A Comparative Assessment of Comprehensive Trail Making Test and Wisconsin Card Sorting Test Among Alcohol Dependence Patients

@#Introduction: Alcohol, when used frequently, accelerates the ageing process, causes brain damage, and results in a reduced volume of grey and white matter, leading to frontal lobe abnormalities. The neurotoxicity resulting from alcohol overuse affects the higher functions of the brain. This study aimed to evaluate the effect of alcohol dependence on the executive functioning of the brain. Methods: This study was carried out as a case-control study among 60 patients with alcohol dependence and 60 controls. Assessment of executive function was carried out using the Comprehensive trail-making test (CTMT) and the Wisconsin card sorting test (WCST). Comparison between the alcohol dependence group and normal healthy controls were calculated using the Mann-Whitney U test as data followed a non-parametric distribution. Results: The mean age of the participants among the cases and controls was 38.3±5.5 years and 37.8±5.4 years, respectively. The results showed a significant difference in both WCST and CTMT between cases and controls (p<0.05). Conclusion: This study concludes that there was an impaired performance in executive functions in alcohol- dependence patients in early abstinence compared to normal controls showing frontal lobe impairment in alcohol-dependence patients.

Visual-motor maturity and executive functions in schoolchildren / Maturidade visomotora e funções executivas em escolares / Madurez visomotora y funciones ejecutivas en escolares

Visual-motor maturity and executive functions are closely related in the child development process. This study aimed to investigate the relation between visual-motor abilities and executive functions in 83 healthy children between 7 and 10 years old. The tools used were the Bender Gestalt Visual-Motor Test - Gradual Scoring System (B-GSS), Wisconsin Card Sorting Test (WCST), Raven's Progressive Matrices (RPM), and Rey-Osterrieth Complex Figure (ROCF). The correlation between the B-GSS and WCST scores was significantly negative (r = -.23, p < .033), while ROCF variables, such as Total Memory and Total Copy, had a moderate, significant correlation with total B-GSS score (r = -.55, p < .001; r = -.44, p < .001, respectively). The results empirically show the relation between executive functions and visual-motor maturity and are discussed in face of developmental neuropsychology.

A maturidade visomotora e as funções executivas estão intimamente relacionadas no processo de desenvolvimento infantil. O objetivo deste estudo foi investigar a relação entre habilidades visomotoras e funções executivas em 83 crianças hígidas, de 7 a 10 anos. Os instrumentos utilizados foram Teste Gestáltico Visomotor de Bender - Sistema de Pontuação Gradual (B-GSS), Teste Wisconsin de Classificação de Cartas (WCST), Matrizes Progressivas de Raven (RPM) e Rey- Osterrieth Figura Complexa Test (ROCF). A correlação entre os escores de B-GSS e WCST foi negativa e significativa (r = 0,23, p < 0,033) e variáveis do ROCF, como Cópia Total e Memória Total apresentaram correlação moderada e significativa com o escore total do B-GSS (r = -0,55, p < 0,001; r = -0,44, p < 0,001, respectivamente). Os resultados evidenciam empiricamente a relação entre funções executivas e maturidade visomotora e são discutidos à luz da neuropsicologia do desenvolvimento.

La madurez visual-motora y las funciones ejecutivas están estrechamente relacionados en el proceso de desarrollo del niño. El objetivo de este estudio fue investigar la relación entre habilidades visomotoras y funciones ejecutivas en 83 niños sanos, de 7-10 años. Los instrumentos utilizados fueron Prueba Gestáltica Visomotora de Bender - Sistema de Puntuación Gradual (B-GSS), Prueba Wisconsin de Clasificación de Cartas (WCST), Matrices Progresivas de Raven (RPM) y Prueba Rey- Osterrieth Figura Compleja (ROCF). La correlación entre las puntuaciones B-GSS y WCST fue negativa y significativa (r = 0,23, p < 0,033) y ROCF variables, como Copiar y Memoria Total mostraron correlación moderada y significativa con la puntuación total de la B-GSS (r = -0,55, p < 0,001; r = -0,44, p < 0,001, respectivamente). Los resultados demuestran empíricamente la relación entre las funciones ejecutivas y la madurez visomotora y se discuten a la luz de la neuropsicología del desarrollo.

Desempenho de idosos com e sem sintomas depressivos no WCST-64 / Elderly performance with and without depressive symptoms on the WCST-64 / Rendimiento de ancianos con y sin síntomas depresivos em WCST-64

É natural que idosos apresentem dificuldades nas funções executivas mesmo nos estágios iniciais de um quadro depressivo, que podem ser detectadas pelo Teste Wisconsin de Classificação de Cartas (WCST). O objetivo do presente estudo foi comparar o desempenho de idosos com e sem sintomas depressivos no WCST, versão abreviada de 64 cartas (WCST-64). A amostra foi composta por 153 idosos, divididos em dois grupos: com e sem sintomas depressivos. Os grupos foram pareados em relação à idade, escolaridade e escore no Mini Exame do Estado Mental (MEEM). Utilizou-se uma ficha de dados sociodemográficos, a Escala de Depressão Geriátrica, o MEEM e o WCST-64. Observou-se que, na medida em que os sintomas de depressão se intensificavam, aumentavam o total de erros, as respostas perseverativas e os erros perseverativos no WCST-64. Os resultados mostraram que idosos que apresentam sintomas depressivos tiveram pior desempenho no WCST-64, quando comparados com aqueles sem sintomatologia depressiva.

It is natural that the elderly would present difficulties in executive functions even in the early stages of a depressive condition, which may be detected by the Wisconsin Card Sorting Test (WCST). This study aimed to compare the performance of elderly people with and without depressive symptoms on the shortened version of the WCST, containing 64 cards (WCST-64). The sample consisted of 153 elderly subjects who were divided into two groups: with and without depressive symptoms. The groups were matched in terms of age, educational level and score on the Mini Mental State Examination (MMSE). A Socio-Demographic Data Sheet, the Geriatric Depression Scale, MMSE and the WCST-64 were used. It was observed that, to the extent that depressive symptoms intensified, total errors, perseverative responses and perseverative errors increased on the WCST-64. The results showed that elderly people who present depressive symptoms had poorer performance on the WCST-64, compared to those without depressive symptoms.

En las etapas iniciales de un cuadro de depresión es natural que los ancianos presenten dificultades en las funciones ejecutivas, que pueden ser detectadas por el Test de Wisconsin de Clasificación de Cartas (WCST). El objetivo de este estudio fue comparar el desempeño de las personas mayores con y sin síntomas de depresión en el WCST, versión abreviada de 64 cartas (WCST-64). La muestra estuvo constituída por 153 ancianos divididos en dos grupos: con y sin síntomas de depresión. Los grupos fueron comparados por edad, nivel educativo y resultado en el Mini Mental State Examination (MMSE). Se utilizó una ficha de datos sociodemográficos, la Escala de Depresión Geriátrica, MMSE y el WCST-64. A medida que los síntomas de depresión se intensificaban, aumentaba el número total de errores, respuestas perseverativos y errores perseverativos en el WCST-64. Los resultados mostraron que los ancianos que presentan síntomas de depresión tuvieron peor desempeño en el WCST-64, comparados con aquellos que no poseían esos síntomas.

Executive Function Deficits in Patients with Brain Injury / 中国康复理论与实践

Objective To investigate the characteristics of executive function in patients with brain injury. Methods From March 1st, to June 30th, 2015, 44 patients with brain injury were investigated with Wisconsin Card Sorting Test (WCST), the indexes including Responses Answer, Categories Completed, Correct Responses, Errors Responses, Trials to Complete First Category, Percent Conceptual Level Respons-es Percentage, Perseverative Responses Errors, Nonperseverative Responses Errors, Failure to Maintain Set, and Learning to Learn. Results The abnormal rates were the most in Nonperseverative Responses Errors and Percent Conceptual Level Responses Percentage (61.36%), and then in Responses Answer/Categories Completed/Correct Responses (59.09%), Correct Responses (43.18%), Trials to Complete First Category (38.64%), Perseverative Errors (29.51%), Learning to Learn (25.00%), and Failure to Maintain Set (9.09%). The patients with trau-matic brain injury were different from those with stroke in Responses Answer, Errors Responses, Perseverative Responses Errors, Catego-ries Completed, Percent Conceptual Level Responses Percentage, and Learning to Learn (Z>2.444, t>2.156, P<0.05). The patients injured in frontal lobe were different from those in other areas in Perseverative Responses Errors (t=2.595, P=0.015). Conclusion Executive function damaged generally in patients with brain injury, which related to concentration, abstract, shifting attention, working memory, etc. The frontal lobe damage may associate with the disorder of shifting attention.

Detecção de simulação com o uso do wisconsin card sorting test e do trail making test / Detection of malingering using the wisconsin card sorting test and the trail making test

Neste trabalho, tentamos identificar índices de simulação na avaliação neuropsicológica forense, através da avaliação dos padrões de resposta em provas neuropsicológicas. A amostra foi constituída por 56 sujeitos com traumatismo crânioencefálico. Todos se encontravam numa situação de possível recompensa monetária por incapacidade. Utilizamos os instrumentos Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), Inventário de Sintomas Psicopatológicos (BSI), e a grelha de análise dos autos do processo. Cerca de 30% da amostra enquadrou-se no grupo de prováveis simuladores. Essa porcentagem é congruente com a literatura. Verificou-se uma grande homogeneidade entre os indivíduos com e sem indicadores de simulação, a nível sintomatológico e características sócio-demográficas, o que reforça a necessidade de desenvolvimento de métodos eficazes na detecção da simulação.

The objective of this study was to identify indicators of malingering in forensic neuropsychological assessment by identifying response patterns in neuropsychological tests. The sample was composed by 56 subjects diagnosed with a cranioencephalic trauma. All subjects were in a situation of monetary reward if incapacity was proven. The instruments used were the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), the Brief Symptom Inventory (BSI), and a legal process data file. Approximately 30% of the studied sample was identified as probable malingerers. This percentage is consistent with the literature. We identified a high level of homogeneity of psychological symptoms and socio-demographic features in the group of subjects with indicators of malingering and in the group without such indicators. These results reinforce the necessity to develop efficient methods to detect malingering.

The Val66Met polymorphism at the BDNF gene does not influence Wisconsin Card Sorting Test results in children and adolescents with bipolar disorder

OBJECTIVES: To assess the role of the Val66Met polymorphism at the brain-derived neurotrophic factor (BDNF) gene on the performance of children and adolescents with bipolar disorder [juvenile bipolar disorder (JBD)] on the Wisconsin Card Sorting Test (WCST). METHODS: Children and adolescents were assessed by the K-SADS-PL and a clinical evaluation for BD and comorbid conditions. Manic and depressive symptoms were assessed with the Young Mania Rating Scale and the Children Depression Rating Scale - Reviewed. The Val66Met polymorphism at the BDNF was genotyped from a blood sample. Patients' IQ and executive functions were assessed by a standard cognitive flexibility test (WCST). RESULTS: Fifty-three subjects were included in the study. No significant difference was observed between the Val/Val and Val/Met+Met/Met groups on any WCST scores in the MANCOVA (F48,5 = .76; p = .59; Perseverative Errors, p = .66; Nonperseverative Errors, p = .58; Categories Completed, p = .34; Attempts to Reach First Category, p=.64; and Percentage of Conceptual Level Responses, p = .99). CONCLUSIONS: Our findings from this sample of children and adolescents with BD do not replicate results from studies of adults and suggest the existence of differences in the neurobiology of this disorder across the life cycle. Investigations of larger samples are necessary to confirm these data.

Adolescent Normative Data on Simple Neuropsychological Tests for Cognitive Behavioral Disorders / The Japanese Journal of Rehabilitation Medicine

Although the Trail Making Test (TMT) Part A, B, Wisconsin Card Sorting Test-KFS version (WCST-KFS) and Miyake's Verbal Paired-Associate Learning Test (MVPLT) are simple tools to evaluate cognitive dysfunction in patients with traumatic brain injury, there is very little normative data for young persons available in Japan. Therefore, we evaluated 124 healthy persons who were from 15 to 30 years old with the three assessment tools. Median numbers of TMT Part A and Part B were 23.8 seconds and 49.0 seconds, respectively. Median numbers of achieved categories, perseverative errors of the Nelson type, and difficulties of maintaining set in the WCST-KFS were 5, 2 and 0, respectively. Median numbers of correct answers for related and unrelated pairs of MVPLT were 10 and 9 at the third trial, respectively. TMT Part B and perseverative errors of the Nelson type had a negative and weak correlation with age. And related pairs of MVPLT at the first trial had a positive and weak correlation with age. The normative values obtained in this study would be a useful standard for clinical assessments and acknowledgment of disabilities.

Evaluación de trastorno de personalidad a partir de estudios de Neuro-SPECT / Assessment of personality disorder by means of NeuroSPECT

We report on functional imaging results in 24 patients of Personality Disorder (P.D.) performed with NeuroSPECT by means of Tc99m HMPAO, in Basal state and during frontal cortical activation by means of the Wisconsin Card Sorting Test. Results demonstrate that we can make the diagnosis of P.D. when we detect significant hypoperfusion (- 2 Stand/ Deviations below the normal mean for the same age group) in the subgenual area (Area 25 of Brodmann) and in Area 24 of Brodmann, the anterior cingulated gyrus. Both areas are paradoxically more hypoperfused during the Wisconsin Test. Among patients diagnosed with P.D. NeuroSPECT can distinguish between patients of Cluster B from the ones from Cluster C in both Basal and Activation State, while Cluster A from B could be differentiated only in Basal State. On the other hand Motor Impulsivity patients could be differentiated from the Cognitive group due to paradoxical hypoperfusion in motor areas 1,2,3, and 4 of Brodmann. While the number of patients studied appears reduced these results demonstrate the capability of diagnosing Personality Disorder and also the capability to improved understanding of the subgroups of this Disorder.

Se comunican los resultados de 24pacientes con Trastornos de Personalidad estudiados mediante Neuro-SPECT HMPAO Tc99m, técnica de imagenología funcional cerebral en condicionas basales y durante activación de la corteza frontal ejecutiva mediante la prueba de Wisconsin. Los resultados demuestras fehacientemente que el diagnóstico de Trastorno de Personalidad se basa en la presencia de disminución de perfusión (- 2 Desviaciones Standard bajo el promedio normal para el mismo grupo etario) en el Cingulado Anterior y región subgenual, exageradas paradojalmente durante la prueba de Wisconsin. Dentro de los pacientes demostrados como Trastorno de Personalidad, Neuro-SPECT es capaz de distinguir los pacientes del Cluster B de los del Cluster C en ambos estados de medición,(Estado Basal vs Prueba de Wisconsin) mientras los Cluster A y B fueron diferenciables en estado Basal solamente. Por otra parte, la Impulsividad Motora pudo ser distinguida de la Cognitiva por la hipoperfusión paradojal de las áreas frontales de Brodmann motoras 1,2,3 y 4. Si bien el número total de pacientes reportados en este trabajo, es relativamente limitado, abre posibilidades interesantes a la imagenología funcional cerebral en estado basal y durante activación mediante la prueba de Wisconsin para el diagnóstico y exploración del Trastorno de Personalidad.

Performance of a Brazilian sample on the computerized Wisconsin Card Sorting Test

The computerized version of the Wisconsin Card Sorting Test (WCST) is based on the same normative data developed previously for the manual version. However, equivalence of the measures of both versions is controversial. This study investigated the performance of a Brazilian student sample with subjects aged 6-15 years in the computerized version of the WCST. As a result of the analyses, the study pointed out that type of school (public or private) was significant in almost all measures and also that age and gender effects were similar to those previously described in the manual version. These results showed that the computerized WCST may not be free of cultural and socioeconomic influences and that the validation and standardization of this version is warranted.

Executive Function in Attention-Deficit/Hyperactivity Disorder : Relationship of Comprehensive Attention, Stoop Color-Word, Children's Color Trails, and Wisconsin Card Sorting Tests / 신경정신의학

OBJECTIVES: The objective of this study was to investigate the relationship of the Comprehensive Attention (CAT), Stoop Color-Word (STROOP), Children's Color Trails (CCTT), and Wisconsin Card Sorting Tests (WCST) in evaluating the executive function in attention-deficit/hyperactivity disorder (ADHD). METHODS: A total of 197 children and adolescents with ADHD (mean age 10.4+/-3.2 years, 173 boys) and 62 without ADHD (mean age 11.8+/-3.5 years, 48 boys) have completed the Swanson, Nolan, and Pelham-IV questionnaire (SNAP-IV), and also the CAT, STROOP, CCTT and WCST. RESULTS: The selective, sustained, divided attention and Flanker tests of the CAT significantly discriminated between the ADHD and non-ADHD groups. The results of the CCTT were significantly correlated with the results of the CAT only in the ADHD group. The results of the STROOP were associated with selective, sustained, divided attention and Flanker tests. The results of the WCST were significantly correlated with the scores of the Working Memory subtest of the CAT only in the non-ADHD group. CONCLUSION: The results of this study suggest that the CAT has strong discriminant validity and moderate concurrent validity. The CAT could be a tool for the evaluation of the executive function of ADHD.

Cognição e Diabetes Mellitus tipo 2 em idosos / Cognition and type 2 diabetes in the elderly

Estudos sobre o status cognitivo em idosos tem tido maior destaque nas pesquisas atuais, identificando prejuízos, principalmente quando uma doença crônica encontra-se presente. A hiperglicemia pode ser um fator significativo para incidência de Alzheimer e uma causa secundária de demência. A Diabetes Mellitus Tipo 2 (DM2) está associada a déficits cognitivos e funcionais, e um dos instrumentos que pode ser utilizado para avaliar funções executivas é o WCST. O objetivo foi avaliar os prejuízos cognitivos em idosos com DM2. Participaram do estudo 254 idosos de ambos os sexos, com idade igual ou superior a 60 anos, sendo 44 idosos com diagnóstico de DM2 e 210 idosos do grupo controle da população geral. O delineamento foi de um estudo quantitativo e transversal. Os instrumentos utilizados foram: Ficha de Dados Sociodemográficos,WCST, MEEM, BDI, BAI e GDS. Os subtestes Vocabulário, Códigos, Dígitos e Cubos da WAIS-III. Os resultados mostraram que houve diferença significativa no desempenho de idosos com DM2, quando comparados com os idosos do grupo controle em quatro descritores do WCST, indicando prejuízos.

Teste Wisconsin de classificação de cartas: uma revisão sistemática de 1952 a 2009 / The Wisconsin card sorting test: systematic review (1952-2009)

O WCST é um teste neuropsicológico de resolução de problemas. Os critérios de resolução são inicialmente desconhecidos e mutantes, exigindo do respondente uma compreensão dos princípios lógicos do problema. Diante da relevância do WCST na avaliação neuropsicológica, este trabalho descreve uma revisão bibliográfica dos artigos que fazem referência ao teste. Realizou-se uma busca bibliográfica em três bases internacionais: Medline, Science Direct, PsycINFO, usando como descritor o unitermo "WCST". Foram identificados 1.076 artigos científicos, desde 1952 até 2009, observando-se significativo aumento das publicações com WCST a partir de 1993, com proporções crescentes a cada ano. Os países que mais publicaram sobre este teste neuropsicológico foram Holanda, Estados Unidos e Reino Unido, sendo os principais descritores das revistas que publicaram sobre o WCST: Psiquiatria, Neuropsicologia, Psicologia e Cérebro. O presente trabalho demonstra, ainda, que os periódicos que publicaram 10 ou mais artigos sobre o WCST têm elevado fator de impacto (JCR).

The WCST is a problem-solving, neuropsychological test, with solving criteria initially unknown and mutant. Such task requires the respondent to understand the logical principles of the proposed problem. Considering the relevance of such test for neuropsychological assessment, this present study describes a bibliographic review of articles mentioning the WSCT. Such articles were searched for in three international databases (Medline, Science Direct and PsycINFO), with WSCT used as the descriptor. From 1952 to 2009, 1076 scientific articles were indentified, with a significant increase of publications from 1993 on. The countries with most studies on the WSCT were the Netherlands, USA, and UK. The main descriptors of journals that published these studies were Psychiatry, Neuropsychology, Psychology and Brain. This present study also demonstrates that the journals that published 10 or more articles on WSCT show an elevated impact factor (JCR).

A ~1H-MRS study of the prefrontal lobe in male schizophrenics / 中国神经精神疾病杂志

Objective To identify the metabolic alterations in the prefrontal lobe in male patients with schizophrenia by proton magnetic resonance spectroscopy (~1H-MRS), and to study the relationship between metabolic alterations and executive function. Methods The study was conducted in 26 male schizophrenics with medicine-free for at least 7 days and 28 normal controls. A multi-voxel ~1H-MRS on the prefrontal lobe was performed in all the subjects within 24 hours of admission. Wisconsin Card Sorting Test (WCST) was used to evaluate executive function. The NAA, Cho and Cr were measured and the ratios of NAA/Cr, Cho/Cr and NAA/(Cho+Cr) were calculated. Results Compared with normal controls, the patients demonstrated significantly lower NAA/Cr ratio (t=2.93, P<0.01) in the left prefrontal lobe and poorer performance in WCST (P<0.05). The NAA/Cr ratio in the left prefrontal lobe was positively associated with the responses errors and the perseverative errors of WCST(r=0.45, P＜0.05; r=0.47, P＜0.05)and negatively associated with the categories completed and conceptual level responses(r=-0.54, P＜0.01; r=-0.56, P＜0.01). Conclusions Abnormalities in neuronal function and/or integrity are present in the left prefrontal lobe of male schizophrenics. The neuron damage in the left prefrontal lobe of male schizophrenic may be the primary cause of cognition dysfunction.

Follow-up study on executive function of frontal lobe in schizophrenics with and without homicide behaviors / 中华行为医学与脑科学杂志

Objective To explore the characteristics of executive function and the changes of executive function in schizophrenics with and without homicide behaviors during follow-up.Methods Twenty-two schizophrenics with homicide behaviors (homicide group)and twenty-one schizophrenics without homicide behaviors (without-homicide group) were examined by Wisconsin Card Sorting Test(WCST),and followed up 3 months.All patients'clinical symptoms were evaluated by positive and negative symptom scale(PANSS)at the same time.Re-suits (1)At the baseline,homicide group showed higher score in complete lst category(R1st)than without-homicide group((28.64±32.73)vs(11.71±8.10),P=0.027)and no difference on other index.(2)No difference on WCST in homicide group between at the baseline and at three-month treatment (P>0.05).Without-homicide group at the baseline showed higher score in conceptual level responses than that of at three-menth treatment((46.80±27.04)vs.(65.02±21.32),P=0.048).(3)Homicide group at three-month treatment showed lower scores in positive scale,general psychopathology scale,PANSS total,thought disorder,activation,paranoid,aggressive than that of at the baseline(P<0.05).Without-hemicide group at three-month treatment showed lower scores in positive scale,negative scale,general psychopathology scale,PANSS total,thought disorder,activation,aggressive than that of at the haseline(P<0.01).(4)At the baseline,there was no correlation between WCST and PANSS in homicide group,only R1st score correlated with activation positively in without-homicide group(P<0.05).At three-month treatment, homicide group showed the score of failure to maintain set negatively correlated with negative scale,PANSS total, and aggressive(P<0.05).Conclusions Schizophrenics with homicide and without-homicide behaviors show executive function deficits.Homicide group shows more deficits in abstraction capacity than without-homicide group.

Impairment of Concept Formation Ability in Children with ADHD: Comparisons between Lower Grades and Higher Grades

OBJECTIVE: We investigated executive functions (EFs), as evaluated by the Wisconsin Card Sorting Test (WCST), and other EF between lower grades (LG) and higher grades (HG) in elementary-school-age attention deficit hyperactivity disorder (ADHD) children. METHODS: We classified a sample of 112 ADHD children into 4 groups (composed of 28 each) based on age (LG vs. HG) and WCST performance [lower vs. higher performance on WCST, defined by the number of completed categories (CC)] Participants in each group were matched according to age, gender, ADHD subtype, and intelligence. We used the Wechsler intelligence Scale for Children 3rd edition to test intelligence and the Computerized Neurocognitive Function Test-IV, which included the WCST, to test EF. RESULTS: Comparisons of EFs scores in LG ADHD children showed statistically significant differences in performing digit spans backward, some verbal learning scores, including all memory scores, and Stroop test scores. However, comparisons of EF scores in HG ADHD children did not show any statistically significant differences. Correlation analyses of the CC and EF variables and stepwise multiple regression analysis in LG ADHD children showed a combination of the backward form of the Digit span test and Visual span test in lower-performance ADHD participants significantly predicted the number of CC (R2=0.273, p<0.001). CONCLUSION: This study suggests that the design of any battery of neuropsychological tests for measuring EF in ADHD children should first consider age before interpreting developmental variations and neuropsychological test results. Researchers should consider the dynamics of relationships within EF, as measured by neuropsychological tests.

Assessing executive functions in older adults: a comparison between the manual and the computer-based versions of the Wisconsin Card Sorting Test

Executive functions (EF) are a group of high-level cognitive processes that control and direct lower-level abilities in order to produce goal-directed behavior. Because these functions are a multidimensional entity, they can be assessed using different tests. One of the tests often used to evaluate EF is the Wisconsin Card Sorting Test (WCST). The WCST is a task that involves hypothesis testing, identification of concepts, resistance to interference, switching categories, and inhibition. Two versions of the task have been used in neuropsychological testing, but little is known about their equivalence. In this study, we investigated the performance of two groups of elderly people in two versions of the task: manual (cards) and computer-based. Fifty-four healthy elderly participants took part in this study; half of the sample was assessed with the computer-based version of the WCST, while the other half performed the manual version. There were no differences between the two versions of the task in our sample of elderly participants (total number correct, perseverative errors, percent conceptual level responses, and number of categories completed). In this sense, the results provide evidence for the equivalence of both versions in the assessment of EF in healthy elderly participants.

O desempenho de idosos com e sem declínio cognitivo leve nos Testes Wisconsin de Classificação de Cartas e Iowa Gambling Test / Desempeño de ancianos con y sin Deterioro Cognitivo Ligero (DCL) en el Test de Ordenamiento de Cartas de Wisconsin y en el Iowa Gambling Test / Performance of elderly with and without mild cognitive impairment in the Wisconsin Card Sorting Test and Iowa Gambling Test

Estudos recentes sugerem a existência de disfunções executivas no Declínio Cognitivo Leve (DCL), além das de memória. O objetivo deste trabalho foi verificar a presença de disfunções executivas em pacientes com DCL. Os instrumentos utilizados foram o Teste Wisconsin de Classificação de Cartas (WCST) e o Iowa Gambling Test (IGT). Foram estudados dez pacientes com e 27 sem DCL. Os dados foram analisados através do teste t de Student para amostras independentes e da análise de variância (ANOVA) para medidas repetidas. Os resultados não evidenciaram diferença significativa entre os grupos nos índices de resposta do WCST e no número de cartas retiradas de cada baralho no IGT. O estudo da evolução do desempenho no IGT revelou diferença qualitativa entre os grupos. Idosos sem DCL aprendem ao longo da tarefa, enquanto idosos com DCL não o fazem, sugerindo uma interferência dos sistemas de memória na tomada de decisão.

Recent studies suggest the existence of executive dysfunctions in Mild Cognitive Impairment (MCI). The aim of this work was to verify the presence of executive dysfunctions in patients with MCI. The instruments used were the Wisconsin Card Sorting Test (WCST) and the Iowa Gambling Test (IGT). Ten patients with and 27 without MCI were assessed. The data were analyzed through Student t test for independent samples and analysis of variance (ANOVA) for repeated measures. The results did not show significant difference between groups in the answer rates of WCST and in the number of cards with drawn from each pack of cards in the IGT. The study of the performance evolution in the IGT revealed a qualitative difference between the groups. Elderly without MCI learn along the task, while elderly with MCI did not, suggesting an interference of memory systems in decision making.

Recientes estudios hacen sugerencia a la existencia de disfunciones ejecutivas, más allá de las de la memoria, en el Deterioro Cognitivo Ligero (DCL). El objetivo de ese trabajo fue verificar la presencia de disfunciones ejecutivas en ancianos con DCL en comparación a un grupo control. Los instrumentos utilizados fueran el Test de Ordenamiento de Cartas de Winsconsin (WCST) y el Iowa Gambling Test (IGT). Fueran estudiados diez pacientes con DCL y 27 controles. Los datos fueran analizados a través del test t de Student para muestras independientes y de la ANOVA para medidas repetidas. Los resultados no traen evidencia de significativa distinción entre los grupos en los índices de respuesta del WCST en el número de cartas tiradas de cada baraja en IGT. El estudio de la evolución del desempeño en el IGT revelo diferencia cualitativa entre los grupos. Ancianos sin DCL aprenden a lo longo de la tarea, mientras ancianos con DCL no lo hacen, haciendo sugerencia de una interferencia de los sistemas de memoria en la tomada de decisión.

Flexibilidade mental na resolução de problemas em indivíduos que cumprem pena por homicídio qualificado / Problem-solving mental flexibility in individuals who were convicted for murder

Este estudo teve como objetivo avaliar a flexibilidade mental na resolução de problemas em indivíduos que cumprem pena por homicídio qualificado em penitenciária de média segurança na região metropolitana de Porto Alegre. O estudo foi quantitativo de tipo transversal. A amostra (n=60) foi localizada por conveniência, contou com 30 indivíduos homicidas pareados quanto a sexo, idade, escolaridade e classe social com 30 sujeitos sem antecedentes criminais. Os instrumentos utilizados foram: Teste Wisconsin de Classificação de Cartas - WCST, Teste Stroop de Cores e Palavras, os subtestes Cubos, Códigos e Vocabulário do WAIS-III, a Mini-International Psychiatric Interview e uma ficha de dados sócio-demográficos. Nas categorias do WCST e no Teste Stroop o grupo de homicidas apresentou escores inferiores ao grupo controle com diferença estatisticamente significativa (p<0,05). Concluiu-se que os indivíduos que cumprem pena por homicídio qualificado apresentam uma menor flexibilidade na resolução de problemas quando comparados a sujeitos sem antecedentes criminais.

This study aimed at assessing problem-solving mental flexibility in individuals who were convicted for qualified murder, and confined in a medium-security prison within the Metropolitan Area of Porto Alegre, Brazil. The quantitative cross-research study had a convenience sample (n=60) including 30 homicides, paired by gender, age, schooling and social class to 30 individuals who had no criminal records. Assessment instruments used were Wisconsin Card Sorting Test; Stroop Color and Word Test, WAIS-III Block Design, Digit-Symbol Coding and Vocabulary subtests, a Mini-International Psychiatric Interview and a socio-demographic datasheet. In the WCST categories and in the Stroop Test, the group of homicides showed lower scores than the control group with a statistically significant difference (p<0,05). It is concluded that individuals convicted for qualified murder show lower problem-solving flexibility, than the individuals having no criminal records.

Cognitive Factors for Predicting Treatment Response in Schizophrenic Patients: One-Year Follow-Up Study

OBJECTIVE: This study was conducted to investigate the cognitive factors that can longitudinally predict the response to treatment in patients with schizophrenia. METHODS: The subjects were 49 patients with schizophrenia who were newly hospitalized in an acute psychiatry ward and had not been treated with medication for at least 8 weeks prior to the study. The symptoms and cognitive functions of the patients were evaluated at baseline before treatment (T0), at eight weeks after treatment (T1), and one year after treatment (T2). Clinical symptoms were assessed using the PANSS, and cognitive functions were estimated using the Vigilance Test, Cognitrone Test, Wisconsin Card Sorting Test (WCST), and the Korean version of the Memory Assessment Scales (K-MAS). RESULTS: The patient group showed marked impairments in cognitive function when compared to the normal group, but the patients' clinical symptoms and cognitive functions improved after drug treatment. The patients also showed consistent improvement in verbal and nonverbal memory function as time progressed. Furthermore, there was a significant correlation between clinical symptoms and cognitive functions in the patient group. The cognitive variables that best predicted treatment response and prognosis were total errors on the WCST and immediate list recall component of the K-MAS. It was also shown that the number of total errors on the WCST was a better cognitive predictor than the number of errors in immediate recall. CONCLUSION: The results of the present study show that the neurocognitive functions of patients with schizophrenia can be stabilized with treatment intervention, that treatment response is related to improvement in cognitive function, and that cognitive domains, especially executive function, can predict treatment response and prognosis in patients with schizophrenia.

Neuropsychological characterization in clinical subtypes of an Obsessive-Compulsive Disorder (OCD) sample of patients / Caracterización neuropsicológica en subtipos clínicos de una muestra de pacientes con Trastorno Obsesivo-compulsivo (TOC)

SUMMARY: Since the decade of the seventies, several neuropsychological abnormalities in very different cognitive domains have been described among patients with Obsessive-compulsive disorder (OCD). Due to the nature of these abnormalities, it was concluded that possibly the main dysfunction for this disorder was located in the right hemisphere, especially in the frontal cortex; nevertheless this particular brain region was found to be involved in other psychiatric disorders, so neuropsychological results were considered to be of limited precision and it was thought that the diversity in results was not due to the malfunction of one particular brain region. So it became evident that a new research methodology based in the information processing model with highly specific neuropsychological paradigms of frontal functioning was needed; as well as considering a subtypology based in the cognitive characteristics in patients with the same disorder and similar phenomenology. Regarding OCD it is well known that the dorsolateral prefrontal cortex is in charge of the regulation of complex actions, executive functions and the elaboration of logical strategies in a problem solving task; so its dysfunction causes a failure in the creation of response patterns and perseverations due to the inability to change a pattern when an alternative response is needed. On the other hand, obsessions are associated mainly with the anterior cingulated cortex and the basal region of the corpus striatum and its connections with the limbic system, giving place to incapacity to select the relevant information from the environment, which makes the individual perceive irrelevant stimuli as threatening for physical integrity. By the way, some clinical subtypes have also been identified: contamination/washing, aggressiveness/checking, hoarding, symmetry/ order. There is also some evidence of different patterns of brain activation to several visual stimuli related to the obsessive or compulsive object in the clinical subtypes, as shown by functional magnetic resonance image in some regions of the frontal lobe, either dorsolateral, medial or basal and its connections with the basal ganglia, and in some cases thalamus or limbic system. In the face of all this evidence, the goal of the present study was to find if within this disorder it was possible, through several neuropsychological paradigms of frontal functioning, to find different patterns of execution, considering the clinical subtype and the severity of obsessions and compulsions. Fifty-eight patients with a diagnosis of OCD were studied; all patients were under treatment at the OCD clinic of the National Institute of Psychiatry Ramón de la Fuente in Mexico City. Two neuropsychological tests were administered: 1) Trail Making Test (TMT) and 2) Wisconsin Card Sorting Test (WCST). From the Target Symptom List, the clinical subtype was obtained. After the statistical analysis, we found no differences between the severity of obsessions and the severity of compulsions as measured by the Yale-Brown Scale. Also, we observed three factors concerning the neuropsychological tests, and patients were grouped in four different groups, each one with a distinct cognitive performance. Through the interpretation of results it was concluded that in a sample of 58 patients with OCD, different groups of neuropsychological functioning where distinguished. In their own, these groups where associated with different clinical subtypes. These results are in accordance with the neurobiological modular organization model of OCD, which sustains the existence of independent systems of cognitive dysfunction that regulate different symptomatic expressions.

RESUMEN: La metodología de investigación, a partir del modelo del procesamiento de información con paradigmas neuropsicológicos de funcionamiento del lóbulo frontal, permite un estudio más específico de los trastornos psiquiátricos con fenomenología parecida, lo que a su vez permite crear modelos basados en una subtipología de índole cognoscitiva y, por ende, lleva al conocimiento de los circuitos neurales involucrados en la manifestación clínica de estos padecimientos. En el caso del trastorno obsesivo-compulsivo (TOC), la corteza prefrontal dorsolateral se encarga de regular las acciones complejas, las funciones ejecutivas y la elaboración de estrategias lógicas en la resolución de problemas, de tal manera que su mal funcionamiento ocasiona fallas en la creación de patrones de respuesta y perseveraciones por incapacidad de cambiar de patrón cuando se requiere otra alternativa de respuesta. Por otra parte, las obsesiones se relacionan predominantemente con el cíngulo anterior y la parte basal del cuerpo estriado y de sus conexiones con el sistema límbico, dando lugar a la incapacidad para seleccionar la información relevante del entorno. Esto genera que el individuo perciba los estímulos inocuos como "amenazantes" para la integridad física. También se han identificado subtipos clínicos de obsesiones y compulsiones, tales como contaminación, lavado, agresividad, comprobación, atesoramiento, simetría y de orden, entre otros, que se han relacionado con distintos patrones de transmisión genética, comorbilidad y respuesta a tratamiento. Además, se han documentado distintos patrones de aumento o disminución, ya sea de metabolismo cerebral o de flujo sanguíneo, en los circuitos fronto- estriados. Con la resonancia magnética funcional también se han encontrado distintos patrones de activación en los circuitos neuronales entre distintos subtipos clínicos, mediante la exposición de imágenes que se relacionan con el contenido de la obsesión o bien con la acción de la compulsión. Ante esta evidencia, se decidió averiguar si en pacientes con este trastorno era posible encontrar, mediante distintos paradigmas neuropsicológicos de funcionamiento frontal, dichos patrones diferenciales, considerando tanto el subtipo clínico como la gravedad de las obsesiones y compulsiones. En este estudio participaron 58 pacientes con este diagnóstico pertenecientes a la Clínica de TOC del Instituto Nacional de Psiquiatría Ramón de la Fuente, de los que 24 eran mujeres y 34, hombres. Una vez que los psiquiatras adscritos a dicha clínica confirmaban el diagnóstico obtenido en la cita de primera vez, referían a los pacientes al programa para computadora de Diagnóstico Neuropsicológico Automatizado (DIANA). Se aplicaron en una sola sesión las siguientes pruebas: 1) Trazado con Hitos (TH) y 2) Test de Categorización de Tarjetas de Wisconsin (TCTW). Con posterioridad a la aplicación de las pruebas a todos los pacientes, se revisó cada uno de los expedientes de la clínica de TOC para obtener el subtipo clínico. En el análisis estadístico de los datos se realizó primero un análisis factorial para disminuir el número de variables y luego un análisis de conglomerados para ver si se formaban grupos conforme a la ejecución de los sujetos en las pruebas aplicadas. De acuerdo con la ejecución de los pacientes se observó que los sujetos se agruparon en cuatro grupos distintos de desempeño cognoscitivo: el primero tuvo una ejecución muy deficiente en ambas pruebas. El segundo exhibió un desempeño regular en las dos pruebas pero fue mas rápido para terminar el TH. El tercero sólo estuvo constituido por dos pacientes que tuvieron un desempeño muy diferente al del resto, al presentar una ejecución sobresaliente en WCST pero con gran cantidad de errores en el TH. En tanto, en el cuarto de estos grupos, donde se concentraba la mayoría de la muestra, se consideró que su ejecución fue la más característica y su desempeño en ambas pruebas regular, pero más lento en TH. Cada uno de estos grupos de funcionamiento neuropsicológico se relacionó con los distintos subtipos de obsesiones y compulsiones, mas no con su gravedad. Encontrar subtipos neuropsicológicos de TOC asociados a sintomatología clínica distinta presta apoyo al modelo de organización modular de los diferentes circuitos neurales que intervienen en la manifestación sintomática de este padecimiento.