Modified Wisconsin Card Sorting Test Research Articles

Similar profiles of cognitive domain deficits between medication-naïve patients with bipolar II depression and those with major depressive disorder

BackgroundBipolar disorder (BD) II is more likely to be misdiagnosed as major depressive disorder (MDD) than other types of BD, leading to incorrect treatment and poor outcomes. Previous studies have shown inconsistent results regarding the differences in cognitive deficits between the two disorders. To eliminate the compounding effects of medication and aging, we sought to investigate changes in cognitive function in medication-naïve, non-late-life patients with BDII and MDD. MethodsThree subject groups were enrolled: 30 depressed BDII patients, 30 depressed MDD patients and 30 healthy controls. All subjects underwent a battery of cognitive tests to assess 8 cognitive domains. The cognitive domains were compared between the three subject groups. In BDII and MDD, the effect sizes were computed as evaluation parameters, weighing the degree of the cognitive deficits and the correlations between cognitive test deficits and clinical variables were also computed. ResultsCompared with the controls, the BDII and MDD patients were characterized by similar deficits in psychomotor speed, working memory, visual memory, attention switching and verbal fluency. Moderate to severe deficits in the majority of cognitive tests were observed in the BDII and MDD patients. Furthermore, correlations between the modified Wisconsin Card Sorting Test total errors and age of onset in the BDII patients and between correct digit span responses (backward and total) and depressive severity were found in the MDD patients. ConclusionsOur findings suggest that BDII and MDD patients may suffer from similar profiles of cognitive domain deficits that may not assist in distinguishing between the two disorders. In addition, cognitive deficits may be correlated with the age of onset and depressive severity in mood disorders.

Modified Wisconsin Card Sorting Test (M-WCST): Normative data for Spanish-speaking pediatric population.

To generate normative data for the Modified Wisconsin Card Sorting Test (M-WCST) in Spanish-speaking pediatric populations. The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the M-WCST as part of a larger neuropsychological battery. Number of categories, perseverative errors, and total error scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. The final multiple linear regression models indicated main effects for age on all scores, such that the number of categories correct increased and total number of perseverative errors and total number of errors decrease linearly as a function of age. Age2 had a significant effect in Chile, Cuba, Ecuador, and Spain for numbers of categories; a significant effect for number of perseverative errors in Chile, Cuba, Mexico, and Spain; and a significant effect for number of total errors in Chile, Cuba, Peru, and Spain. Models showed an effect for MLPE in Cuba (total errors), Ecuador (categories and total errors), Mexico (all scores), Paraguay (perseverative errors and total error), and Spain (categories and total errors). Sex affected number of total errors for Ecuador. This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate way to interpret the M-WCST with pediatric populations.

Analysis of performance on a modified Wisconsin Card Sorting Test for the military

Purpose Current Army doctrine stresses a need for military leaders to have the capability to make flexible and adaptive decisions based on a future unknown environment, location and enemy. To assess a military decision maker’s ability in this context, this paper aims to modify the Wisconsin Card Sorting Test which assesses cognitive flexibility, into a military relevant map task. Thirty-four military officers from all service branches completed the map task. Design/methodology/approach The purpose of this study was to modify a current psychological task that measures cognitive flexibility into a military relevant task that includes the challenge of overcoming experiential bias, and understand underlying causes of individual variability in the decision-making and cognitive flexibility behavior of active duty military officers on this task. Findings Results indicated that non-perseverative errors were a strong predictor of cognitive flexibility performance on the map task. Decomposition of non-perseverative error into efficient errors and random errors revealed that participants who did not complete the map task changed their sorting strategy too soon within a series, resulting in a high quantity of random errors. Originality/value This study serves as the first step in customizing cognitive psychological tests for a military purpose and understanding why some military participants show poor cognitive flexibility.

Neurocognitive functions in inpatient suicide attempters and non-attempters: A comparison

IntroductionAccording to many studies, suicide attempters, compared to healthy general population, exhibit some neurocognitive deficits, which are considered promising endophenotype of suicidal behavior disorder. A similar pattern of impairment is widespread in individuals affected by psychiatric disorders.ObjectivesTo compare neurocognitive functions of hospitalized suicide attempters (A) with those of an inpatient group without history of suicidal behavior (NA), likewise affected by psychiatric disorders.AimsThe purpose of the study is to evaluate if neurocognitive impairment is associated to suicidal behaviors, regardless of underlying psychiatric diagnosis.MethodsThe whole sample is composed of 70 adult psychiatric inpatients (34 males, 36 females), divided into two groups (A and NA) of 35 patients with diagnosis of Psychotic, affective and personality disorders. Neurocognitive functions were assessed using Tower of London Test (TOL), Modified Wisconsin Card Sorting Test (MCST), Stroop Test (ST) and Attentional Matrices (AM). Differences between A and NA groups were analyzed using U-test of Mann–Whitney and cross tabulations, taking into account the three diagnostic areas.ResultsStatistically significant differences were found between A and NA with regard to the ability of categorization (MCST), planning, problem solving and inhibition of automatic response (TOL), which proved to be more preserved in A individuals. No significant differences were found on selective attention tasks (ST and AM).ConclusionsThese preliminary findings show statistically significant differences on executive functions between suicide attempters and psychiatric non-attempter individuals. Further research on larger samples is needed to investigate these associations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Two-step cluster analysis application to a sample of psychiatric inpatients at psychiatric service of diagnosis and care

IntroductionRecent findings demonstrated significant overlaps among major psychiatric disorders on multiple neurocognitive domains. However, it is not clear which are the cognitive functions that contribute to this phenomenon.ObjectivesTo find the optimal clustering solution using the two-step cluster analysis on a sample of psychiatric patients.AimsTo classify into subgroups a cross-diagnostic sample of psychiatric inpatients on the basis of their neurocognitive profiles.MethodsSeventy-one patients with psychotic, bipolar, depressive and personality disorders hospitalised at Psychiatric Diagnosis and Care Service of Bufalini Hospital of Cesena participated in the study. The symptomatology was assessed using Health of the Nation Outcome Scales-Roma and Brief Psychiatric Rating Scale. Cognitive functions were evaluated using Tower of London, Modified Wisconsin Card Sorting Test, Judgment and Verbal Abstract Tasks test, Raven matrices, Attentional Matrices, Stroop Test and Mini Mental State Examination. Two-step cluster analysis was conducted using the standardized scores of each neurocognitive test.ResultsTwo groups were obtained:– group 1, with good cognitive performances;– group 2, with almost all subjects having impaired cognitive performances.Executive functions and attention are the major determinants of the cluster solution. The clusters did not differ on socio-demographic correlates. Different diagnoses were equally distributed amongst the clusters.ConclusionsTwo-step cluster analysis was useful in identifying subgroups of psychiatric inpatients with different cognitive functioning, overcoming other cluster techniques limitations. According to former literature, these results confirm a continuum of severity in cognitive impairment across different psychiatric disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Performance of Verbal Fluency as an Endophenotype in Patients with Familial versus Sporadic Schizophrenia and Their Parents.

What’s the neurocognitive deficit as an endophenotype to familial schizophrenia? Here, we investigate the neurocognitive endophenotype in first-episode patients with familial schizophrenia (FS) and sporadic schizophrenia (SS), and their parents. 98 FS patients and their 105 parents; 190 SS patients and their 207 parents; 195 controls matched with patients, and 190 controls matched with the patients’ parents, were assessed with the short version of the Wechsler Adult Intelligence Scale-Revised in China (WAIS-RC), the immediate and delayed logical memory tests from the Wechsler Memory Scale-Revised in China (WMS-RC), the Verbal Fluency Test (VFT), the Trail Making Test Parts A and B-Modified (TMA, TMB-M), and the Modified Wisconsin Card Sorting Test (WCST-M). The results showed that with age, gender, and education as covariates, after controlling for false discovery rates, the FS group and their parent group performed worse than the SS group and their parent group on VFT. No significant differences were found for other neurocognitive tests between the FS and SS patient groups, and their respective parent groups. Our findings suggest the patients with familial and sporadic schizophrenia and their respective parent groups may have a different genetic predisposition in relation to a cognitive endophenotype.

Executive functioning and risk-taking behavior in Parkinson's disease patients with impulse control disorders.

Impulse control disorders (ICD) are common in Parkinson's disease (PD) and are associated with dopaminergic medication. The purpose of this study was to investigate executive function and risk-taking behavior in PD patients with ICD. 17 PD patients with ICD (ICD-PD) were compared to 20 PD patients without ICD (CTRL-PD) using neuropsychological and experimental tasks. Executive functions were assessed using standard executive testing (Conner's Performance Test, Modified Wisconsin Card Sorting Test, Trail Making Test and phonological verbal fluency). Subjects were also submitted to an experimental gambling task consisted of three decks of money cards: neutral deck (equal opportunity for gains as losses), winning deck (small amount of money with a positive balance) and loser deck (high amount of money with a negative balance), evaluating risk-taking behavior (number of cards picked in each deck) and valuation of the reward (subjective appreciation of the value of each deck). There was no significant difference in executive functioning between groups. Both groups selected more cards in the losing deck (high amount of money) as compared to the neutral deck (Mann-Whitney test, ICD-PD, p=0.02; CTRL-PD, p=0.003) and to the winning deck (Mann-Whitney test, ICD-PD p=0.0001; CTRL-PD p=0.003), suggesting an increased risk-taking behavior. Interestingly, we found that ICD-PD patients estimated the value of decks differently from CTRL-PD patients, taking into account mainly the positive reinforced value of the decks (Mann-Whitney test, p=0.04). This study showed that executive pattern and risk-taking behavior are similar between ICD-PD and CTRL-PD patients. However, ICD-PD patients showed a specific deficit of the subjective estimation of the reward. Links between this deficit and metacognitive skills are discussed.

Abnormal frontal theta oscillations underlie the cognitive flexibility deficits in children with high-functioning autism spectrum disorders.

Deficits in cognitive flexibility have been suggested to underlie the repetitive and stereotyped behavior in individuals with autism spectrum disorders (ASD). Because cognitive flexibility is primarily mediated by the frontal lobe, where structural and functional abnormalities have been extensively found in these individuals, it is conceivable that their deficits in cognitive flexibility are related to abnormal activations of the frontal lobe. The present study investigates cognitive flexibility and its underlying neurophysiological activities as indicated by theta oscillations in children with ASD. Twenty-five children with high-functioning ASD and 25 IQ- and age-matched typically developing (TD) children were subjected to neuropsychological assessments on cognitive flexibility and electroencephalography recordings. The children with ASD performed significantly worse than the TD children across the tasks of cognitive flexibility, including the modified Wisconsin Card Sorting Test (WCST). These children also demonstrated a reduced increase of the theta power localized in multiple brain regions, including various sectors of the frontal lobe at the late stage (i.e., 600 ms-900 ms poststimulus interval) but not the early stage (i.e., 250 ms-550 ms poststimulus interval) of the performance of the modified WCST. The suppressed late frontal theta activities were further shown to be significantly correlated with a poorer performance on the cognitive flexibility measures. Our findings suggest that abnormal activations of multiple cortical regions, especially the frontal lobe, form the neural basis of the cognitive flexibility deficits in children with ASD. In addition, we found an EEG marker of cognitive flexibility which could be used to monitor treatment outcomes objectively.

Test modificado de clasificación de tarjetas de Wisconsin: normalización y estandarización de la prueba en población española

The Modified Wisconsin Card Sorting Test (M-WCST) is a shorter, modified version of the WCST that assesses executive functioning and mental flexibility. The M-WCST presents some differences and advantages compared to other versions of the WCST, as previously described in the scientific literature. To standardize and develop demographically-calibrated norms for the M-WCST in a sample representing of the population of Spain. This study is part of the multisite Normacog project. Seven hundred participants from 18 to 90 years old were assessed using the M-WCST. The effects of age, sex, and educational level on M-WCST performance were analyzed, and demographically-calibrated percentiles and scaled scores corresponding to each raw score were created. The effect of age and level of education on the M-WCST variables analyzed (correct categories, perseverative errors and total errors) was statistically significant, whereas sex was not significant. Age and education explained 5.0-21.2% of the variance in M-WCST performance. Older participants with lower level of formal education completed fewer category sorts and made more errors than younger and more educated participants. This study reports the first normative data for the M-WCST in a contemporary Spanish sample, taking socio-demographic characteristics of the population into account. The influence of age and level of education on the M-WCST performance was confirmed.

Modified Wisconsin Card Sorting Test (M-WCST): Normative data for the Latin American Spanish speaking adult population.

To generate normative data on the Modified Card Sorting Test (M-WCST) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico. Each subject was administered the M-WCST as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. The final multiple linear regression models explained between 2-33% of the variance in M-WCST scores. Although t-tests showed significant differences between men and women from seven different countries on the M-WCST, the effect sizes were small. As a result, gender-adjusted norms were not generated. This is the first normative multicenter study conducted in in Latin America aiming to create norms for the M-WCST; this study will have important implications for the future of neuropsychology in the region.

Retraction Note to: Association of Catechol-O-methyltransferase val/met polymorphism with cognitive function in Gilles de la Tourette syndrome patients.

Gilles de la Tourette syndrome (GTS) is a kind of neuropsychiatric disorder with childhood onset. The cognitive dysfunction caused by GTS could affect the growth and learning of children and adolescents. The mechanism of cognitive functions was associated with dopaminergic system, thus we access the associations between polymorphism of some dopaminergic system-related genes including Catechol-O-methyltransferase (COMT) met/val, Dopamine receptor D4 (DRD4) exon III 48 bp VNTR (variable number of tandem repeats), Interleukin 1 (IL-1) Ra 86 bp and IL-1β exon 5, and cognitive functions in GTS patients. Genotyping analysis was performed through polymerase chain reaction (PCR). Test for cognitive functions of GTS patients included modified wisconsin card sorting test (WCST), trail making test, visual reproduction test, stroop test and verbal fluency test. The patients with COMT met/met genotype showed less perseverative errors in modified WCST test compared with patients with COMT val/val genotype (P < 0.05). Meanwhile, patients without allele val had better delayed memory in visual reproduction test, less errors in the stroop test and less perseverative errors in modified WCST test compared with patients with allele val (P < 0.05). However, no significant difference was found in cognitive functions among patients with different genotypes or alleles of polymorphisms of DRD4 exon III 48 bp VNTR, IL-1 Ra 86 bp and IL-1β exon 5 (P > 0.05). Polymorphism of COMT met/val was correlated with cognitive functions in GTS patients. This study provided basis for the analysis of molecular genetic pathology of cognitive dysfunctions in GTS.

Brazilian preliminary norms and investigation of age and education effects on the Modified Wisconsin Card Sorting Test, Stroop Color and Word test and Digit Span test in adults.

Executive functions are involved in a series of human neurological and psychiatric disorders. For this reason, appropriate assessment tools with age and education adjusted norms for symptom diagnosis are necessary.ObjectiveTo present normative data for adults (19-75 year-olds; with five years of education or more) on the Modified Wisconsin Card Sorting Test (MWCST), Stroop color and word test and Digit Span test. Age and education effects were investigated.MethodsThree samples were formed after inclusion criteria and data analysis: MWCST (n=124); Digit Span (n=123), and Stroop test (n=158). Groups were divided into young (19-39), middle-aged (40-59) and older (60-75) participants with five to eight years of education and nine years of education or more. Two-way ANOVA and ANCOVA analyses were used.ResultsEducation effects were found in most variables of the three tasks. An age effect was only found on color naming and color-word naming speed from the Stroop test. No interactions were detected.ConclusionIn countries with heterogeneous educational backgrounds, the use of stratified norms by education to assess at least some components of executive functions is essential for an ethical and accurate cognitive diagnosis.

An investigation of attributional style, theory of mind and executive functioning in acute paranoia and remission

This study assessed associations between attributional style and ToM measures in patients with paranoid symptoms and non-clinical controls, as well associations between these aspects of social cognition and executive skills. Using a longitudinal design, we further assessed performance on measures following the remission of paranoid symptoms. Patients and controls completed the Internal Personal and Situational Attributions Questionnaire (IPSAQ), ToM tasks, the Stroop, the modified Wisconsin Card Sorting Test (WCST) and a measure of premorbid IQ at time one. Following the remission of paranoid symptoms, the patient group repeated the assessment process. Patients had a higher personalising bias for negative events and impairments in second order false belief and executive skills compared to control participants. Personalising bias for negative events was associated with poorer IQ, a tendency to make perseverative errors, a poorer performance on the second order false belief task and more severe symptoms. Personalising bias for negative events, performance on the second order false belief task or the tendency to make perseverative errors did not significantly change following symptom remission. The findings increase understanding of the mechanisms that potentially underpin the development and maintenance of paranoia. Specifically targeting personalising attributions for negative events in remitted patients may be an important goal of psychological therapy.

Study on executive function in clinical subtypes of attention deficit hyperactivity disorder

Objective To explore the executive function in clinical subtypes of attention deficit hyperactivity disorder(ADHD). Methods 19 children with ADHD/ inattentive type(ADHD-I), 13children with ADHD/ hyperactive-impulsive(ADHD-HI) 33 children with ADHD/combined type(ADHD-C) and 30 normal children were tested by Stroop test (included Stroop C and Stroop CW), modified Wisconsin card sorting test(M-WCST), tower of Hanoi, digital span and verbal fluency. Results The scores of Stroop C and Stroop CW, digit inverse reciting, tower of Hanoi and WCST in the children with ADHD were worse than those in normal control((104.8±4.0), (105.9±4.2), (104.8±3.7), (104.8±4.0), P<0.05; (84.0±9.2), (84.8±7.9), (78.2±7.8), (92.2±7.1), P<0.01; (4.0±1.8), (3.7±1.2), (3.8±1.5), (5.1±1.6), P<0.01; (3.0±1.0), (3.3±1.0), (2.7±1.3), (3.8±1.3), P<0.01; (4.1±1.6), (4.2±1.9), (4.3±2.1), (5.4±1.7), P<0.05; (6.6±3.2), (6.7±2.4), (8.0±2.9), (5.3±2.4), P<0.01; (10.2±2.8), (11.1±3.8), (12.3±4.0), (9.4±3.2), P<0.05). The scores of Stroop CW in the children with ADHD-C were worse than those in other two subtypes(P<0.01). Conclusion The executive functions of the children with ADHD are impaired, including poor response inhibition, working memory, planning and cognitive flexibility. The dysfunction of response inhibition is possible an index to discriminate the subtypes of ADHD. Key words: Attention deficit hyperactivity disorder; Subtype; Executive function

A-37 * A Normative Study of the Modified Wisconsin Card Sorting Test across Latin American Countries

Objective: To systematically generate the first and most comprehensive demographic-adjusted norms for the Modified Wisconsin Card Sorting Test (M-WCST) in Latin America. Method: The sample consisted of 3, 279 healthy subjects from 10 countries in Latin America that approximated the demographic distribution of the countries' populations. The majority of participants were women (61.3%), and the average age was 50.1 ± 20.0 years. The average length of education was 10.2 ± 5.6 years. Participants completed the M-WCST. Results: Two analyses of variance (ANOVAs) showed significant differences in age and education among countries (p's < .001). An ANOVA adjusted by age and education was then run that showed significant differences among countries in categories scores on the M-WCST, F(9, 3255) = 29.11, p < .001, suggesting the development of differential norms by country. A linear regression yielded main effects for age (β = −.240; p < .001) and education (β = .395; p < .001) on the M-WCST (R2 = .268). As a result, age and education corrections were created, and a table of percentiles by country was calculated based on the distribution of corrected scores. In the table, percentiles for individual raw scores are generated by adding the corrections and looking up the resulting corrected score for patients in a particular country. Conclusion(s): This study was the first to create norms for the M-WCST across Latin America and include appropriate adjustments for age and education. These data represent a critical advance in the assessment of cognitive deficits among individuals with and without neurological conditions in Latin America.

Verbal and visuospatial executive functions in healthy elderly: The impact of education and frequency of reading and writing.

ObjectiveTo assess the predictive role of education and frequency of reading and writing habits (FRWH) on the cognitive flexibility, inhibition and planning abilities of healthy elderly individuals.MethodsFifty-seven healthy adults aged between 60 and 75 years with 2 to 23 years of formal education were assessed as to the frequency with which they read and wrote different types of text, as well as their number of years of formal education. Executive functions were evaluated using the Hayling Test and the Modified Wisconsin Card Sorting Test (MWCST).ResultsWeak to moderate positive correlations were found between education, FRWH and the number of categories completed in the MWCST, while negative correlations were identified between these variables and the number of perseverative and non-perseverative errors on the task. Only the FRWH was significantly correlated with the number of failures to maintain set. Speed and accuracy on the Hayling Test were only correlated with participant education. Both education and FRWH significantly predicted performance on the MWCST, and the combination of these two variables had a greater predictive impact on performance on this task than either of the two variables alone. Variability in scores on the Hayling Test was best accounted for by participant education.ConclusionIn this sample of elderly subjects, cognitive flexibility was sufficiently preserved to allow for adequate performance on verbal tasks, but may have benefitted from the additional stimulation provided by regular reading and writing habits and by formal education in the performance of more complex non-verbal tasks.

Relationship between diminished expression and cognitive impairment in first-episode schizophrenia: A prospective three-year follow-up study

BackgroundDiminished expression (DE) is a core sub-domain of negative symptoms construct in schizophrenia. There is limited, yet inconsistent data regarding DE and its associations with cognition, particularly in the early illness course. This study aimed to examine cross-sectional and longitudinal relationships of DE with cognitive functions in first-episode schizophrenia utilizing a prospective design. MethodNinety-three Hong Kong Chinese aged 18 to 55years presenting with first-episode schizophrenia-spectrum disorder were studied. Severity of DE was measured as sum of individual item scores indicative of affect flattening and alogia. Symptom evaluation was conducted at intake, after clinical stabilization of first psychotic episode, at 12, 24 and 36months. Cognitive functions were evaluated at clinical stabilization, 12, 24 and 36months. ResultsDE was significantly correlated with various cognitive functions in successive follow-up assessments. Regression analyses adjusting confounding effects of sex, pre-morbid adjustment, duration of untreated psychosis and chlorpromazine equivalents showed that DE was associated with performance on verbal fluency at 12 (p<0.01) and 24months (p<0.05), visual reproduction at 24 (p<0.05) and 36months (p<0.01), logical memory at 36months (p<0.05) and Modified Wisconsin Card Sorting test at 24 (p<0.05) and 36months (p<0.05). Neither cross-lagged associations between DE and cognition nor significant correlations between changes in these two domains over three years were observed. ConclusionsDE and cognitive functions were correlated concurrently but no longitudinal associations between these two domains could be demonstrated. Our findings indicated that DE and cognitive impairment represented relatively independent domains of the illness with potentially distinctive therapeutic implications.

Correlates of insight with symptomatology and executive function in patients with first-episode schizophrenia-spectrum disorder: A longitudinal perspective

The present study aimed to examine the relationships of insight with symptomatology and executive function, both cross-sectionally and longitudinally in patients with first-episode schizophrenia-spectrum disorders. Ninety-two medication-naïve patients were recruited and 71 completed the assessments. Insight, symptoms and executive function were assessed at baseline, 6 months and 1 year. Insight was measured with the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Executive function was measured with the Modified Wisconsin Card Sorting Test (MCST). The most significant improvement of insight and symptomatology was found over the first 6 months, whereas the perseverative errors of MCST were significantly improved between 6 and 12 months. Differential correlations of perseverative errors of the MCST and PANSS scores with SUMD were found at different time points. This suggests the involvement of different mechanisms in insight deficit at different stages of the illness. The baseline MCST perseverative errors were correlated significantly with the SUMD total score at 6 months and the change of SUMD scores over the first 6 months. Although the variance explained was small, it suggests better set-shifting capacity facilitates the improvement of insight at an early stage of the illness.

Longitudinal study of cognitive and psychiatric functions in spinocerebellar ataxia types 1 and 2

The role of the cerebellum in cognition, both in healthy subjects and in patients with cerebellar diseases, is debated. Neuropsychological studies in spinocerebellar ataxia type 1 (SCA1) and type 2 (SCA2) demonstrated impairments in executive functions, verbal memory, and visuospatial performances, but prospective evaluations are not available. Our aims were to assess progression of cognitive and psychiatric functions in patients with SCA1 and SCA2 in a longitudinal study. We evaluated at baseline 20 patients with SCA1, 22 patients with SCA2 and 17 matched controls. Two subgroups of patients (9 SCA1, 11 SCA2) were re-evaluated after 2 years. We tested cognitive functions (Mini Mental State Examination, digit span, Corsi span, verbal memory, attentional matrices, modified Wisconsin Card Sorting Test, Raven Progressive Matrices, Benton test, phonemic and semantic fluency), psychiatric status (Scales for Assessment of Negative and Positive Symptoms, Hamilton Depression and Anxiety Scales), neurological conditions (Scale for Assessment and Rating of Ataxia), and functional abilities (Unified Huntington Disease Rating Scale–part IV). At baseline, SCA1 and SCA2 patients had significant deficits compared to controls, mainly in executive functions (phonemic and semantic fluencies, attentional matrices); SCA2 showed further impairment in visuospatial and visuoperceptive tests (Raven matrices, Benton test, Corsi span). Both SCA groups had higher depression and negative symptoms, particularly apathy, compared to controls. After 2 years, motor and functional disability worsened, while only attentive performances deteriorated in SCA2. This longitudinal study showed dissociation in progression of motor disability and cognitive impairment, suggesting that in SCA1 and SCA2 motor and cognitive functions might be involved with different progression rates.

Clinical and cognitive correlates of insight in first-episode schizophrenia

This study aims to explore the relationship between clinical symptoms and cognitive functions with different insight dimensions in patients with first-episode schizophrenia. Seventy-nine patients were assessed following six months of treatment. Insight was assessed using the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using Positive and Negative Syndrome Scale (PANSS). Cognitive functions were assessed using the Modified Wisconsin Card Sorting Test (MWCST), semantic verbal fluency and the letter-number sequencing (LNS) test from the Wechsler Adult Intelligence Scale (WAIS). Positive, negative and disorganized symptoms were found to be correlated with overall insight and all three general insight dimensions. Only perseverative errors and categories completed of MWCST were correlated with overall insight. Perseverative errors and non-perseverative errors of MWCST were correlated with the awareness of medication effects; perseverative errors of MWCST were also correlated with the awareness of social consequence of the illness. These support the link between poor insight and impaired executive function particularly measured by MWCST. The specific correlation of cognitive functions and different dimensions of insight suggests different underlying mechanism within each dimension of insight. The combined model of symptomatology and cognitive function explained 20.6% to 36.4% of the variance in the lack of insight within the different dimensions. The modest combined relationship of clinical and cognitive function with insight suggests that the exploration of other models in relationship to different insight dimensions is important.