Assessment Of Cognitive Flexibility Research Articles

Children’s color trails test: Greek normative data and clinical validity in children with traumatic brain injury and attention deficit - Hyperactivity disorder

The Children’s Color Trail Test (CCTT) is considered a culture fair equivalent of the Trail Making Test for the assessment of cognitive flexibility in pediatric populations, while others emphasize its additional validity as a measure of attention, perceptual tracking, processing speed, susceptibility to interference and inhibition. The need for standardized neuropsychological tests in Greece, especially for the pediatric population is significant. In the present study, considering the relatively good psychometric properties of the CCTT and its wide cross-cultural application, we decided that such a tool would be useful to Greek clinicians and researchers, and therefore developed norms for the Greek child and adolescent population. Additionally, we examined the clinical validity of the test, administering it to two groups of patients (children with Traumatic Brain Injury and Attention Deficit - Hyperactivity Disorder). We administered the test to 417 native healthy Greek children 6-15 years, recruited primarily from Southwestern Greece from several public schools. Linear regression analysis revealed a significant influence of age on completion time in both parts of the CCTT, whereas sex did not influence time to completion. Older children consistently completed the test faster than younger children, whereas girls and boys performed similarly on both conditions. In addition, CCTT differentiated the performance of children who have had a TBI and those diagnosed with ADHD from the performances of their typically developing peers. This study provides much needed performance and clinical utility data for the pediatric population in Greece on a promising neuropsychological tool for use in clinical and research settings.

Assessment of Cognitive Flexibility in Jordanian Diabetic Patients by Wisconsin Card Sorting and Trail Making Tests: Implications with Demographic, Anthropometric and Therapeutic Variables.

Cognitive flexibility is a mental ability that aids in smoothly alternating between them tasks in the brain. Diabetes Mellitus (DM) is a, common disorder that has been associated with impairments in cognitive functions. This research is a retrospective case-control study aimed at establishing a clear relationship between cognitive flexibility and diabetes among Jordanians, considering demographic, anthropometric, and therapeutic variables. TheWisconsin Card Sorting Test (WCST)-64 item and the Trail Making Test (TMT) assessed cognitive flexibility in 268 people with diabetes and healthy control. Demographic, therapeutic data were collected. We also measured waist-to-hip ratio (WHR) and body mass index (BMI). As the variables were non-normally distributed, non-parametric statistical tests were used to examine differences (Kruskal-Wallis) and correlation (Spearman) between variables. The patient group did worse on the WCST In contrast to the control group, patients exhibited more significant delays for both Part A and Part B of the TMT (p<0.05). Males had higher WCST conceptual level responses than females. In addition, participants with professional jobs showed less delay in TMT Part A (p<0.05). Age was positively correlated with WCST's total errors and TMT's Parts A and B (p<0.05). BMI was negatively correlated with the WCST's conceptual level of responses and positively correlated with TMT's Part B (p<0.05). In addition, urea and albumin levels were positively correlated with TMT's Part A (p<0.05). Furthermore, creatinine was positively correlated with WCST's total errors and TMT's Part A (p<0.05). Some measures of cognitive flexibility are associated with DM status in the studied sample of Jordanians and other variables (educational levels, occupation, lifestyle, average duration of illness, and age).

Measuring cognitive flexibility: A brief review of neuropsychological, self-report, and neuroscientific approaches.

Cognitive flexibility involves dynamic processes that allow adaptation of our thinking and behavior in response to changing contextual demands. Despite a large consensus about its beneficial effects, cognitive flexibility is still poorly understood. In this mini review, we examined the main conceptualizations and approaches for assessing cognitive flexibility: (1) neuropsychological tasks, (2) self-report questionnaires, and (3) neuroscientific approaches. The reviewed evidence shows that the definition and assessment of cognitive flexibility are not unified within the field and suggests that a more consensual and consistent conceptualization and operationalization of this important concept is needed. We propose that an integrative behavior-brain-context approach can help advance our understanding of cognitive flexibility.

Investigating self-report and neuropsychological assessments of cognitive flexibility in people with and without persistent pain: An online, cross-sectional, observational study.

People with persistent pain experience problems modifying their cognition and behaviours when task or environmental demands change - abilities otherwise known as cognitive flexibility. However, limitations and inconsistent results of previous studies raise concerns over the quality of that evidence. We aimed to determine whether people with and without persistent pain differ on two assessments that are commonly used to assess cognitive flexibility. We also examined the relationship between the two assessments and explored whether people with and without persistent pain are distinguishable based on their scores on these assessments. Participant demographics and symptoms of anxiety and depression were assessed. Participants completed the Cognitive Flexibility Inventory (CFI) and the Wisconsin Card Sorting Test (WCST). Multiple linear regression on the two outcome variables: CFI (total score) and WCST (% perseverative responses) was applied using backward stepwise selection. Both outcomes were calculated as a standardised proportion of the outcome scale and log-odds transformed to meet the model assumptions. Correlation analysis and logistic regression were used to investigate our secondary and exploratory aims. Data were available from 128 participants with persistent pain and 68 pain-free controls. After adjusting for covariates, no differences were found between people with and without persistent pain on either assessment of cognitive flexibility. No significant correlations were detected between the two assessments in either group. The probability of having persistent pain was also not associated with scores on either or both assessments. 'Cognitive flexibility' appears similar in people with and without persistent pain.

Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report.

Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and cost-effective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin. We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n=42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points. We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain. Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings. Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological markers of the inflexible thinking style thought to be characteristic of anorexia nervosa and exercise dependence.

Executive dysfunction in affective disorders: differences in bipolar affective disorder and depressive episode

Aim. To identify the differences in executive function (inhibitory control, working memory, cognitive flexibility) between patients with bipolar affective disorder and depressive episode.Materials and methods. A total of 72 patients with affective disorders aged 20–40 years were examined. Of them, 30 patients had bipolar affective disorder, a current episode of mild or moderate depression, and 42 patients had a mild, moderate, and severe depressive episode without symptoms of psychosis. The executive function was evaluated using PsyToolkit, a set of software tools for programming psychological experiments. Computerized Go/ No–go tasks (assessment of inhibitory control and psychomotor functions), the Corsi block-tapping test (assessment of visual and spatial working memory capacities), and the Stroop Color and Word Test (assessment of cognitive flexibility) were used.Results. An intergroup comparison of patients revealed that patients with bipolar disorder significantly more often demonstrated false button press in the Go/No–go task (p = 0.043); however, they exhibited a greater working memory capacity in the Corsi block-tapping test (p = 0.049) compared with patients with a depressive episode.Conclusion. Important data were obtained regarding the specifics of executive dysfunction depending on the type of affective disorder. The presented data expand and supplement available information about the cognitive characteristics of patients with bipolar affective disorder and depressive episode, which may be useful in clinical practice and serve a focus of future research.

Assessment of cognitive flexibility in personnel selection: Validity and acceptance of a gamified version of the Wisconsin Card Sorting Test

AbstractThe present study contributes to the emerging field of gamification in personnel selection by examining validity and acceptance of the Gamified Set‐Shifting Task (GSST), which is based on a well‐established neuropsychological test of cognitive flexibility, the Wisconsin Card Sorting Test (WCST). Results based on a sample of 180 participants in an online study provided preliminary support for construct and criterion‐related validity. The GSST was better accepted among test‐takers than both the WCST and a cognitive ability test. Overall, the findings suggest that the GSST may be an attractive and valid method to assist organizations in selecting employees who are able to adapt to changing environments.

Considerations for using the Wisconsin Card Sorting Test to assess cognitive flexibility.

The Wisconsin Card Sorting Test (WCST) is a popular neurocognitive task used to assess cognitive flexibility, and aspects of executive functioning more broadly, in research and clinical practice. Despite its widespread use and the development of an updated WCST manual in 1993, confusion remains in the literature about how to score the WCST, and importantly, how to interpret the outcome variables as indicators of cognitive flexibility. This critical review provides an overview of the changes in the WCST, how existing scoring methods of the task differ, the key terminology and how these relate to the assessment of cognitive flexibility, and issues with the use of the WCST across the literature. In particular, this review focuses on the confusion between the terms 'perseverative responses' and 'perseverative errors' and the inconsistent scoring of these variables. To our knowledge, this critical review is the first of its kind to focus on the inherent issues surrounding the WCST when used as an assessment of cognitive flexibility. We provide recommendations to overcome these and other issues when using the WCST in future research and clinical practice.

Toward a Computational Neuropsychology of Cognitive Flexibility.

Cognitive inflexibility is a well-documented, yet non-specific corollary of many neurological diseases. Computational modeling of covert cognitive processes supporting cognitive flexibility may provide progress toward nosologically specific aspects of cognitive inflexibility. We review computational models of the Wisconsin Card Sorting Test (WCST), which represents a gold standard for the clinical assessment of cognitive flexibility. A parallel reinforcement-learning (RL) model provides the best conceptualization of individual trial-by-trial WCST responses among all models considered. Clinical applications of the parallel RL model suggest that patients with Parkinson’s disease (PD) and patients with amyotrophic lateral sclerosis (ALS) share a non-specific covert cognitive symptom: bradyphrenia. Impaired stimulus-response learning appears to occur specifically in patients with PD, whereas haphazard responding seems to occur specifically in patients with ALS. Computational modeling hence possesses the potential to reveal nosologically specific profiles of covert cognitive symptoms, which remain undetectable by traditionally applied behavioral methods. The present review exemplifies how computational neuropsychology may advance the assessment of cognitive flexibility. We discuss implications for neuropsychological assessment and directions for future research.

Parallel model-based and model-free reinforcement learning for card sorting performance

The Wisconsin Card Sorting Test (WCST) is considered a gold standard for the assessment of cognitive flexibility. On the WCST, repeating a sorting category following negative feedback is typically treated as indicating reduced cognitive flexibility. Therefore such responses are referred to as ‘perseveration’ errors. Recent research suggests that the propensity for perseveration errors is modulated by response demands: They occur less frequently when their commitment repeats the previously executed response. Here, we propose parallel reinforcement-learning models of card sorting performance, which assume that card sorting performance can be conceptualized as resulting from model-free reinforcement learning at the level of responses that occurs in parallel with model-based reinforcement learning at the categorical level. We compared parallel reinforcement-learning models with purely model-based reinforcement learning, and with the state-of-the-art attentional-updating model. We analyzed data from 375 participants who completed a computerized WCST. Parallel reinforcement-learning models showed best predictive accuracies for the majority of participants. Only parallel reinforcement-learning models accounted for the modulation of perseveration propensity by response demands. In conclusion, parallel reinforcement-learning models provide a new theoretical perspective on card sorting and it offers a suitable framework for discerning individual differences in latent processes that subserve behavioral flexibility.

Color Trails Test: A New Set of Data on Cognitive Flexibility and Processing Speed in Schizophrenia.

BackgroundAlthough schizophrenia patients have been reported to manifest deficits in cognitive flexibility and lower processing speed (measured with i.a., the Color Trails Test, CTT), there still remain a few matters that require further investigation. We have therefore formulated three research aims: 1) to examine the factor structure of CTT in schizophrenia patients and healthy controls, 2) to compare different CTT performance measures in the two groups, 3) to investigate the relationship between these measures and selected psychopathological symptoms in the patient group.MethodsSixty-seven patients with paranoid schizophrenia and 67 healthy controls, matched for gender, age, number of years of education, and overall cognitive functioning underwent assessment of cognitive flexibility and processing speed with the CTT.ResultsFactor analysis of CTT variables based on the principal component method revealed a four-factor solution in both groups. Compared with healthy controls, the patients performed poorer on CTT 1 time, CTT 2 time, 2-1 difference, prompts in CTT 2, and had higher regression factor scores for Factor 1 (reflecting the slower speed of perceptual tracking). Furthermore, significant links were found between some CTT measures, and negative and disorganization symptoms.ConclusionsSchizophrenia patients exhibit problems with speed of perceptual tracking and executive processes dependent on processing speed. Our results may be useful for the development of neuropsychological diagnostic methods for schizophrenia patients. It seems that, compared to other CTT indices, CTT 1 time, CTT 2 time, and 2-1 difference are more appropriate measures of cognitive performance in schizophrenia patients.

Risky decision making and cognitive flexibility among online sports bettors in Nigeria.

Online sports betting is a popular recreational activity in Nigeria. Like other forms of gambling, risk of pathological progression exists for gamblers who continue betting despite severe financial and psychosocial consequences. In the present study, we examined whether this population of gamblers shows deficits in decision making and cognitive flexibility that have been documented in Western gambling populations. Thirty‐six online sports bettors and 42 non‐gambling participants completed a version of the Iowa gambling task (IGT) and an established set‐shifting task for the assessment of cognitive flexibility. The two groups did not differ significantly in the selection of disadvantageous decks on the IGT. In contrast, sports bettors committed significantly more errors on the set‐shifting task than non‐gambling control participants. As this performance deficit was not specific to trials requiring a set shift, it most likely resulted from gambling‐related changes in general cognitive or motivational abilities that are required to successfully complete challenging mental tasks. While our results illustrate that findings from Western populations cannot automatically be generalised to other contexts, it should be noted that we focused on only one particular type of gambling and included mostly participants with mild gambling‐related problems.

Predicting school achievement: Differential effects of dynamic testing measures and cognitive flexibility for math performance

Dynamic testing aims to assess potential for learning by measuring performance improvement as a response to training while testing. Dynamic test outcomes have been argued to be related to children's present and future achievements at school. The current study aimed to investigate whether dynamic measures of inductive reasoning would provide additional predictive value of math achievement while taking into account static inductive reasoning performance. In addition, as cognitive flexibility, one of the core executive functions, has been argued to be significantly involved in children's math performance, it was explored whether dynamic test outcomes would hold unique predictive value for math achievement while taking into account cognitive flexibility. Participants were 152 six- and seven-year-old children who were administered either a dynamic test of series completion comprising a pre-test–training–post-test format or a static series completion test consisting of a pre-and post-test, in combination with a test of cognitive flexibility. Children in the experimental, dynamic test condition were trained in series completion, while the children in the control condition only practiced series completion. The dynamic measures of inductive reasoning and cognitive flexibility were each found to provide additional predictive value to static pre-test performance and to hold unique predictive value for math achievement. The results underline the importance of both dynamic testing and cognitive flexibility in educational assessment and suggest that the assessment of cognitive flexibility should be an integral part of dynamic testing.

Assessing children's cognitive flexibility with the Shape Trail Test.

In this paper we report an initial validation of the Shape Trail Test–Child Version (STT-CV) with a non-clinical sample of children aged 6 to 9 years. The STT-CV has been developed as an age-appropriate and culturally fair direct downward extension of the Trail Making Test (TMT) for the assessment of cognitive flexibility. Children completed the STT-CV and four established measures of executive functions that assessed working memory, inhibitory control and task switching. Results showed the expected age-based differences in completion times for both parts of the STT-CV (Trail A and Trail B). Children’s performance on the STT-CV correlated significantly with all four measures of executive functions. After controlling for the effects of chronological age, completion times for Trail B remained correlated with most other measures of executive functions. These findings provide emerging evidence for the utility of the STT-CV, and highlight the need for designing and using appropriate variants of the TMT in the behavioural assessment of cognitive flexibility in developmentally and culturally diverse populations.

Determining Practice Effects on a Cognitive Flexibility Assessment

The Youmans Cognitive Flexibility Assessment (YCFA) was created as an easy-to-administer and entertaining assessment of cognitive flexibility. Although a validation and reliability study of the YCFA was conducted, practice effects were not assessed. This present study aims to uncover whether practice effects occur for the YCFA. Thirty-six undergraduate university students completed four rounds of the YCFA (six trials per round). Practice effects occurred in the first and second rounds, but task performance stabilized after the third round. Implications are discussed.

Moderate-to-vigorous physical activity, executive functions and prefrontal brain oxygenation in children: A functional near-infrared spectroscopy study

ABSTRACTDespite accumulating evidence that regular exercise improves executive functioning, the underlying neurophysiological mechanisms have rarely been investigated. The present study aimed to compare cognitive performance as well as task-specific concentration changes in oxygenated haemoglobin in the prefrontal cortex between children with higher and lower moderate-to-vigorous physical activity (MVPA). Physical activity was measured over 7 consecutive days using actigraphy. Afterwards, participants (N = 50) completed verbal fluency tests (VFTs) and mental arithmetic (MA) for the assessment of cognitive flexibility and working memory capacity. During the tasks, changes of oxygenated haemoglobin were measured with functional near-infrared spectroscopy. Using average MVPA of 11-year-old children as cut-point, the sample was divided into children with lower and higher MVPA. Analyses of variance revealed no significant differences in correct and false responses on the cognitive tests between groups. With regard to oxygenated haemoglobin, no group differences were found for concentration changes in response to the cognitive tasks. In conclusion, VFTs and MA increased children’s activation in prefrontal regions associated with cognitive flexibility and working memory, respectively. However, these executive functions and cortical activation were not different between children with lower and higher MVPA.

Diagnosis of Dementia-Circadian Dependency?

Little is known whether tests used for the diagnosis of dementia syndromes are sensitive to time of day effects. In a sample of 145 participants, no such effect (test administration either in the morning from 9.30 to 11.30 a.m. or in the afternoon from 2.30 to 4.30 p.m.) could be found for most subtests of a neurocognitive test battery (CERAD-Plus) used for the detection of dementia syndromes. However, for subjects suffering from mild cognitive impairment, completion time for the Trail-Making Test B, a brief cognitive test for the assessment of cognitive flexibility, was longer in the afternoon compared to the morning.

Cognitive Flexibility: A Default Network and Basal Ganglia Connectivity Perspective.

The intra/extradimensional set-shifting task (IED) provides a reliable assessment of cognitive flexibility, the shifting of attention to select behaviorally relevant stimuli in a given context. Impairments in this domain were previously reported in patients with altered neurotransmitter systems such as schizophrenia and Parkinson's disease. Consequently, corticostriatal connections were implicated in the mediation of this function. In addition, parts of the default mode network (DMN), namely the medial prefrontal and posterior cingulate/precuneus cortices, are also being progressively described in association with set-shifting paradigms. Nevertheless, a definitive link between cognitive flexibility and DMN connectivity remains to be established. To this end, we related resting state functional magnetic resonance imaging (fMRI)-based functional connectivity of DMN with IED task performance in a healthy population, measured outside the scanner. The results demonstrated that greater posterior cingulate cortex/precuneus (DMN) connectivity with the ventromedial striatopallidum at rest correlated with fewer total adjusted errors on the IED task. This finding points to a relationship between DMN and basal ganglia connectivity for cognitive flexibility, further highlighting this network's potential role in adaptive human cognition.

Use of a modified version of the switching verbal fluency test for the assessment of cognitive flexibility.

ObjectiveVerbal fluency tests are widely used for the assessment of executive functions. However, traditional versions of the test depend on several cognitive factors beyond these components. The aim of this study was to evaluate the associations of a modified version of the verbal fluency with specific measures of executive functions.MethodsSixty adults were evaluated using traditional versions of verbal fluency (animals/fruits) and a modified condition where subjects must switch between animals and fruits. Processing speed, semantic abilities, psychiatric symptoms and executive functions were also assessed.ResultsPartial correlations between the verbal fluency tests and measures of executive functions, controlled for demographic, cognitive and psychiatric symptoms, suggest that cognitive flexibility has 9% shared variance with the verbal fluency test – category animals, 2 % with category fruits, 8% with total words in switching condition, and 20% with total correct word-pairs produced in switching condition. The other aspects of executive functions during the task had shared variance of between 1% and 7% with the verbal fluency tasks.ConclusionThe results suggest that correct word-pairs produced in switching verbal fluency may be a more specific measure for evaluating cognitive flexibility compared to other versions of verbal fluency.

Does depression matter in neuropsychological performances in anorexia nervosa? A descriptive review.

This review aims to examine the impact of depressive symptoms on the assessment of cognitive flexibility, central coherence, and decision-making in individuals with anorexia nervosa (AN). An online search was carried out using PubMed and PsycInfo. Articles were selected for review if they were published in English between 1990 and 2014 and used the Wisconsin Card Sorting Test, the Trail Making Task parts A and B, the Brixton Test, the Rey-Osterrieth Complex Figure Test, and/or the Iowa Gambling Task. Sixty-two studies were included. Thirty (48%) of the studies statistically assessed the association between depression and neurocognition in AN versus healthy controls. Where significant correlations were found, it became clear that the more serious the depression, the greater the neuropsychological impairment. Only six (10%) studies examined whether increased depressive symptoms were able to eliminate the differences between individuals with AN and healthy controls, and one study found that depressive symptoms did eliminate group differences in cognitive flexibility and decision-making. Only a subgroup of articles on neuropsychology in AN adjusted for depression. However, given the role of depression that some articles suggest, future studies should pay closer attention to the evaluation of this potential confounder.