Modified Card Sorting Test Research Articles

Non-mnestic cognitive function in the scopolamine model of Alzheimer's Disease

The contribution of cholinergic dysfunction to the non-mnestic cognitive impairments associated with senile dementia of the Alzheimer type (SDAT) was investigated. Scopolamine (0·5 mg) was administered intravenously to 12 healthy individuals, and their performance on selected subtests of the Wechsler Adult Intelligence Scale—Revised (WAIS-R), and on additional non-mnestic neuropsychological tests were compared to that of 12 healthy control participants. The results demonstrate that scopolamine does impair performance on components of the WAIS-R, but that the Fuld WAIS-R profile does not have a cholinergic basis. Scopolamine did not impair performance on verbal fluency, the Token Test, Judgment of Line Orientation, finger tapping, the Modified Card Sorting Test, or the Mini-Mental State Examination. The results do not support the hypothesis that the cholinergic system contributes to the non-mnestic impairments in SDAT. © 1998 John Wiley & Sons, Ltd.

A clinical comparison of two forms of the card sorting test

This study examined 67 older adults with dementia and 157 predominantly younger individuals with HIV-1 infection to determine the comparability of two commonly used forms of the Card Sorting Test: the traditional Wisconsin Card Sorting Test (WCST) and Nelson's Modified Card Sorting Test (MCST). Three frequently used clinical outcome measures were examined: the total number of categories achieved; the ratio of perseverative errors to total trials; and the number of failures to maintain set exhibited in the protocol. Our results indicated that when the number of perseverative errors relative to total trials is used as a clinical indicator, the WCST and MCST appear to be comparable. For the number of categories achieved, the forms appear comparable only in the non-elderly, non-demented sample. Finally, we did not find comparable results between the two forms for the number of failures to maintain set.

Nelson's (1976) modified card sorting test: A review

We review studies of Nelson's (1976) Modified Card Sorting Test (MCST) that have examined the performance of subjects with frontal lobe dysfunction. Six studies investigated the performance of normal controls and patients with frontal lobe dysfunction, whereas four studies compared the performance of frontal and nonfrontal patients. One further study compared the performance of amnesic patients both on the MCST and on the original Wisconsin Card Sorting Test (WCST). Evidence regarding the MCST's differential sensitivity to frontal lobe dysfunction is weak, as is the evidence regarding the equivalence of the MCST and WCST. It is likely that the MCST is an altogether different test from the standard version. In the absence of proper normative data for the MCST, we provide a table of scores derived from the control groups of various studies. Given the paucity of evidence, further research is required before the MCST can be recommended for use as a marker of frontal lobe dysfunction.

Cerebral activation during performance of a card sorting test.

The Wisconsin Card Sorting Test (WCST) is used clinically for evaluating frontal lobe function, but there is some controversy as to its specificity for detecting frontal lobe damage. To investigate the cerebral regions essential to the performance of the Card Sorting Test, we measured the regional cerebral blood flow (rCBF) in 18 normal subjects by PET under the three conditions: (i) during the Modified Card Sorting Test (MCST); (ii) during a matching-to-sample (MTS) task, based on the MCST, but with selective attention to one of three stimulus categories (colour, number or shape) as a control to cancel the effects of maintenance of sets in the MCST; (iii) under resting conditions as overall control. When rCBF during the MCST was compared with that during each MTS task separately, significant activations were observed during the MCST in the left or bilateral dorsolateral prefrontal cortex (DLPFC), bilateral inferior parietal lobes, left superior occipital gyrus and left cerebellum. Compared with all the MTS tasks inclusively, significant increase in rCBF was detected during the MCST in the bilateral DLPFC, inferior parietal lobes, striate cortex, cerebellum and left occipital cortex. These results suggest the involvement of the DLPFC and other related areas such as the inferior parietal cortex in the execution of the MCST, and may help explain why a variety of brain lesions can result in impaired performance on the Card Sorting Test.

Neuropsychological function in peripheral vascular disease amputee patients

Approximately 75% of major lower-extremity amputations are the result of peripheral vascular disease (PVD). Factors that predispose a patient to PVD (smoking, hyperlipidemia, diabetes mellitus) are also risk factors for the development of cerebrovascular disease, which could adversely affect rehabilitation. The purpose of this study was to test the hypothesis that cognitive deficits are present in amputee patients with PVD. Fourteen patients with lower-extremity amputations secondary to PVD (4 women, 10 men; mean age = 67.4 years) were recruited from a tertiary-care center for physical rehabilitation. Fourteen community-dwelling healthy volunteers (9 women, 5 men; mean age = 69.9 years) served as age-matched and education-matched controls. To assess a broad range of cognitive function, we administered standard neuropsychological tests of memory and learning, language, praxis, visuospatial skills, and abstract reasoning. PVD patients performed significantly more poorly on certain measures of psychomotor speed (Wechsler Adult Intelligence Scale-Revised Digit Symbol subtest) and problem solving/abstract reasoning (Modified Card Sorting Test) relative to controls (using the Bonferroni correction for multiple comparisons, p < .002). There were trends toward poorer patient performance on certain measures of oral fluency, concentration, reasoning, and visuoperceptual organization and constructional skills (p < .01). We propose that these cognitive deficits may be the result of unrecognized concomitant cerebrovascular disease in PVD patients and are part of a generalized pattern of vascular disease. Future research should control affective factors such as stress or depression surrounding amputation and attempt to identify the etiologic or demographic factors that are associated with neuropsychological deficits in patients with PVD.

An investigation of the relationship between perseveration and impulsiveness

Impulsive behaviour and perseveration are both associated with disorders affecting the frontal lobes. The present study found that perseverative responding on the Modified Card Sorting Test was significantly correlated with an ‘impulsiveness index’ derived from the Matching Familiar Figures Test in a normal sample. No significant relationship was found between perseveration and a questionnaire measure of impulsiveness. The implications of these results for the frontal lobe model of impulsiveness are discussed.

A Comparison of the Wisconsin Card Sorting Test with the Modified Card Sorting Test for Use with Older Adults

This study correlated the performance of 18 adults, 50 years old or older, on the Wisconsin Card Sorting Test (WCST) and on a modification of the test, the Modified Card Sorting Test (MCST), in which all ambiguous response cards had been removed. This common modification is reportedly less stressful for the subjects and is easier to interpret unambiguously. Six of eight correlations were significant, including both measures sensitive to preservation. These findings suggest that the WCST and MCST are measuring alternative to the WCST to help reduve the stress experienced by elderly patients during typical neuropsycological assessments.

Visuospatial problem solving, conceptual reasoning and sorting behaviour in multiple sclerosis out-patients

Visuospatial problem solving, conceptual reasoning and shifting of set were studied in out-patients with definite and probable MS. The sample of MS patients was homogeneous with respect to 2 important dimensions. All were out-patients, leading a normal although handicap-restricted social life. Furthermore, in all patients relapse or obvious instability of the disease were absent for at least a month. On Raven's Progressive Matrices, the Category test and the Wisconsin Modified Card Sorting test, no significant differences were found between the group of MS patients and a control group of healthy volunteers. However, 18% of MS patients and 4% of controls were rated as performing slightly below the expected levels of cognition. Stepwise regression analysis failed to reveal effects of illness variables, and no difference between patients with definite and probable MS could be detected. Clearly, most socially integrated MS patients in stable disease stages are capable of normal visuospatial problem solving, abstract reasoning and shifting of set.

A Modified Card Sorting Test Sensitive to Frontal Lobe Defects

Milner's (1963) report of impaired performance on the Wisconsin Card Sorting Test (WCST) in a group of patients with frontal lobe lesions suggested that this test might be a useful one in the investigation of individual patients with suspected brain lesions. However, for many of our older hospital population the WCST was found to be too difficult and distressing, and also the inherent ambiguities associated with certain responses limited the test's usefulness for research purposes. Therefore, a simpler and less ambiguous modification was devised (MCS) and a new method of measuring perseverative errors proposed. In a group of 53 patients with unilateral cerebral lesions, those with frontal lobe lesions performed less well with the MCST and made a higher proportion of perseverative errors than those with lesions elsewhere: there were no laterality effects in either frontal or non-frontal groups. The usefulness of the MCST for detecting frontal lobe lesions in individual patients was established, and the use of cut-off scores briefly discussed.

The effects of overtraining on a reversal and nonreversal shift

Children, 12–13 years old, were given criterion or overtraining on a modified card sorting test, then transferred to a reversal or nonreversal shift. Type of shift was found to be significant, while degree of training had no significant effect. While the results of reversal ease are interpreted in terms of the operation of a dimension-specific mediator, the failure to find an ORE is accounted for in terms of the S’s age, motivation, as well as prior experience in learning tasks.