Development of Chinese Card Sorting Test and its Validity Assessment

Abstract

Objective To develop Chinese Card Sorting Test (CCST) as an efficient, brief test for evaluating executive function in Chinese elderly. Methods Thirty ⁃ five patients with mild Alzheimer's disease (AD), 69 cases with mild cognitive impairment (MCI) [amnesic MCI⁃single domain (aMCI⁃s), 25; amnesic MCI⁃multiple domain (aMCI⁃m), 24; non⁃amnesic MCI (naMCI), 20] and 124 cognitively normal controls (NC) were administered a battery of neuropsychological tests including CCST. Three sets (including figures, words and numbers) of cards were adopted. Each set had 6 cards. Subjects were asked to sort cards according to shape, number, and Full mark was 4 for each set and 12 for total 3 sets. Results 1) Comparison among NC, MCI and AD: according to test score, in NC group, Set Ⅱ was most difficult while Set Ⅰ was easiest. However, in MCI and AD group, patients' scores were similar among 3 sets, which indicated that discriminative efficacy was same among 3 sets. Set Ⅰ and Ⅲ sorting started with color and followed with meaning. Set Ⅱ sorting started with meaning. The accuracy score for Set Ⅱ was lowest which may due to inhibition effect of meaning against other sorting strategy (similar as the Stroop effect). Number was most difficult and least adopted sorting dimension. There were few misclassification which indicated that test design produced few misunderstanding. When total score of CCST ≤ 6, sensitivity and specificity for differentiating AD was 94.32% and 74.24%, respectively. When total score of CCST ≤ 5, sensitivity and specificity for differentiating AD was 74.35% and 89.52%, respectively. For subjects with low education, optimal cut⁃ off score should be selected as ≤ 5. For subjects with high education, optimal cut⁃off score should be set as ≤ 6. 2) Comparison among 3 MCI subgroups: score in naMCI subgroup was lowest (4.25 ± 2.07), while in aMCI ⁃ s subgroup was highest (6.68 ± 1.65). The score in aMCI ⁃ m was between 2 above subgroups (5.16 ± 2.26). There were significant differences among 3 subgroups (P < 0.01, for all). CCST can be used to differentiate amnesic and non⁃amnesic MCI. There were significant differences between aMCI ⁃ s and naMCI for all 3 sets of cards. Significant differences only existed for Set Ⅱ between aMCI⁃m and naMCI. There were significant differences among 3 subgroups in color dimension. There were no differences among 3 subgroups in number and meaning dimension. There were significant differences between aMCI and naMCI in color and number dimension. There were no differences between aMCI and naMCI in shape and meaning dimension. Conclusion Chinese Card Sorting Test is an effective, rapid and usable test for differentiating amnesic and non⁃amnesic MCI. DOI：10.3969/j.issn.1672-6731.2010.02.014