Perseverative Responses Research Articles

Characteristics of deficit syndrome schizophrenic outpatients: Neuropsychological and social functioning

Patients with first-episode schizophrenia (n = 27) and age- and education-matched healthy controls (n = 27) were administered the standard version of the Wisconsin Card Sorting Test (WCST), the Wechsler Adult Intelligence Scale-Revised (WAIS-R), and the Rorschach according to the Comprehensive System (CS). Schizophrenic patients achieved a significantly lower full-scale IQ and made more perseverative responses and achieved fewer categories on the WCST than the healthy control group. No significant associations were observed between effort or motivation and WCST performance. Schizophrenic patients who made more perseverative responses tended to be impoverished in terms of available resources, and functioned in a simplistic way when attending to details of the stimulus field. First-episode schizophrenics are able to generate motives and initiate goal-directed activity, but some of them fail to achieve their goals because the cognitive abilities and available resources required for effective planning, purposeful action, or effective performance are impaired.

Affective blunting in schizophrenia reflects both affective deficit and neuromotor dysfunction

Neuropsychological findings support a hypothesized relationship between obsessive-compulsive disorder (OCD) and the frontal lobe. The aim of the present study was to compare findings of neuropsychological tests of frontal lobe function in 28 OCD patients and 29 patients with major depressive disorder (MDD), all diagnosed according to DSM III-R criteria. The patient groups were homogeneous for educational level, handedness, duration of illness, and sex distribution. All 57 subjects received a battery of tests sensitive to frontal lobe dysfunction as well as the Wechsler Memory Scale (WMS). Clinical symptomatology in the MDD and OCD groups was assessed with the Hamilton Rating Scale for Depression and the Yale-Brown Obsessive-Compulsive Scale, respectively. The only significant difference between the two diagnostic groups for any of the neuropsychological indices, with age as a covariate, was in the Object Alternation Test, in which OCD patients had a significantly higher number of perseverative responses. Test performances were not correlated with clinical symptomatology or severity of illness. Our preliminary results confirm the hypothesis that there is a selective impairment of orbito-frontal cortex in OCD and seem to exclude the existence of specific frontal lobe dysfunction in MDD, even though the two disorders show clinical similarities.

The gating paradigm: effects of presentation format on spoken word recognition by children and adults.

This study focused on the impact of stimulus presentation format in the gating paradigm with age. Two presentation formats were employed--the standard, successive format and a duration-blocked one, in which gates from word onset were blocked by duration (i.e., gates for the same word were not temporally adjacent). In Experiment 1, the effect of presentation format on adults' recognition was assessed as a function of response format (written vs. oral). In Experiment 2, the effect of presentation format on kindergarteners', first graders', and adults' recognition was assessed with an oral response format only. Performance was typically poorer for the successive format than for the duration-blocked one. The role of response perseveration and negative feedback in producing this effect is considered, as is the effect of word frequency and cohort size on recognition. Although the successive format yields a conservative picture of recognition, presentation format did not have a markedly different effect across the three age levels studied. Thus, the gating paradigm would seem to be an appropriate one for making developmental comparisons of spoken word recognition.

Neuropsychological correlates of intractable anxiety disorder before and after capsulotomy.

A comprehensive neuropsychological test battery was administered to 10 consecutive patients undergoing neurosurgical intervention, capsulotomy, as a last resort treatment for chronic, incapacitating, and otherwise intractable illness, either obsessive-compulsive disorder (OCD; n = 5) or non-OCD anxiety disorder (n = 5). The aim was to study the neuropsychology of severe anxiety disorders before and after a defined neurosurgical intersection of connections between the frontal lobes and related brain regions. Although extremely disabled by their illness before surgery, the patients performed within the normal range on most tests. After capsulotomy, there was significant improvement on measures of clinical morbidity and of psychosocial functioning, and the general neuropsychological performance remained remarkably intact. In a subgroup of 5 patients, however, perseverative responses were more common postoperatively, possibly indicating dysfunction of systems involving the frontal lobes. Although admittedly sparse, these data can be interpreted as suggesting that in vulnerable individuals, capsulotomy may give rise to increased perseverative behaviour in the laboratory, and possibly in the real world as well. This risk must be weighed against the potential clinical benefit of capsulotomy in this extremely disabled, sometimes suicidal patient population.

Psychological mechanisms of enhanced risk of addiction in children of alcoholics: a dual pathway?

The background and rationale of a recently started project of the Amsterdam Institute for Addiction Research are outlined. This project is aimed at the psychological mechanisms underlying an enhanced risk of (later) addiction in children of alcoholics and the relationship with childhood psychopathology. A dual pathway mechanism is proposed, in which the type of alcoholism of the parent plays a major role. The child of a multigenerational primary alcoholic parent may suffer from an inherited mild dysfunction of the prefrontal cortex, expressed in neuropsychological and personality characteristics similar to those of the alcoholic parent. These are impulsive, aggressive and reward-seeking behaviour, response perseveration and, in some children, related psychopathology such as conduct disorders. For a child of a secondary alcoholic parent, another mechanism is proposed. In these children, stress and social learning may lead to negative affectivity and repressive coping style, with emotional problems at a later age, and the risk of falling into the "circle of secondary alcoholism". In both pathways, alcohol-related expectancies are suggested to constitute a "final common pathway" between different risk factors and later alcohol abuse. Specific expectancies might be related to different pathways and to gender differences in later drinking patterns.

Effects of methylazoxymethanol-induced micrencephaly on temporal response differentiation and progressive ratio responding in rats

Micrencephalic Sprague-Dawley rats were produced by an injection of 20 mg/kg methylazoxymethanol acetate on gestational Day 14. Brain weights of the offspring were 70% of controls while weights of frontal cortex and hippocampus were approximately 58% (Ferguson, Racey, Paule, & Holson, 1993). Operant performance was measured with particular emphasis on assessment of time estimation. The temporal response differentiation (TRD) and the progressive ratio (PR) tasks, previously used in the NCTR operant test battery for monkeys, were chosen for evaluation. The TRD schedule is notably different from other temporal tasks in that it requires subjects to initiate and maintain a lever press for 10-14 s. The PR task was included as a measure of motivation to work for food reinforces. Micrencephalics acquired and performed both tasks comparably to controls. During extinction, however, micrencephalics exhibited an increased TRD lever hold duration. This suggests an atypical response perservation, that is, perseverating the previously correct response. Previously, frontal cortical alterations were suggested to contribute heavily to micrencephalic-induced behavioral alterations (Ferguson et al., 1993). This study provides further evidence that response perseveration, a hallmark of frontal cortical lesions, is expressed in micrencephalic rats.

Comparison of Four Wisconsin Card Sorting Test Scoring Guides With Novice Raters

The utility of the Wisconsin Card Sorting Test (WCST) is predicated on the ability of its users to accurately administer and score the task. This study evaluated four different WCST scoring guides in an effort to determine the most reliable and accurate instructional set for use by individuals previously unfamiliar with scoring the WCST. The study targeted the scoring of perseverative responses, as this is the most difficult of the measures to learn. Novice raters using one of four methods (original manual alone, decision tree [key guide] with the original manual, written supplement with the original manual, and revised manual only) and expert raters each scored 20 technically difficult WCST protocols. The results demonstrated that novice raters who used the written supplement to score these difficult protocols were as reliable and accurate in scoring perseverative responses as the experts. Those who used either the original manual alone or the key guide with the manual were less reliable. Scoring perseverative responses with the revised manual's instructions was considerably more reliable and accurate than scoring with the original manual. However, scoring performance for perseverative responses with the revised manual did not achieve that of the novice raters using the written supplement. It is recommended that scoring accuracy for cognitive measures be empirically validated rather than assumed.

Relationship between frontal lobe lesions and Wisconsin Card Sorting Test performance in patients with multiple sclerosis.

Conceptual reasoning deficits are common in patients with multiple sclerosis (MS) and are typically associated with focal lesions involving the frontal lobes. In this study, we predicted that MS patients with frontal white matter lesions (MS-F) would be more impaired on a standard conceptual reasoning task (Wisconsin Card Sorting Test; WCST) than patients with minimal frontal lesions (MS-NF), even if the total cerebral lesion area (TLA), measured from MRI, was equivalent across groups. We subdivided 43 definite MS patients into three groups based on MRI findings: seven in the MS-F group (mean TLA = 41.4 cm2) and seven in the MS-NF group (mean TLA = 50.0 cm2); 29 MS patients served as a low lesion burden control group (MS-C; mean TLA = 6.4 cm2). The groups did not differ with regard to demographic and illness characteristics. Although the three subgroups obtained comparable scores on a measure of global cognitive functioning (verbal intelligence), the MS-F group achieved significantly fewer categories and made more total errors on the WCST than did the MS-NF and MS-C groups. The MS-F group made significantly more perseverative responses than the MS-C group and nonsignificantly more than the MS-NF group. These results suggest that the pattern of cognitive decline in MS is a function of the location of demyelinating lesions within the cerebral hemispheric white matter. Finally, we supplement the group study results with a case report of an MS patient who was studied serially with MRI and cognitive testing.

Wisconsin Card Sorting Test performance before and after temporal lobectomy

Wisconsin Card Sorting Test (WCST) performance was studied before and after patients underwent right (n = 34) or left (n = 34) temporal lobectomy. Patients had hemisphere language dominance judged on intracarotid amobarbital testing and were free of space-occupying lesional pathology by magnetic resonance imaging (MRI). Right and left lobectomy patients did not differ before or after surgery on WCST parameters: categories completed, perseverative errors, total correct responses, total errors, nonperseverative errors, and perseverative responses. There was no relationship between WCST performance and MRI-determined hippocampal volumes or age of recurrent seizure onset. These findings are contrary to previous reports, suggesting the presence of laterality effects on preoperative WCST performance, relationships between WCST performance and age of seizure onset, and association of WCST performance and degree of mesial temporal sclerosis. Data from this study are consistent with a report on a larger group of temporal lobectomy patients, which found no laterality effect on WCST performance. The WCST seems to be of no value when attempting to lateralize seizure onset in nonlesional temporal lobe epilepsy.

Memory for facts, source, and context: Can frontal lobe dysfunction explain age-related differences?

Age-related differences in memory for facts, source, and contextual details were examined in healthy young (18-35 years old) and old (65-80 years old) volunteers. In all tested memory functions, decline over time was greater in the elderly than in the young. A time-dependent increase in the prevalence of source amnesia errors was clearly associated with old age. Contrary to several recent reports, measures of frontal lobe functions did not predict source memory. Nevertheless, some of these putative frontal function measures were related to memory for contextual details. The number of perseverative responses on the Wisconsin Card Sorting Test was inversely related to performance on both factual and contextual memory tests, but the association with contextual memory was stronger. Difficulties with response selection on a Stroop task predicted poor contextual memory in young but not in old adults.

Can perseverative responses on the Wisconsin card sorting test be scored accurately?

Anecdotal reports have led to questions concerning the reliability and accuracy with which Heaton's Wisconsin Card Sorting Test perseverative response criteria can be applied. In addressing this question, this study found that practicing clinicians were less accurate than “experts” and two groups of novices. A computer scoring system allowed one novice to score with “expert” level accuracy. Utilization of this system should increase scoring accuracy. However, the program cannot accurately score protocols when the response cards are in nonstandard order. Solutions to this problem are discussed.

Effects of in Utero Methylmercury Exposure on a Spatial Delayed Alternation Task in Monkeys

Adult female monkeys ( Macaca fascicularis) were exposed to 0, 50, 70, or 90 μg/kg/day of methylmercury prior to and throughout pregnancy and produced 11, 9, 2, and 2 infants, respectively. At birth, blood mercury levels of treated infants ranged from 1.04 to 2.46 ppm. At approximately 7 to 9 years of age, the monkeys were trained by successive approximation to respond on a lit button for a small amount of apple juice. The monkeys were then trained on a 0.1-sec spatial delayed alternation task to a specified criterion of performance. This was followed by 10 sessions each of fixed delay times of 0.5, 1, 3, 5, and 10 sec, followed by 20 sessions containing variable delay times of 0.1 to 15 sec. Data from all treated monkeys were combined. There were no differences between treated and control monkeys in initial button training or number of sessions to reach criterion on 0.1-sec delay procedure. On the fixed delay sessions, the treated monkeys had significantly more correct trials, and fewer incorrect responses, perseverative responses, and delay responses than controls. There were no differences between the treated and control monkeys on performance on the variable delay schedule. Results from this study indicate that in utero methylmercury exposure did not adversely affect the spatial memory of adult monkeys when tested on a delayed alternation task and may have facilitated performance on this task.

Problem-solving deficits in alcoholics: evidence from the California Card Sorting Test.

In an attempt to clarify the nature of the problem-solving deficits exhibited by chronic alcoholics, the California Card Sorting Test (CCST) and other measures of abstraction and problem solving were administered to 23 alcoholics and 16 nonalcoholic controls, equated for age, education and vocabulary. On the CCST, the alcoholics exhibited three types of deficits which appeared to be relatively independent. First, the alcoholics generated and identified fewer correct concepts than controls, although they executed concepts normally when cued by the examiner. Second, the alcoholics made more perseverative sorting responses and perseverative verbal explanations for their sorting behavior than did controls. Third, alcoholics provided less complete verbal explanations of the concepts that they correctly generated or identified. The differential importance of these factors on various measures of problem solving may help to explain the varied patterns of inefficient problem solving exhibited by alcoholics.

Unawareness of illness and neuropsychological performance in chronic schizophrenia

This research attempts to explore empirically the relationship between lack of illness and neuropsychological performance in a group of chronic schizophrenic subjects. Thirty one chronic schizophrenics were administered the recently developed Scale to Assess Unawareness of Mental Disorder (SUMD) and 3 neuropsychological tests that have demonstrated ability to assess frontal lobe performance: the Wisconsin Card Sorting Test (WCST), Verbal Fluency Test and Trails A and B. The number of categories completed and the percent perseverative responses on the WCST were found to significantly correlate with lack of illness awareness as measured by the SUMD. These two WCST variables were also able to significantly discriminate between subjects of high versus low awareness. A discriminant function analysis found that a linear combination of WCST percent perseverative responses and symptom severity could successfully categorize 84% of the aware versus unaware subjects. These results are taken to support the hypothesis that at least in some of its manifestations lack of awareness among chronic schzophrenics has an organic etiology probably mediated by the frontal lobes.

Age differences on the California Card Sorting Test: Implications for the assessment of problem solving by the elderly

The performance of young, middle-aged, and old groups of healthy normal controls was compared on two tests of problem solving: the Wisconsin and the California Card Sorting Tests (WCST and CCST). In agreement with previous studies of the WCST, subjects 60 years of age and older achieved fewer categories and made more perseverative responses and errors than did younger subjects. However, the number of categories achieved and the measures of perseveration were so highly and negatively correlated that they are not likely to be independent. On the CCST, which provides multiple measures of performance, the old subjects generated and identified fewer correct concepts and executed concepts less accurately when guided by abstract cues, but they showed increased perseveration on only one of three measures. Furthermore, the old subjects executed concepts in response to explicit cues and explained the correct sorts that they produced as accurately as did the younger subjects. Recent studies demonstrate that distinctive patterns of problem-solving impairment on the CCST are exhibited by patients with Parkinson’s disease, multiple sclerosis, chronic alcoholism, or schizophrenia, although performance by patients with these disorders is qualitatively indistinguishable on the WCST. Since the CCST is about twice as sensitive as the WCST for detecting impairment in patients with Parkinson’s disease, the CCST may prove especially useful for evaluating problem solving in the elderly.

Response perseveration, inhibitory control, and central dopaminergic activity in childhood behavior disorders.

We screened students (N = 710) in grades four through six at two public elementary schools for behavior problems, using the Revised Behavior Problem Checklist. Five groups of children were identified: conduct disorder (n = 8), attention deficit disorder (n = 9), conduct disorder plus attention deficit disorder with hyperactivity (n = 11), anxiety-withdrawal (n = 12), and normal control (n = 15). A response perseveration task, inhibitory control task, and a noninvasive measure of dopaminergic activity were administered to selected students, and group differences were predicted based on Quay's hypotheses as derived from Gray's theory of brain function. Hypothesized group differences were not found, although analyses revealed dimensional relationships that were consistent with the hypotheses. Results are discussed in terms of Quay's hypotheses and potential modifications to tasks for future research.

Executive function and social communication deficits in young autistic children.

Preschool-aged, autistic children were compared with both developmentally delayed children of similar non-verbal mental age and normally developing children of similar verbal skill on measures of executive function and social communication skills. Autistic children exhibited significantly more perseverative responses on a test of executive function when compared to both comparison groups. Autistic children also exhibited significantly fewer joint attention and social interaction behaviors. Moreover, a significant relationship was found between executive function skill and the two social communication skills, which was independent of group membership or verbal ability. Competing hypotheses to account for the relationship between executive function deficits and social communication deficits in autism are discussed.

Risk for alcoholism, antisocial behavior, and response perseveration.

Numerous studies have demonstrated the existence of an association between alcoholism and antisocial personality (ASP). The present study tested two hypotheses: First, that nonalcoholic men with a multigenerational familial history (MGH) of alcoholism would play more cards on a card task that has been shown previously to differentiate antisocial populations from normals and, second, that MGH subjects would display more evidence of ASP on two personality questionnaires: The Self-Report Psychopathy scale and the Socialization scale of the California Psychological Inventory. A total of 28 subjects (14 MGH and 14 family history negative for alcoholism [FH-]) were employed in this study. MGH subjects played significantly more cards during the card task than did FH- subjects. However, the two groups did not differ on the ASP questionnaires. The possibility that a subtle frontal-lobe deficit, rather than ASP per se, underlies the poorer performance of the MGH males is discussed.

Evaluation of response perseveration of rats in the radial arm maze following reinforcing and nonreinforcing drugs

The behavioral effects of three drugs with high abuse potential (amphetamine, heroin, and nicotine) and two substances with low abuse potential (haloperidol and scopolamine) were evaluated in an eight-arm radial maze. Rats were trained to explore the maze for the food reward. Unlike most radial arm maze paradigms, a food pellet was made available every time the rat entered an arm; thus, no external restrictions were placed upon rats' exploratory pattern. Following 3 days of drug-free training, rats were injected prior to testing with one of the five drugs. Analysis of the sequences of arm entries demonstrated that the variability of the search strategy was significantly decreased by amphetamine, heroin, and nicotine. In contrast, scopolamine and haloperidol either decreased or had no effect on perseveration. These data, along with previous data on ethanol and diazepam, lead to the speculation that drugs of abuse may share the common property of reducing behavioral variability.

Wisconsin Card Sorting Test performance in healthy, older adults: relationship to age, sex, education, and IQ.

We obtained Wisconsin Card Sorting Test (WCST) scores on 91 (35 male and 56 female) healthy, well-educated individuals aged 45 to 83. Women scored better than men on six WCST scores (categories, errors, perseverative responses, % perseverative errors, % conceptual level responses, and trials to first category), while subjects with more than 16 years of education outscored those limited to high school education on four measures (perseverative responses, errors, % perseverative errors, % conceptual level responses). Individuals older than 70 years of age scored less well than younger subjects on only two indices (errors, % conceptual level responses). Full Scale IQ was not related to WCST scores. Our findings suggest that WCST scores should be interpreted within the context of patient gender, education, and age.