On the historical and conceptual background of the Wisconsin Card Sorting Test

In this paper, we describe the development of the Wisconsin Card Sorting Test (WCST). We trace the history of sorting tasks from the studies of Narziss Ach on the psychology of thinking, via the work of Kurt Goldstein and Adhémar Gelb on brain lesioned patients around 1920 and subsequent developments, up to the actual design of the WCST by Harry Harlow, David Grant, and their student Esther Berg. The WCST thus seems to originate from the psychology of thinking ('Denkpsychologie'), but the test, as it is used in clinical neuropsychological practice, was designed by experimenters working within the behaviorist tradition. We also note recent developments suggesting that, contrary to the general impression, implicit learning may play a role in WCST-like discrimination learning tasks.     

Latent Structure of the Wisconsin Card Sorting Test after Pediatric Traumatic Head Injury

The performance of 80 pediatric patients with traumatic head injury (THI) on the Wisconsin Card Sorting Test (WCST; Heaton, Chelune, Talley, Kay, & Curtiss, 1993) was examined to determine the underlying latent structure. Exploratory factor analysis with oblique rotation identified three factors: response accuracy, failure to self-monitor, and learning. The response accuracy factor was directly affected by both age and length of coma. Level of performance on this factor also covaried with post-injury psychometric intelligence. It is concluded that interpretation of the WCST results of children with THI should consider the multifactorial nature of the instrument in combination with injury severity characteristics and demographic variables.     

Latent structure of the Wisconsin Card Sorting Test after pediatric traumatic head injury.

The performance of 80 pediatric patients with traumatic head injury (THI) on the Wisconsin Card Sorting Test (WCST; Heaton, Chelune, Talley, Kay, & Curtiss, 1993) was examined to determine the underlying latent structure. Exploratory factor analysis with oblique rotation identified three factors: response accuracy, failure to self-monitor, and learning. The response accuracy factor was directly affected by both age and length of coma. Level of performance on this factor also covaried with post-injury psychometric intelligence. It is concluded that interpretation of the WCST results of children with THI should consider the multifactorial nature of the instrument in combination with injury severity characteristics and demographic variables.     

Wisconsin Card Sorting Test embedded validity indicators developed for adults can be extended to children

Past studies have examined the ability of the Wisconsin Card Sorting Test (WCST) to discriminate valid from invalid performance in adults using both individual embedded validity indicators (EVIs) and multivariate approaches. This study is designed to investigate whether the two most stable of these indicators—failures to maintain set (FMS) and the logistical regression equation S-B_LRE—can be extended to pediatric populations.

The classification accuracy for FMS and S-B_LRE was examined in a mixed clinical sample of 226 children aged 7 to 17 years (64.6% male, MAge = 13.6 years) against a combination of established performance validity tests (PVTs).

The results show that at adult cutoffs, FMS and S-B_LRE produce an unacceptably high failure rate (33.2% and 45.6%) and low specificity (.55–.72), but an upward adjustment in cutoffs significantly improves classification accuracy. Defining Pass as <2 and Fail as ≥4 on FMS results in consistently good specificity (.89–.92) but low and variable sensitivity (.00–.33). Similarly, cutting the S-B_LRE distribution at 3.68 produces good specificity (.90–.92) but variable sensitivity (.06–.38). Passing or failing FMS or S-B_LRE is unrelated to age, gender and IQ.

The data from this study suggest that in a pediatric sample, adjusted cutoffs on the FMS and S-B_LRE ensure good specificity, but with low or variable sensitivity. Thus, they should not be used in isolation to determine the credibility of a response set. At the same time, they can make valuable contributions to pediatric neuropsychology by providing empirically-supported, expedient and cost-effective indicators to enhance performance validity assessment.     

The impact of frontal and non-frontal brain tumor lesions on Wisconsin Card Sorting Test performance

Several lesion and imaging studies have suggested that the Wisconsin Card Sorting Test (WCST) is a measure of executive dysfunction. However, some studies have reported that this measure has poor anatomical specificity because patients with either frontal or non-frontal focal lesions exhibit similar performance. This study examined 25 frontal, 20 non-frontal low-grade brain tumor patients, and 63 normal controls (NC) on the WCST. The frontal patients were also assigned to either a left frontal (n=10) group or a right frontal group (n=15) and compared with the non-frontal group and NC. It was hypothesized that the frontal brain tumor patients would display greater deficits on categories achieved and a higher number of perseverative errors than non-frontal brain tumor patients on the WCST. Finally, it was predicted that right frontal brain tumors would result in greater executive functioning deficits than left frontal or non-frontal brain tumors. Results indicated that the left frontal group achieved the fewest categories and committed the most perseverative errors compared to the other patient and normal control groups. In addition, the left frontal group committed significantly more perseverative errors than the right frontal group. These results suggest that the WCST is sensitive to the effects of low-grade brain tumors on executive functioning.     

The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: A critical update

For over four decades the Wisconsin Card Sorting Test (WCST) has been one of the most distinctive tests of prefrontal function. Clinical research and recent brain imaging have brought into question the validity and specificity of this test as a marker of frontal dysfunction. Clinical studies with neurological patients have confirmed that, in its traditional form, the WCST fails to discriminate between frontal and non-frontal lesions. In addition, functional brain imaging studies show rapid and widespread activation across frontal and non-frontal brain regions during WCST performance. These studies suggest that the concept of an anatomically pure test of prefrontal function is not only empirically unattainable, but also theoretically inaccurate. The aim of the present review is to examine the causes of these criticisms and to resolve them by incorporating new methodological and conceptual advances in order to improve the construct validity of WCST scores and their relationship to prefrontal executive functions. We conclude that these objectives can be achieved by drawing on theory-guided experimental design, and on precise spatial and temporal sampling of brain activity, and then exemplify this using an integrative model of prefrontal function [i.e., Miller, E. K. (2000). The prefrontal cortex and cognitive control. Nature Reviews Neuroscience, 1, 59–65.] combined with the formal information theoretical approach to cognitive control [Koechlin, E., & Summerfield, C. (2007). An information theoretical approach to prefrontal executive function. Trends in Cognitive Sciences, 11, 229–235.].     

The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: A critical update

For over four decades the Wisconsin Card Sorting Test (WCST) has been one of the most distinctive tests of prefrontal function. Clinical research and recent brain imaging have brought into question the validity and specificity of this test as a marker of frontal dysfunction. Clinical studies with neurological patients have confirmed that, in its traditional form, the WCST fails to discriminate between frontal and non-frontal lesions. In addition, functional brain imaging studies show rapid and widespread activation across frontal and non-frontal brain regions during WCST performance. These studies suggest that the concept of an anatomically pure test of prefrontal function is not only empirically unattainable, but also theoretically inaccurate. The aim of the present review is to examine the causes of these criticisms and to resolve them by incorporating new methodological and conceptual advances in order to improve the construct validity of WCST scores and their relationship to prefrontal executive functions. We conclude that these objectives can be achieved by drawing on theory-guided experimental design, and on precise spatial and temporal sampling of brain activity, and then exemplify this using an integrative model of prefrontal function [i.e., Miller, E. K. (2000). The prefrontal cortex and cognitive control. Nature Reviews Neuroscience, 1, 59–65.] combined with the formal information theoretical approach to cognitive control [Koechlin, E., & Summerfield, C. (2007). An information theoretical approach to prefrontal executive function. Trends in Cognitive Sciences, 11, 229–235.].     

Temporal stability of the Wisconsin Card Sorting Test in a chronic traumatic brain injury sample

The aim of the present study was to investigate the temporal stability of the Wisconsin Card Sorting Test (WCST) in a clinical population with documented brain pathology, stable cognitive deficits, and for whom repeated testing is common: chronic severe traumatic brain injury (TBI). Participants were 34 patients at least 1 year post severe TBI living at a large residential rehabilitation facility. The WCST was administered in standard fashion with both the standard and 64-card versions scored. All derived scores with norms were examined. Results indicated acceptable temporal stability of most scores for both the standard and short WCST, although the stability of the WCST-64 was poorer than for the standard WCST. Three sets of significant change indices are provided for clinical use.     

An attempt to discriminate different types of executive functions in the Wisconsin Card Sorting Test

This study examined the roles of the phonological working memory and the central executive in the Wisconsin Card Sorting Test by altering the materials and the procedure of the task and using a dual-task design, in which cognitive abilities of normal participants were manipulated by performance of the secondary tasks selectively taxing the phonological loop or the central executive. The present study used three novel versions of the Wisconsin Card Sorting Test, namely the WCST-4 stimuli, the WCST-12-stimuli, and the WCST-12-stimuli-box, in all of which the participants were given the exact sorting criterion. So the tasks did not involve processes such as maintenance of inferences about the sorting criterion which would require phonological memory load. However, the tasks were assumed to require the executive process of response inhibition. In the WCST-4-stimuli condition no change was made to the WCST materials. In the other two conditions, relying on the assumption that the three-dimensional nature of the cards triggers inappropriate responses, unidimensional stimulus cards were used instead of the four normal three-dimensional WCST stimulus cards. The difference between these two conditions was that, in the WCST-12-stimuli-box condition, boxes were used to conceal the response cards previously sorted. The results supported Dunbar and Sussman's (1995) argument that some executive processes in the Wisconsin Card Sorting Test require the use of phonological store, and the present design was able to differentiate the type of executive functions that do not involve the use of a phonological loop from the ones that do. In addition, the results concerning manipulations of the visual aspects of the Wisconsin Card Sorting Test suggest that the three-dimensional nature of the WCST stimulus cards leads to an increase in the number of inappropriate responses produced with the executive secondary task interference.     

Developmental Patterns and Use of the Wisconsin Card Sorting Test for Children and Adolescents with Learning Disabilities

This study examined the Wisconsin Card Sorting Test (WCST) by testing 129 children and adolescents with learning disabilities (LD) who were between 7 and 13 years of age. Developmental trends were examined across age groups using scores from the WCST. Several scales yielded developmental patterns, supported by statistically significant main effects for age. Additionally, multiple regression analyses were run examining the relationship of the WCST with other measures. The models yielded were in predicted directions. The results of this study support the clinical utility of the WCST in children and adolescents with LD.     

The Role of Switching,Inhibition and Working Memory in Older Adults' Performance in the Wisconsin Card Sorting Test

ABSTRACT

The Wisconsin Card Sorting Test (WCST) is considered a typical executive test. However, several interesting questions are still open as to the specific executive processes underlying this task. In the present study, we explored how local and global switching, inhibition and working memory, assessed through the Number–Letter, the Stop Signal and the Reading Span tasks, relate to older adults' performance in the WCST. Results showed that older adults' performance variability in the number of perseverative errors was predicted by the local switch component of the Number–Letter task. Results also showed age-related differences in inhibition, working memory and global switching, while local switching resulted largely spared in aging. This study provides evidence that switching abilities may contribute to performance of older adults in the WCST. It also provides initial evidence suggesting that switching processes, associated with local switch costs, are involved in performance on the WCST, at least in older adults.     

Effects of increased processing demands on age differences in working memory

Three studies investigated (a) the plausibility of the claim that increasing the processing demands in a memory task contributes to greater involvement of a central processor and (b) the effects of altering reliance on the central processor on the magnitude of age-related differences in working-memory tasks. In the first study, young adults performed versions of 2 tasks presumed to vary in the degree of reliance on the central processor. In the second and third studies, young and older adults performed versions of a computation-span task that were assumed to vary along a rough continuum of the amount of required processing. The results indicated that although a central processor appears to be involved when working-memory tasks require simultaneous storage and processing of information, age-related differences in working memory seem to be determined at least as much by differences in the capacity of storage as by differences in the efficiency of processing.     

Age differences in visual working memory capacity: not based on encoding limitations

Why does visual working memory performance increase with age in childhood? One recent study ( Cowan et al., 2010b ) ruled out the possibility that the basic cause is a tendency in young children to clutter working memory with less‐relevant items (within a concurrent array, colored items presented in one of two shapes). The age differences in memory performance, however, theoretically could result from inadequate encoding of the briefly presented array items by younger children. We replicated the key part of the procedure in children 6–8 and 11–13 years old and college students (total N = 90), but with a much slower, sequential presentation of the items to ensure adequate encoding. We also required verbal responses during encoding to encourage or discourage labeling of item information. Although verbal labeling affected performance, age differences persisted across labeling conditions, further supporting the existence of a basic growth in capacity.     

Wisconsin Card Sorting in adolescents: analysis of performance, response times and heart rate

Forty-nine adolescents performed the Wisconsin Card Sorting Test (WCST). A main PCA component of WCST performance was identified as 'efficiency of reasoning'. This factor was related to feedback processing. From the WCST, a perseveration score can be derived. Perseveration is the continued application of a rule, after it has been disconfirmed. We compared more and less perseverating subjects in relation to stimulus-response (SR) time, feedback inspection time and cardiac acceleration and deceleration. Less perseverating subjects responded faster, and had longer and more adaptive inspection times of error feedback. We examined the switch from rule application to rule search, and the difference between correct and error responses. A transient cardiac deceleration at the initiation of rule search was interpreted as a change in supervisory attention. An error-related deceleration to negative feedback was interpreted as a disturbance of higher control processing. Previous trial feedback influenced current processing time, feedback inspection time, and the cardiac acceleration and deceleration responses.     

Gender differences in episodic memory and visual working memory including the effects of age

Analysing the relationship between gender and memory, and examining the effects of age on the overall memory-related functioning, are the ongoing goals of psychological research. The present study examined gender and age group differences in episodic memory with respect to the type of task. In addition, these subgroup differences were also analysed in visual working memory. A sample of 366 women and 330 men, aged between 16 and 69 years of age, participated in the current study. Results indicate that women outperformed men on auditory memory tasks, whereas male adolescents and older male adults showed higher level performances on visual episodic and visual working memory measures. However, the size of gender-linked effects varied somewhat across age groups. Furthermore, results partly support a declining performance on episodic memory and visual working memory measures with increasing age. Although age-related losses in episodic memory could not be explained by a decreasing verbal and visuospatial ability with age, women's advantage in auditory episodic memory could be explained by their advantage in verbal ability. Men's higher level visual episodic memory performance was found to result from their advantage in visuospatial ability. Finally, possible methodological, biological, and cognitive explanations for the current findings are discussed.     

Construction and validation of an ecological version of the Wisconsin Card Sorting Test applied to an elderly population

ABSTRACT

The goal of this project was to construct and validate an ecological version of the Wisconsin Card Sorting Test (WCST) aimed at the elderly. This was accomplished by replacing the geometric stimuli of the traditional version with stimuli belonging to the semantic category of transport vehicles, and by elimination of the color yellow. The results showed the ecological WCST version was preferred over the traditional version and older people felt less tired during test performance. In the two independent normal elderly groups, all pairs of scores that can be derived from the WCST correlated significantly with each other. Six of 11 outcome measures of the traditional WCST-128 (long) version were significantly influenced by age. By contrast, in the WCST-64 (short) version and in the ecological WCST-54 version only one measure was affected by the age variable. No significant effect of education level or gender emerged from the results in any WCST version. Again, the subjects with cognitive deterioration had lower performance in the ecological WCST-54 version than in the two traditional WCST versions. It seems reasonable to assume that the ecological version of WCST is more discriminating and has more advantages than the traditional versions. Further research on individual differences in the performance on this task will increase understanding of the components of the test, and of the variety of factors and possible deficits that could lead to an impaired performance of the test.     

Influence of processing speed on adult age differences in working memory.

Two studies are reported in which adults ranging from 18 to 80 years of age performed tasks designed to measure working memory functioning and perceptual comparison speed. The results from both studies indicated that statistical control of the measures of perceptual comparison speed greatly attenuated the age-related variance in measures of working memory even when working memory was assessed under self-paced conditions. Additional results in the second study supported the hypothesis that the speed influence was manifested in the rate of activating information rather than in the rate at which it was lost as a function of time or other processing.     

Binding and inhibition in working memory: individual and age differences in short-term recognition

Two studies investigated the relationship between working memory capacity (WMC), adult age, and the resolution of conflict between familiarity and recollection in short-term recognition tasks. Experiment 1 showed a specific deficit of young adults with low WMC in rejecting intrusion probes (i.e., highly familiar probes) in a modified Sternberg task, which was similar to the deficit found in old adults in a parallel experiment (K. Oberauer, 2001). Experiment 2 generalized these results to 3 recognition paradigms (modified Sternberg, local recognition, and n back tasks). Old adults showed disproportional performance deficits on intrusion probes only in terms of reaction times, whereas young adults with low WMC showed them only in terms of errors. The generality of the effect across paradigms is more compatible with a deficit in content-context bindings subserving recollection than with a deficit in inhibition of irrelevant information in working memory. Structural equation models showed that WMC is related to the efficiency of recollection but not of familiarity.     

Beyond resources: Formal models of complexity effects and age differences in working memory

We explore several alternative formal models of working memory capacity limits and of the effect of ageing on these capacity limits. Three models test variations of resource accounts, one assumes a fixed number of free slots in working memory, one is based on decay and processing speed, one attributes capacity limits to interference, and one to crosstalk between associations of content and context representations. The models are evaluated by fitting them to time–accuracy functions of 16 young and 17 old adults working on a numerical memory-updating task under varied memory-load conditions. With increasing complexity (i.e., memory load), both asymptotic accuracy and the rate of approach to the asymptote decreased. Old adults reached lower asymptotes with the more complex tasks, and had generally slower rates. The interference model and the decay model fit the individual time–accuracy functions reasonably well, whereas the other models failed to account for the data. Within the interference model, age effects could be attributed to the older adults' higher susceptibility to interference. Within the decay model, old adults differed from young adults by a higher degree of variability in the activation of working memory contents.