡片分类测验(WCST).用阳性和阴性症状量表(PANSS)对精神病患者进行评定,并对阳性、阴性和解体症状因子和威斯康星卡片分类测验结果作相关分析.结果:精神分裂症患者WCST操作较正常人差,差异有显著性(P＜0.05).阴性症状因子和解体症状因子与WCST操作存在相关性,阳性症状因子与WCST操作不相关.结论:精神分裂症患者在执行功能和概念化水平方面存在缺陷,其中解体和阴性症状可能与额叶功能障碍相关,前者相关性可能更大.