Wisconsin Card Sorting Research Articles

Neuropsychological profile in young girls at high risk of developing anorexia nervosa.

Previous research has shown anorexia nervosa (AN) to be associated with a specific neuropsychological profile, including set-shifting and central coherence deviances. A similar profile has been shown in adult unaffected relatives. The aim of this study was to examine whether poor set-shifting and central coherence abilities could be detected in children at high risk of developing AN. Twenty-eight biological healthy daughters of women with previous or current AN and 42 biological daughters of healthy women, all between six and 12 years of age, participated in the study. A neuropsychological test battery (Wechsler Intelligence Scale for Children, Wisconsin Card Sorting Test, Trail Making Test and Rey Complex Figure Test) was used to assess set-shifting and central coherence abilities. No differences in set-shifting or central coherence performance were detected between the high-risk group and the comparison group. Adjustments for age and intelligence quotient (IQ) did not affect the results. Our results did not support the notion of preexisting neuropsychological deficits in AN-related cognitive domains among high-risk girls.

Acute exercise impacts heart rate variability but not cognitive flexibility during subsequent simulated firefighter occupational tasks.

Acute exercise can transiently enhance cognitive flexibility. The cognitive demand of firefighters makes it relevant to understand if on-shift exercise could produce similar improvements in cognitive performance during subsequent occupational tasks. Metrics of heart rate variability (HRV), such as time- and frequency-domain outcomes, may shed light upon the influence exercise has on cognition, as they discern information related to cardiac autonomic (sympathetic/parasympathetic) function. We aimed to determine if acute resistance and aerobic exercise impact cognitive flexibility during occupational tasks and its relation to HRV. 32 participants completed a baseline Wisconsin Card Sorting Task (WCST) and three experimental trials: resistance exercise (RE), aerobic exercise (AE), or a rested control (CON). An occupational task assessment (OTA) including four rounds of 10 deadlifts and a 0.15-mile sandbag carry in an environmental chamber (35°C/50% humidity) was completed after each trial. The second round was followed by the WCST. Repeated measures ANOVAs were used to analyze differences by condition. For the WCST, total, perseverative, and non-perseverative errors did not differ (ps > 0.39). Time-domain HRV metrics were not different (ps > 0.05). All frequency-domain metrics, other than low-frequency power, were not different (ps > 0.24). Low-frequency power was lower based on condition (p = 0.03). Post hoc analysis showed low-frequency power was lower following AE compared to RE and CON. Results suggest an acute bout of on-shift aerobic or resistance exercise may not impact cognitive flexibility during subsequent simulated occupational tasks, despite depressed metrics of heart rate variability following aerobic exercise.

Assessing cognitive impairment in chronic pain: a cross-sectional study with healthy controls

Purpose The aim of this study is to clarify inconsistencies in the literature regarding the neuropsychological impact of chronic pain and determine how pain catastrophizing and pain intensity may explain cognitive impairment. Methods This cross-sectional study involved 30 participants with chronic primary musculoskeletal pain and 30 healthy controls without pain. The instruments used were the Pain Catastrophizing Scale, the Visual Analogue Scale, the Beck Anxiety Inventory, the Beck Depression Inventory–II, the Wisconsin Card Sorting Test, the Stroop Test, and the Working Memory Index of the Wechsler Adult Intelligence Scale. Results Chronic pain patients showed slight cognitive impairments in selective attention, sustained attention, working memory, problem solving, planning, abstract reasoning, inhibition, and resistance to interference. The data also indicate that higher levels of pain catastrophizing and pain intensity were independently associated with greater cognitive impairment in patients with pain, specifically in attention and executive functioning. Additionally, the interaction between these pain-related variables predicted further cognitive impairment. Conclusions This research has contributed to establishing the neuropsychological profile of patients with chronic primary musculoskeletal pain and reinforces evidence of the impact of chronic pain on cognition. These findings may help guide the design of programs aimed at improving cognitive performance.

Impaired cognitive flexibility in schizophrenia: A systematic review of behavioral and neurobiological findings

Background and hypothesisImpaired cognitive flexibility in schizophrenia (SZ) is well documented and correlation with worse functional outcome indicates clinical relevance. Paradigms that assess cognitive flexibility include the Wisconsin Card Sorting Test (WCST) and the Cambridge Neuropsychological Test Automated Battery’s (CANTAB) Intra-Extra Dimensional Set Shift (IED). This systematic review provides an overview of the current state of research on cognitive flexibility in schizophrenia and points out relevant areas of non-consensus. MethodsTwo electronic databases (Embase and PubMed) were searched for records published from 1993 to 2024 on adult SZ patients that were assessed for cognitive flexibility/set-shifting ability using WCST and/or IED. Results38 studies were included in the review, most of which reported significantly worse performance of SZ patients in WCST and/or IED compared to healthy controls (HC). Most publications focused on the specific profile of cognitive inflexibility. Other aspects included progression of cognitive inflexibility over the course of the illness, neurobiological correlates, IQ as a possible confounder and whether cognitive inflexibility is a heritable trait. ConclusionIncluded studies show that cognitive inflexibility rather reflects a stable trait than a state, indicating a lasting prefrontal impairment in SZ. Further longitudinal studies are needed to clarify how these deficits evolve during progression of the disorder. Neither antipsychotic medication nor intelligence seem to explain impaired cognitive flexibility. However, a disease-specific cognitive phenotype has not yet been established and additional research on neuro-computational mechanisms is thus needed to identify possible targets for interventional studies.

Chanting and meditation: an 8-week intervention to promote executive functions in school-age children

The present study investigated the effectiveness of a newly developed 8-week meditation program, which included chanting and meditation, on executive functions (EFs) in school-age children. Twenty-five students assigned to an experimental group participated in the meditation program, engaging in daily and weekly activities for 8 weeks. Another 25 students served as a control group and participated in regular school activities. Pretest and posttest assessments included the n-back task for working memory, the go/no-go task for inhibition, and the Wisconsin Card Sorting Test (WCST) for cognitive flexibility. A mixed repeated measures ANOVA was conducted to analyze interaction effects, within-group differences, and between-group differences. The experimental group demonstrated greater improvement compared to the control group across several measures: (1) reaction time in the 1-back task, (2) correct responses in the no-go condition of the go/no-go task, and (3) percentage of correct responses, errors, perseverative errors, non-perseverative errors, perseverative responses, and conceptual level responses in the WCST (p < 0.001). These findings underscore the potential benefits of an 8-week school-based meditation program incorporating chanting and meditation for enhancing EFs in school-age children.

Manifestation of Psychosis and Impairments of Executive Functions Emphasize the Interaction of Psychological and Neurological Dysfunctions in People Who Use Methamphetamine

Aim: Cumulative evidence has demonstrated the neurotoxic effect of methamphetamine (Meth) on the central nervous system. Meth can induce psychotic symptoms and impairments of cognitive abilities, including executive function (EF). Method: In this study, we hypothesized the interaction of the neurotoxic effects of Meth on psychotic symptoms and EF performances. The Stroop test evaluated the EF performances, Go/No-Go task, one-back test (OBT), and Wisconsin Card Sorting Test (WCST) in people who use Meth with psychosis (MWP) and without psychosis (MWOP) compared with healthy control participants. Result: The results showed that MWOP and MWP exhibited EF deficits in attention, working memory, and initial conceptualization. Moreover, a deficit in inhibition was observed in MWOP, while poorer processing speed and cognitive flexibility were found in MWP. Conclusion: The correlation between psychotic symptoms and poor EF performances was observed in MWP. These findings underline the interaction of the mechanistic neurotoxic effect of Meth to induce psychological and neurological dysfunctions in people who use Meth.

Assessing cognitive flexibility in adaptive learning technologies for special education

This study used quantitative methods to examine the correlation between adaptive learning technology and cognitive flexibility in kids receiving special education. The study included a cohort of 120 kids, ages 8–12, who were diagnosed with particular learning difficulties, ADHD, or autism spectrum disorder. Cognitive flexibility was evaluated using the Wisconsin Card Sorting Test (WCST), while the utilization of adaptive learning technologies was quantified using self–report questionnaires. The data was analyzed using several statistical methods, such as independent samples t-tests, regression, Pearson correlation coefficients, ANOVA, and ANCOVA. The findings revealed a noteworthy and favorable correlation between the utilization of adaptive technology and the scores of cognitive flexibilities. This correlation remained significant even after accounting for demographic characteristics. Moreover, it was shown that the diagnostic status had a moderating effect on the correlation between the utilization of adaptive technology and cognitive flexibility. The results emphasize the capacity of adaptive learning technologies to improve cognitive flexibility abilities in kids with special needs, offering significant knowledge for educators, legislators, and technology developers.

Mapping common and distinct brain correlates among cognitive flexibility tasks: concordant evidence from meta-analyses.

Cognitive flexibility allows individuals to switch between different tasks, strategies, or ideas; an ability that is important for everyday life. The Wisconsin card sorting test (WCST) and task switching paradigm (TSP) are popular measures of cognitive flexibility. Although both tasks require switching, the TSP requires participants to memorize switching rules and retrieve them when they view a cue (rule-retrieval), whereas the classic WCST requires participants to discover the switching rule via trial-and-error (rule-discovery). Many functional magnetic resonance imaging studies have examined brain responses to these tasks. Extant meta-analyses show concordance in activation in a widespread set of areas including frontal, parietal, and cingulate cortices. Critically, past meta-analyses have not specifically examined brain correlates associated with rule derivation (i.e., rule-discovery vs. rule-retrieval) in cognitive flexibility tasks. We examine for the first time common and distinct concordance in brain responses to rule-discovery (i.e., WCST) and rule-retrieval (i.e., TSP), as well as TSP subtypes using quantitative meta-analyses. We analyzed data from 69 eligible articles with a total of 1617 young-adult participants. Conjunction results show concordance in common fronto-parietal areas predominantly in the left hemisphere. Contrast analyses show that rule-discovery required increased involvement in multiple cortical and subcortical regions such as frontopolar (Brodmann Area 10), parietal, insular cortex, thalamus and caudate nucleus predominantly in the right hemisphere. No significant differences in concordance were observed among the three, task switching paradigm sub-types. We propose a neuroanatomical model of cognitive flexibility and discuss theoretical and practical applications.

A Comparative Analysis of Neurocognitive Function in Community- and Hospital-Based Patients With Schizophrenia.

The study compared differences in various neurocognitive characteristics across treatment modalities among schizophrenia patients recruited in one city between July 2020 and June 2023 who were on regular medication. Of the 151 participants, 113 were included in the analysis. Participants were divided into community-based and hospital-based groups, and their demographics and clinical characteristics, including insight, quality of life, positive and negative symptoms, and personal and social functioning, were examined. In addition, several aspects of cognition were assessed using neurocognitive assessments such as the Trail Making Test (TMT), Stroop test, and Wisconsin Card Sorting Test (WCST). After adjusting for age differences between groups, the final analysis included data from 42 participants in the community-based group and 33 participants in the hospital-based group. Hospital-based group participants completed Stroop-W more rapidly, excelled in Rey-Osterrieth Complex Figure Test recall and recognition, and incurred fewer TMT Part B (TMT-B) and Stroop-C errors. Additionally, they outperformed in WCST total, non-persistent errors, and categories completed. Contrastingly, community-based group participants showed superior outcomes in WCST persistent responses and errors, suggesting specific neurocognitive strengths. We found differences in neurocognitive characteristics between the two groups. These differences were consistent across a range of cognitive domains, including attention, visual discrimination, memory, and executive functioning. Further large-scale study is needed to generalize cognitive characteristics across treatment modalities.

Executive functions in older adults with generalised anxiety disorder and healthy controls: Associations with heart rate variability, brain-derived neurotrophic factor, and physical fitness

Executive functions (EF) decline with age and this decline in older adults with generalised anxiety disorder (GAD) may be influenced by heart rate variability (HRV), brain-derived neurotrophic factor (BDNF), and physical fitness. Understanding these relationships is important for tailored treatments in this population. In this study, 51 adults with GAD (M age = 66.46, SD = 4.08) and 51 healthy controls (M age = 67.67, SD = 4.04) were assessed on cognitive inhibition (Stroop task), shifting (Trails part 4), flexibility (Wisconsin Card Sorting Test – Perseverative errors), working memory (Digit Span Backwards), IQ (Wechsler Abbreviated Scale of Intelligence), high frequency HRV, serum mature BDNF levels, and VO2 max. Results indicated that participants with GAD exhibited better cognitive inhibition compared to controls, with no general reduction in EF. Cognitive inhibition was predicted by gender, HRV, and BDNF levels, while cognitive shifting was predicted by gender and IQ, and cognitive flexibility and working memory by IQ. The enhanced cognitive inhibition in GAD participants might stem from maladaptive use of this function, characteristic of GAD, or protection from EF decline due to normal HRV. Increased BDNF levels, possibly due to good fitness, or compensatory mechanisms related to the disorder, might also play a role. These findings highlight the complexity of EF and related mechanisms in GAD, highlighting the need for interventions that consider both cognitive and physiological factors for optimal outcomes.

The impact of rehabilitation on the recovery of executive functions in stroke patients with different location of the ischemic focus.

Cognitive dysfunction is part of the clinical picture of stroke. Most of the executive dysfunctions are diagnosed in the early stage of rehabilitation, a few weeks after the vascular incident. Coexistence of executive dysfunctions with other disorders in stroke patients may hinder patient's functions, slow down the rehabilitation process, and disrupt self-awareness, interpersonal communication, and professional activity in everyday life. Ninety patients after ischemic stroke were examined (right hemisphere stroke: N = 33, left hemisphere stroke: N = 57). The study group (N = 45) consisted of patients rehabilitated in the Department of Rehabilitation and Physical Medicine of the University Teaching Hospital of the Military Medical Academy in Lodz, Łódź, Poland, in whom a comprehensive neurorehabilitation program was implemented, consisting of motor and neuropsychological rehabilitation. The control group (N = 45) consisted of patients awaiting admission to the department, who were covered by comprehensive environmental rehabilitation including exercise therapy and neuropsychological therapy. Executive function was measured with 3 popular diagnostic tools: the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT part A, TMT part B), and the letter test and category test with the Verbal Fluency Test (VFT). The tests were carried out twice: the first time before the start of rehabilitation and 5 weeks later after its completion. Although patients with right-hemispheric stroke showed better improvement in executive functions, stroke location did not prove to have significant impact on how effective the rehabilitation was. Right hemisphere stroke patients showed greater improvement in restoring executive functions after rehabilitation compared to left hemisphere stroke patients. The location of the stroke did not significantly correlate with the efficiency of the rehabilitation setting. Int J Occup Med Environ Health. 2024;37(4).

Cognitive flexibility predicts attitudes towards vaccination: evidence from a New Zealand sample

BackgroundVaccine hesitancy (the reluctance or refusal to vaccinate) poses a significant threat to public health worldwide, with declining vaccination coverage resulting in the resurgence of vaccine-preventable diseases (e.g., measles) in recent years. Despite efforts to combat vaccine hesitancy through information-based campaigns and other interventions, vaccine-hesitant attitudes persist. Given that such interventions likely expose individuals to information that conflicts with their own viewpoints about vaccination, cognitive flexibility – the ability to adapt one’s thoughts, attitudes, beliefs, or behavior in response to changing information or environmental demands – may play a role in vaccine hesitancy.MethodsThe current study investigated the relationship between cognitive flexibility and attitudes towards vaccination in a sample of New Zealand residents (N = 601). Cognitive flexibility was measured using perseverative responses in the Wisconsin Card-Sorting Task, and vaccination attitudes were measured using an adapted version of the Multidimensional Vaccine Hesitancy Scale (MVHS). Linear regression was used with MVHS scores as the dependent variable and cognitive flexibility and sociodemographic variables (age, gender, ethnicity, education level, religion) as predictors.ResultsCognitive flexibility predicted personal barriers to vaccination (e.g.,” vaccines go against my personal beliefs”), with participants with lower levels of cognitive flexibility reporting greater personal barriers. In contrast, there was no significant relationship between cognitive flexibility and external barriers to vaccination (e.g., “vaccines cost too much”). Additionally, religious participants reported overall higher levels of vaccine hesitancy than non-religious participants.ConclusionsThese findings join others demonstrating that individual differences in cognitive style are associated with attitudes towards vaccination, and tentatively suggest that interventions aiming to reduce vaccine hesitancy may be more effective if combined with techniques to increase cognitive flexibility. To be sure, future work is needed to test the causal relationship between cognitive flexibility and attitudes towards vaccination.

Differential Neural Mechanisms of Feedback Processing in Children with Developmental Language Disorder: An Examination of Midfrontal Theta Connectivity.

Previous research indicates that children with Developmental Language Disorder (DLD) face challenges learning from feedback, resulting in suboptimal performance and learning outcomes. Feedback processing, a key developing executive function, involves cognitive processes critical for goal-directed behavior. This study examined the neural mechanisms underlying feedback processing in school-age children with DLD compared to typically developing (TD) peers, focusing on midfrontal theta band (4-8 Hz) oscillations as an index of cognitive control and error monitoring. We measured midfrontal theta inter-trial coherence (ITC) and inter-site coherence (ISC) at midfrontal (FCz), lateral prefrontal (F3/F4), and lateral central (C3/C4) sites in children with and without DLD (n = 33, age 8-13 years) in response to feedback provision within a Wisconsin Card Sorting Test (WCST) in two time windows (200-400 ms, which is associated with the Feedback-Related Negativity, or FRN, and 400-600 ms, which is associated with the P3a). Children with and without DLD showed elevated midfrontal theta oscillations in response to negative feedback that was followed by successful behavioral adjustments in the FRN time window. Activation in the P3a time window was only found in the TD group. Group differences were also noted in the inter-site coherence (ISC) associated with the effective processing of negative feedback. While in the TD group, effective processing of negative feedback was linked to high connectivity between midfrontal and right sensorimotor regions, in the DLD group, effective processing of negative feedback was associated with high connectivity between midfrontal and left sensorimotor sites. Differential ISC patterns in children with DLD may indicate that they employ alternative or compensatory neural strategies, possibly due to atypical right sensorimotor engagement.

The Effect of Contextual Interference on the Acquisition and Learning of Motor Skill with an Emphasis on Cognitive Flexibility

Background: The effect of contextual interference (CI) on motor skill learning may be influenced by various factors, such as cognitive abilities. Objectives: The purpose of the current research was to investigate the effect of CI on the acquisition and learning of soccer skills, with an emphasis on the role of cognitive flexibility (CF). Methods: Eighty students, aged 9 - 12 years, were randomly selected and administered the Wisconsin Card Sorting Test. From this group, 60 students who scored the highest and lowest points were selected as the final subjects. After completing the pre-test on Moore-Christine's pass, shoot, and dribble skills, the subjects were divided into four groups of 15 participants each (high CF with Random Practice (RP) and Blocked Practice (BP), low CF with RP and BP). The subjects then engaged in practice sessions according to their assigned protocols for three sessions, with each session consisting of three blocks of 12 trials across all three skills—passing, shooting, and dribbling. Following the practice, acquisition, immediate retention, delayed retention, and transfer tests were conducted. Results: The results showed that practice in all four groups had significant beneficial effects on the acquisition and learning of skills. Additionally, the high CF with RP group demonstrated better performance in all skills compared to the other groups. Conclusions: Therefore, it can be concluded that RP may be more beneficial for individuals with higher CF. Teachers and educators should consider this when teaching sports skills.

Radon mitigation in Native communities: A partnership between a tribal health clinic and University of Wisconsin Carbone Cancer Center.

44 Background: Radon is the second leading cause of lung cancer in the United States, and the Native communities in Wisconsin bear an outsized burden of lung cancer. Radon testing is attainable for these communities, but the cost of one-time mitigation is high and out of reach for many. The University of Wisconsin Carbone Cancer Center (UWCCC) partnered with the Stockbridge-Munsee Band of the Mohican Nation (S-M) Health Center to test homes for radon levels and mitigate (repair) those structures when levels were high to mitigate a structural barrier of health. Prior tests had suggested 10% of homes across Wisconsin test “high” for radon (above 4 pCi/L). The mean radon level among tested homes in Wisconsin is 5.7 pCi/L (American Lung Association, Radon Testing Disparities: Wisconsin, 2022). Methods: The project was co-developed with the UW and S-M. A key partner was the Wisconsin Radon Program, housed at the Wisconsin Department of Health Services. We aimed to educate, test for radon, and mitigate all homes that tested high for radon. Education, promotion of the program and testing were done in collaboration between state, university, and tribal officials. The environmental health and community health coordinators at S-M was the key person for distributing and ensuring the return of kits. Mitigation was performed by a private certified contractor over the project. We used descriptive statistics to evaluate the percentage of Wisconsin homes that tested high for radon in our sample. We also surveyed community members about their satisfaction with the mitigation contractor. Results: This project was done from April 2023 to April 2024. Staff reported educational sessions were successful in improving their knowledge of radon and testing and mitigation procedures. The S-M had 1822 enrolled tribal members at the start of the study. A total of 85 kits were distributed, with 64 returned (75.3% return rate). Of those, 42 of 64 tested positive for high radon in the home (65.6%), much higher than the expected 10% positive rate. The mean radon level among all homes was 14.1 pCi/L (0-111.6pCi/L) and 18.7 pCi/L among homes that tested positive. All homes testing high have completed radon mitigation. All reported their homes could not have been mitigated without this collaboration. The community was satisfied with the services of the certified contractor. Conclusions: Radon levels were much higher than anticipated in Native lands in Wisconsin and may explain higher rates of lung cancer. Cancer centers are key partners in addressing high radon levels and mitigating structural determinants of health among Native communities, such as with housing quality.

Executive function tests: Normative data for Spanish-speaking adults in the United States.

Normative data for Spanish-speaking populations, particularly Hispanics in the U.S., is notably scarce. This study aims to establish normative data for executive function tests (Modified Wisconsin Card Sorting Test and Stroop Color and Word Test) among Spanish-speaking Hispanics in the U.S. We assessed 245 individuals aged 18-80 from eight U.S. states (California, Connecticut, Florida, Indiana, New Jersey, Oregon, Virginia, and Wisconsin) and employed Bayesian regression to estimate norms, considering various sociodemographic factors influencing performance. The posterior distribution suggests a high probability that age impacts SCWT performance, with older adults likely to show greater declines, particularly among those with high proficiency in Spanish. The posterior distribution suggests a stronger effect of age on M-WCST performance among individuals with longer U.S. residency. Educational attainment demonstrates a robust positive impact on M-WCST outcomes, with lower levels of education associated with a higher probability of increased errors. An interaction between education and Spanish proficiency was observed, influencing SCWT scores differently across proficiency levels. Sex and acculturation levels interact to affect SCWT performance, with distinct patterns observed between men and women. This suggests that the impact of acculturation on cognitive test performance may vary by gender. Establishing culturally sensitive normative data can enhance accurate identification of executive dysfunction and reduce misdiagnosis risks. This study underscores the importance of considering sociocultural factors including acculturation and language proficiency in neuropsychological assessments to better serve diverse populations.

Exploring the efficacy of memory specificity training on depression among Iranian adolescents: a comparative analysis of online vs. in-person delivery

Depression in adolescence is common worldwide, with the burden being highest in low- and middle-income countries. This study assessed the efficacy of in-person Memory Specificity Training (MeST) and computerized MeST (c-MeST) as cognitive training programs aimed at addressing depression among Iranian adolescents. A secondary aim was to evaluate the efficacy of MeST and c-MeST on autobiographical memory specificity, emotion regulation and cognitive control. Ninety Iranian male adolescents (aged 13–18 years) with depression were randomly assigned to three groups; MeST group (n = 30), c-MeST group (n = 30) and the non-active control group (n = 30). Participants completed the Beck Depression Inventory-II, Autobiographical Memory Test, Cognitive Emotion Regulation Questionnaire, Wisconsin Card Sorting Test and Stroop Color and Word Test. The groups underwent either MeST and c-MeST. All the assessments were re-conducted after the intervention (post-intervention) and at 1-month post-intervention (follow-up). The in-person MeST group exhibited significantly higher autobiographical memory specificity at post-intervention and follow-up compared to the c-MeST group. Both groups demonstrated significantly lower levels of depression at post-intervention and follow-up. Both groups showed improvements in emotion regulation and cognitive control, which were found to mediate improvements in depression symptomatology. c-MeST and MeST appear promising brief interventions for the treatment of depression among adolescents in Iran.

The inflexible mind: A critical factor in understanding and addressing COVID-19 vaccine hesitancy

BackgroundVaccine hesitancy has gained heightened relevance amid the COVID-19 pandemic, underscoring the urgency of understanding its determinants. This study explores the association between Covid-19 vaccine hesitancy, mental health variables and inflexible thinking. MethodsA convenience sample of 252 UK adults was assessed online between June 2021–July 2022 (when Covid-19 lockdown restrictions had finally eased). We assessed participants using the Oxford Covid Vaccine Hesitancy Scale (OCVHS), various aspects of mental health, using: the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Depression, Anxiety, and Stress scale (DASS-21), and finally, performance on a computerized version of the Wisconsin Card Sort Task (WCST). This study was preregistered at the Open Science Framework (https://osf.io/xd5wz). ResultsMultiple regression analyses showed that only cognitive inflexibility, and specifically the WCST item of perseverative errors, significantly predicted vaccine hesitancy. ConclusionOur exploratory analysis provides the first evidence that cognitive inflexibility, measured using an objective task, is an independent risk-factor for vaccine hesitancy. Public health strategies should consider the impact of an inflexible thinking style on the decision-making of those most at risk of vaccine hesitancy and adapt interventions accordingly.

Adolescent Executive Function Measurements in Indonesia : Systematic Review and Implications in Educational Settings

This study examines the landscape of executive function (EF) assessments for Indonesian adolescents, focusing on their psychometric properties. The adolescent development phase, marked by cognitive growth, presents opportunities and risks, especially in education settings where well-developed EF is beneficial. This research used a qualitative approach, with a systematic literature review method using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis), analyzing peer-reviewed empirical studies from databases such as SCOPUS and others, focusing on EF measurements for adolescents in Indonesia from 2014 to 2024. Nine studies met the inclusion criteria, highlighting tools like the Behavior Rating Inventory of Executive Function (BRIEF)-Indonesian version, Executive Skills Questionnaire-Revised (ESQ-R), Executive Function Questionnaire (EFQ), and performance-based measures like the Wisconsin Card Sorting Test and Stroop Test. Using content analysis, this study reveals that while the BRIEF is widely used in clinical studies, its applicability in educational settings requires improvement. The findings highlight the importance of adapting EF tools with cultural sensitivity and developing new comprehensive assessments with clear psychometric properties regarding all critical EF components. In recommendations, the study pinpoints a multi-method approach combining inventory-based and performance-based measures to provide a thorough understanding of EF while maintaining practicality for educational settings. The implications for advancing EF research and practice in Indonesia, particularly in education, are discussed, emphasizing the need for reliable, valid, culturally sensitive, and accessible assessment tools.

Predictors of response to accelerated rTMS in the treatment of treatment-resistant depression.

Accelerated repetitive transcranial magnetic stimulation (rTMS) is a promising treatment for treatment-resistant depression (TRD). We aimed to investigate the existence of clinical predictive factors in response to accelerated rTMS in the treatment of TRD. In total, 119 TRD patients who received accelerated rTMS were included in this study. The stimulation protocol was 15Hz stimulation over the the left dorsolateral prefrontal cortex. The protocol consisted of 25 sessions, each session lasting 30min for a total of 3000 pulses. Five sessions were applied per day for 5 consecutive days. At baseline (T0), day 5 (immediately after treatment) (T1), 4 weeks after treatment (T2), depression severity was evaluated using the 17-item Hamilton Depression Rating Scale (HAMD-17), cognitive function was evaluated using Wisconsin Card Sorting Test (WCST), the intensity of suicidal ideation was evaluated using the Columbia-Suicide Severity Rating Scale (C-SSRS). Systemic immune-inflammation index (SII) was calculated at T0 and T2. The HAMD-17 scores, WCST performance, the C-SSRS scores at T1 and T2 were improved from T0 (P < 0.01). The SII at T2 was lower than at T0 (P < 0.01). The response rates at T1 and T2 were 57.98% (69/119) and 48.74% (58/119), respectively. The results of binary logistic analysis showed that shorter course of depression, two failed antidepressant trials, no history of ECT treatment, and lower levels of SII were predictive factors for accelerated rTMS treatment response at T1 and T2 (P < 0.05), while not having a history of hospitalization was a predictive factor for response at T2 (P < 0.05) but not at T1 (P > 0.05). Based on ROC curve analysis, the optimal cut-off values of SII for discriminating responders from non-responders at T1 and T2 were < 478.56 and < 485.03, respectively. The AUC of SII at T0 predicting response for T1 and T2 were 0.729 and 0.797. We found several clinical predictors of better responses to the accelerated rTMS. Identifying clinical predictors of response is relevant to personalize and adapt rTMS protocols in TRD patients.