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.

Factors Affecting Executive Functions In Patients Recovered From Acute And Transient Psychotic Disorder

Objectives: Executive function is an important cognitive function affected in many psychiatric disorders but limited data is available regarding its course in patients recovered from acute and transient psychotic disorder. The aim of this study was to assess the executive function of recovered patients of acute and transient psychotic disorder and to evaluate different factors affecting the executive function of patients recovered from acute and transient psychotic disorder. Method: This was a non-invasive, one point, comparative study where the executive function was assessed after clinical recovery from acute and transient psychotic disorder. The patients were divided into two groups (poor and fair) on the basis of their executive performance. Retrograde analyses of different factors affecting executive performance were carried out. Results: A total of 28 patients had undergone assessment on Wisconsin Card Sorting Test (WCST) out of which 13 patients had poor and 15 patients had fair executive performance. The fair executive performance group had shorter duration of psychosis, male preponderance and more years of education. Conclusion: Average duration of psychosis seems to be a reliable predictor of better or poor executive functioning.

Avaliação das funções atentivas e flexibilidade mental em dependentes químicos / Assessment of attention functions and mental flexibility in drug addicts

O presente estudo teve como objetivo investigar possíveis alterações na focalização atentiva e na flexibilidade mental de sujeitos diagnosticados com dependência química (G1; n= 20) quando comparado a um grupo controle que não faz uso nocivo de substâncias psicoativas (G2; n= 20). Os participantes foram avaliados através do Teste Wisconsin de Classificação de Cartas (WCST) e um Teste de Desempenho Contínuo (TDC). Os resultados sugerem que os indivíduos do grupo G1 apresentaram um desempenho significativamente inferior no teste WCST e na maioria dos índices do teste TDC. Em conjunto, os desempenhos observados sugerem um déficit na flexibilidade cognitiva e um quadro de desatenção apresentado pelos participantes do grupo G1 em comparação ao grupo G2. Os achados são discutidos em termos de possíveis implicações para o tratamento de dependentes químicos...

The present study aimed to investigate possible changes in attentive focus and mental flexibility of drug-addicted subjects (G1, n = 20) compared to a control group that does not make use of psychoactive substances (G2, n = 20). Participants were assessed using the Wisconsin Card Sorting Test (WCST) and a Continuous Performance Test (CPT). The results suggest that G1 individuals showed significantly lower performance on the WCST and in most CPT indexes. Altogether, the performances observed suggest a deficit in cognitive flexibility and a condition of inattention shown by G1 individuals in comparison to G2. The findings are discussed in terms of possible implications for the treatment of drug addicts...

WCST and NEUPSILIN: relationships among executive functions, attention, memory and language / WCST e NEUPSILIN: relações entre funções executivas, atenção, memória e linguagem

This study investigated the relationship between measures of the Wisconsin Card Sorting Test (WCST) and a brief battery of cognitive functions (NEUPSILIN) with the goal of providing a better understanding of the association between executive processes and other functions. The sample included 39 people, from 14 to 61 years old, with an average education of 12.38 (SD = 3.65) years of study. The hypothesis that correlations would be moderate to strong between the measures of executive function, working memory, attention and prospective memory from NEUPSILIN and WCST scores was partially corroborated because the intensity of the correlations was below than the expected. Other correlations were also found between the WCST scores and tasks that assess semantic-episodic memory, oral language (inference processing) and writing (reading) components...

Este estudo investigou a relação entre medidas do WCST e de uma bateria breve de funções cognitivas (NEUPSILIN), com o objetivo de fornecer uma melhor compreensão sobre a associação entre processos executivos e demais funções. Participaram 39 pessoas entre 14 e 61 anos de idade e média de escolaridade de 12,38 (DP=3,65) anos de estudo. A hipótese de que correlações moderadas a fortes se dariam entre as medidas de funções executivas, memória de trabalho, atenção e memória prospectiva do NEUPSILIN e os escores no WCST foi parcialmente corroborada, porque a intensidade das correlações foi inferior ao previsto. Também foram encontradas correlações entre escores do WCST e tarefas que mensuram componentes de memória episódico-semântica, linguagem oral (processamento inferências) e escrita (leitura)...

Potencial informativo e desafios técnicos do Teste Wisconsin de classificação de cartas / Potential information and technical challenges of the wisconsin card sorting test / Capacidad informativa y desafío técnico del test de clasificación de tarjetas de wisconsin (wcst)

O Teste Wisconsin de Classificação de Cartas (WCST) é um instrumento bastante relevante na avaliação neuropsicológica, considerado internacionalmente como padrão de referência para exame das Funções Executivas do cérebro, amplamente reconhecido a partir de 1993. Apesar disso, existem dificuldades para sua adequada aplicação, complexa apuração dos escores e interpretação dos resultados, fazendo-se necessário aprimorar esses processos. O presente estudo apresenta as principais áreas de aplicabilidade do WCST, conforme literatura científica disponível na área de avaliação psicológica, e discute suas dificuldades metodológicas relativas à aplicação e à análise. Por fim, argumenta-se sobre desafios deste instrumento neuropsicológico e são propostas averiguações qualitativas complementares a seus dados psicométricos, visando ampliar seu potencial informativo, bem como estimular adequada utilização do WCST em diferentes contextos.

The Wisconsin Card Sorting Test (WCST) constitutes a very important technique in neuropsychological assessment, internationally regarded as a benchmark for examining the executive functions of the brain, widely recognized since 1993. Nevertheless, it has experienced difficulties for its proper application, complex calculation of scores and interpretation of results, so it is necessary to enhance these processes. This study presents the main areas of applicability of the WCST available in the area of psychological assessment literature, and discusses methodological difficulties concerning its application and analysis. Finally, it argues challenges of this neuropsychological test and proposes complementary qualitative investigations to its psychometric data, aiming to expand its informative potential and encourage appropriate use of the WCST in different contexts.

El Test de Clasificación de Tarjetas de Wisconsin (WCST) constituye una herramienta muy importante en la evaluación neuropsicológica, considerado internacionalmente como un punto de referencia para el examen de las funciones ejecutivas del cerebro, ampliamente reconocido desde 1993. Sin embargo, existen dificultades para su buen funcionamiento, complejo cálculo de las puntuaciones y la interpretación de los resultados, por lo que es necesario mejorar estos procesos. Este estudio presenta las principales áreas de aplicación del WCST disponibles en el área de la literatura de evaluación psicológica, y discute sus dificultades metodológicas a respecto de la aplicación y el análisis. Por último, se argumenta a respecto de desafíos del test neuropsicológico y los resultados cualitativos complementarios propuestos en sus datos psicométricos, con el objetivo de expandir su potencial informativo y fomentar el uso adecuado del WCST en diferentes contextos.

Flexibilidad cognitiva después de un traumatismo craneoencefálico / Cognitive Flexibility after Traumatic Brain Injury

La flexibilidad cognitiva es la capacidad para realizar cambios entre diferentes desplegados de respuestas, ya sea de pensamientos o de acciones, en dependencia de las demandas de la situación. Al ser un proceso crucial de las funciones ejecutivas, puede ser extremadamente susceptible a daño, como en el caso del traumatismo craneoencefálico (TCE). El propósito del estudio fue evaluar el desempeño en tareas de flexibilidad cognitiva de un grupo de pacientes con TCE. Fueron evaluados 25 pacientes con TCE (Moderado=10; edad M=34.60; Severo= 15; edad: M=29.73), pareados con un grupo Control sano. Se aplicaron 4 pruebas de flexibilidad cognitiva: Fluidez verbal (verbos), Clasificación Semántica (animales), la Torre de Hanoi y la Clasificación de Cartas de Wisconsin (WCST). El análisis con ANOVA de una vía mostró que el grupo con TCE-Severo tuvo un desempeño menor en todas las tareas, seguido del TCE-Moderado. En general requirieron mayor tiempo para realizar las tareas, cometieron más errores perseverativos y tuvieron dificultades al cambiar de un set cognitivo a otro, esto evidencia su pobre flexibilidad cognitiva. Los hallazgos del estudio permitirán la elección de tareas de evaluación apropiadas para los pacientes con TCE, a su vez ayudará en la generación de programas de intervención cognitiva y conductual.

Cognitive flexibility is the ability to make changes between different responses, either of thought or action, depending on the demands of the situation. Like a crucial process of executive functions, can be extremely susceptible to damage as in the case of traumatic brain injury (TBI). Approximated a third of the population have a secondary brain damage due to TBI. The purpose of this study was to evaluate the performance on tasks of cognitive flexibility in a group of patients with TBI. Were evaluated 25 patients with TBI, 10 Moderate-TBI (age M = 34.60; education: M=14.70) and 15 with Severe-TBI (age: M= 29.73; education: M=13.88) matched with a healthy control group by age, sex, and education. Were applied 4 tests of cognitive flexibility: Verbal Fluency (verbs), Semantic Classification (animals), the Tower of Hanoi (3 and 4 desks) and the Wisconsin Card Sorting Test (WCST), that are included in the Battery of Executive Functions and Frontal Lobes. Analysis with one-way ANOVA to compare the three groups showed that the Severe-TBI group had a lower performance on all tasks, mainly in semantic classification and WCST, followed by TCE-Moderate, this last group had a similar performance to control group for this reason few significant statistical differences were found. Overall patients required more time to perform the tasks, made more perseverative errors and had difficulty in shifting between cognitive set, making that their performance significantly decrease, also this is evidence of a poor cognitive flexibility. In conclusion the severity of TBI are related with a poor performance on executive functions, negatively influencing in learning, to generate new strategies to solve a problem, in divided attention and the capacity to process new information. The study findings will allow the selection of appropriate assessment tasks for patients with TBI and influence on the generation of cognitive and behavioral intervention.

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).

Idosos com diabetes mellitus tipo 2 e o desempenho cognitivo no teste Wisconsin de classificação de cartas(WCST) / Elderly people with Diabetes Mellitus Type 2 and Cognitive Performance in the Wisconsin Card Sorting Test (WCST)

Estudos identificam a existência de uma conexão entre Diabetes Mellitus (DM) e demência. A hiperglicemia pode ser um fator significativo para incidência de Alzheimer e uma causa secundária de demência. Pesquisas revelaram que as funções executivas dos idosos com DM estavam mais prejudicadas do que naqueles sem DM. 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. Foi realizada uma revisão sistemática com o objetivo de verificar as características das publicações indexadas nos últimos oito anos, que abordam os temas DM2, idosos, WCST, flexibilidade cognitiva, do pensamento e funções executivas. Os resultados demonstraram que estudos envolvendo DM2, idosos e WCST são reduzidos.

Studies have identified the existence of a connection between Diabetes Mellitus and dementia. High blood sugar level can be a significant factor of the incidence of Alzheimer, which could be a secondary cause of dementia. Other research revealed that the executive functions of the elderly with DM were more impaired than in those without DM. Type 2 Diabetes Mellitus (DM2) is associated with cognitive and functional deficits and, one of the tools, which can be used to assess executive functions, is the Wisconsin Card Sorting Test (WCST). A systematic review was performed with the aim of verifying the characteristics of indexed publications in the last eight years, using the following subjects: Type 2 Diabetes, elderly people, the WCST,thought and cognitive flexibility, and executive functions. Results show that studies involving DM2, elderly people and WCST are few.

The Effects of Board-Game Therapy on Cognitive Rehabilitation in Patients with Chronic Schizophrenia

OBJECTIVES: In order to explore effects of board-game therapy for cognitive rehabilitation in patients with schizophrenia, we investigated the change of executive cognitive function over a 2-month period of board-game therapy in patients with schizophrenia. METHODS: Two groups of chronic schizophrenic inpatients were participated in this study. One group(n=21) were treated with board-game therapy for 2 months and the other control group(n=19) were not treated. For the evaluation of the executive cognitive function, a Wisconsin Card Sorting Test(WCST) was administered before and after the introduction of the board-game therapy. PANSS score change was also evaluated. RESULT: At the beginning of this study, there was no significant difference in performance of cognitive function tests, demographical data or clinical severity between both patient groups. After 2 months of treatment with the board-game therapy, the board-game therapy group showed significant improvements of executive cognitive function without any significant change of their schizophrenic symptoms. On the contrary, there was no change in control group. CONCLUSION: This study showed that a board-game therapy is effective for the enhancement of executive cognitive function in patients with chronic schizophrenia. A board-game therapy could be introduced with ease into psychiatric fields, such as inpatients' or outpatients' clinic wards and day hospital. Our result indicates that the board-game therapy is a promising tool for the enhancement of cognitive function, especially executive cognitive function and helpful for cognitive rehabilitation for schizophrenic patients.

The Relationship between Temporal Lobe Epilepsy and Depression: The Test of Functional Involvement of Frontal and Parietal Lobe Hypothesis / 신경정신의학

OBJECTIVES: Regarding the relationship between the laterality of seizure focus and depression in temporal lobe epilepsy (TLE), previous studies reported inconsistent results. The role of frontal function as moderating variable between laterality and depression had been proposed. We attempted to replicate functional involvement of frontal lobe (FIFL) and, as an effort to extend previous findings, to test the functional involvement of parietal lobe (FIPL) to prove the hypothesis derived from Heller's valencearousal theory of emotion. METHODS: In study 1, patients with TLE (right 19, left 17) performed MMPI-D as a depression measure, Wisconsin Card Sorting Test (WCST) as a frontal function measure, and block design (BD) as a parietal function measure in the course of pre-operation assessment. Multiple regression model of depression which includes the interaction terms both between laterality and WCST and between laterality and BD were tested. In study 2, patients underwent anterior temporal lobectomy (ATL;right 20, left 25) were assessed and analyzed in the same way as study 1. RESULTS: In study 1, contrary to the FIFL and FIPL prediction, interaction of laterality with WCST or BD were not significant. In study 2, the interaction with frontal function was significant. Consistent with FIFL prediction, depression came to be evident when seizure focus was lateralized to the left side and simultaneously frontal function declined. But the interaction with BD remained insignificant, which suggests the invalidity of FIPL hypothesis. CONCLUSION: We replicated the FIFL hypothesis in the depression of ATL patients. The relation of depression with frontal function was more evident in post rather than pre operation sample. This pattern may be due to the inter-hemispheric interference of frontal functions in pre-operation sample and to the release-of-function phenomenon in post-operation sample. On the other hand, we did not succeed in confirming the role of parietal function in depression. Intactness of the parietal function in TLE was considered as the main cause of the negative finding.

Executive Function in Psychiatric Patient Groups through Wisconsin Card Sorting Test Computer Version (WCST) / 신경정신의학

OBJECTIVE: This study was aimed to compare executive functions in patients with Organic Brain Syndrome(OBS), Schizophrenia, Depression and normal control group with Wisconsin Card Sorting Test Computer Version (WCST). METHODS: WCST was administered to 82 normal adults, 32 OBS patients, 29 schizophrenic patients, and 22 depressive patients. WCST 16 indices in four groups were compared, using ANOVA and posthoc comparison. WCST performance was examined by factor analysis on the 15 indices of WCST on total subjects and the factor scores were compared. RESULT: WCST 16 indices in mental disorders (OBS, Schizophrenia, Depression) were lower than those of control groups. Three factors were derived from the analysis. These consisted of 'perseveration', 'nonperseverative error' and 'inefficient sorting'. Comparing factor scores, differences in 'perseverative error' factor and 'inefficient sorting' factor were found. CONCLUSION: The impairment of higher cognitive functions, especially executive function impairment in OBS and schizophrenia, was qualitatively different from those of depression and normal control groups. WCST can differentiate specific pattern of executive function impairment in mental disorders.

The Effect of Attention Level of Attention Deficit Hyperactivity Disorder on CPT and WCST / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the effects of attention level in normal children and Attention Deficit Hyperactivity Disorder(ADHD) children on Continuous Performance Test(CPT) and Wisconsin Card Sorting Test(WCST) performances. METHODS: For this survey, the ADHD children were classified into low, medium, and high attention groups according to the attention level. Normal group of children, chosen for their same attention level as that of high attention level group among ADHD groups, was compared in their CPT and WCST performances with ADHD groups. RESULTS: The findings of the study were as follows. 1) the ADHD groups distinguished by their attention level;in other words, the low, medium, and high attention level groups;showed no differences in CPT performances. This means the unique cognitive deficit of ADHD group is not the character of attention capacity limit. 2) the ADHD group showed lower performances on WCST than the normal group, regardless of attention level. CONCLUSION: ADHD group have a deficit in the ability of regulation strategy, adaptability of attention, and non appropriate response, which are needed for efficient division of prescribed information processing. These results imply that the cognitive deficit of ADHD is a character which shows that the execution deficit, which is a higher cognitive function, is a cognitive deficit of ADHD group, rather than simple attention deficit.

The Comparison of the Executive Functions in Children with Tourette's Disorder with Those with Attention Deficit Hyperactivity Disorder / 신경정신의학

OBJECTIVES: This study was performed to verify and compare deterioration of executive functions in the children with Tourette's disorder (TS) with those with Attention Deficit Hyperactivity Disorder (ADHD) and to understand the differentes. METHOD: We administered Kaufman Assessment Battery for Children (K-ABC), Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST) on three groups of 18 children each: tow groups of outpatients, one pure TS and one pure ADHD, diagnosed using DSM-IV criteria, and the third, a control group of normal, healthy children who were selected considering age, sex and academic achievement. The children performed all testings without the use of medications RESULTS: In comparisons of CPT perfotmance, the ADHD group showed poor performance with significant difference in commission error, attentiveness and risk taking (p< .05), and the TS group showed significant difference in attentiveness (p< .05) when compared with the control group. There was significant difference between the ADHD group and the TS group in commission error (p< .05). In comparisons of WCST, the ADHD group and the TS group showed significantly poorer performance than the controls in number of trials administered, total number of errors, conceptual level response, number of categories complete, perseverative response and perseverative error (p< .05), but only the ADHD group showed poor performance in perseverative response and perseverative erro r (p< .05). When the results of CPT were analyzed after adjustment for IQ, the ADHD group showed significantly more errors than the TS disorder group in commission error, and only the ADHD group showed significant difference in attentiveness compared with the normal controls (p< .05). In WCST, while these two groups showed significant difference in number of trials administrated, only the ADHD group showed significantly poor performance compared with the normal children group in the 5 sub-categories such as total number of errors, perseverative response, perseverative error, conceptual level response and number of categories complete (p< .05). CONCLUSION: The abnormalities of executive functions appear in both ADHD and Tourette's disorder, but more apparent abnormalities in executive functions were shown in ADHD than in Tourette's disorder. Also the differences of executive functions suggest that these two diseases may have different psychopathophysiology in these dimensions.

Long-term Effect of Concept Formation Training on the Performance of the Wisconsin Card Sorting Test in Schizophrenic Patients / 신경정신의학

OBJECTIVES: This study evaluated the long-term effect of concept formation training on the performance of the Wisconsin Card Sorting Test(WCST) in schizophrenic patients. METHODS: The subjects were 22 schizophrenic patients, who performed poorly on WCST(completing less than 4 categories). The subjects were divided into two groups. The training group(N=11) underwent 3 days of concept formation training after baseline WCST and had post-training test 1 week later. The concept formation training is a stepwise training designed to teach the sorting principles of WCST, using cards different from WCST. Control group(N=11) did not undergo concept formation training and repeated test 1 week after baseline test. Both groups were retested for the 3rd time after almost a year(61.4+/-7.6 weeks later in training group; 35.2+/-12.0 weeks later in control group) RESULTS: The training group made significant improvements in total number correct, total number of errors, perseverative responses, perseverative errors, conceptual level responses, number of categories completed, and trials to complete first category after training. However, only the perseverative response and perseverative errors improved in the follow-up test. In control group, there were no significant differences among 3 testings. CONCLUSION: This result suggests that schizophrenic patients with poor performance in WCST may be able to improve their performance by stepwise concept formation training not only in short-term but also in long-term performance.