Normative data for tests of attention and executive functions in a sample of European Portuguese adult population.

OBJECTIVE: The main goal of this study was to produce normative data for the Portuguese population on five neuropsychological tests frequently used to assess executive functions and attention: the Modified Wisconsin Card Sorting Test (M-WCST), the Stroop Color and Word Test, the Trail Making Test (TMT), the Brief Test of Attention (BTA), and the Symbol Digit Modalities Test (SDMT). METHOD: The study included 300 individuals aged between 18 and 93 years, who had educational backgrounds ranging from 3 to 25 years. RESULTS: The influence of age, education, and sex was explored for each measure, as well as their contribution to explain the performance variance. CONCLUSIONS: The normative data are presented as regression-based algorithms to adjust direct and derived test scores for sex, age, and education. This study provides a calculator of normative data, derived from the results of the regression models.

Normative data of neuropsychological tests of attention and executive functions in Ecuadorian adult population.

OBJECTIVE: The purpose of this study was to generate normative data for five tests of attention and executive functions (M-WCST, Stroop test, TMT, BTA, and SDMT), in a group of 322 Ecuadorian adults from Quito between the ages of 18 and 85. METHOD: Multiple regression analyzes taking into account age, education, and gender were used to generate the normative data. RESULTS: Age and education were significantly related to test performance such that scores decreased with age and improved as a function of education. An online calculator is provided to generate normative test scores. CONCLUSIONS: This is the first study that presents normative data for tests of executive functions and attention in an Ecuadorian adult population. This data will improve the clinical practice of neuropsychology and help to develop the field in the country.

Parallel model-based and model-free reinforcement learning for card sorting performance.

The Wisconsin Card Sorting Test (WCST) is considered a gold standard for the assessment of cognitive flexibility. On the WCST, repeating a sorting category following negative feedback is typically treated as indicating reduced cognitive flexibility. Therefore such responses are referred to as 'perseveration' errors. Recent research suggests that the propensity for perseveration errors is modulated by response demands: They occur less frequently when their commitment repeats the previously executed response. Here, we propose parallel reinforcement-learning models of card sorting performance, which assume that card sorting performance can be conceptualized as resulting from model-free reinforcement learning at the level of responses that occurs in parallel with model-based reinforcement learning at the categorical level. We compared parallel reinforcement-learning models with purely model-based reinforcement learning, and with the state-of-the-art attentional-updating model. We analyzed data from 375 participants who completed a computerized WCST. Parallel reinforcement-learning models showed best predictive accuracies for the majority of participants. Only parallel reinforcement-learning models accounted for the modulation of perseveration propensity by response demands. In conclusion, parallel reinforcement-learning models provide a new theoretical perspective on card sorting and it offers a suitable framework for discerning individual differences in latent processes that subserve behavioral flexibility.

Age, education and gender effects on Wisconsin card sorting test: standardization, reliability and validity in healthy Argentinian adults.

The Wisconsin Card Sorting Test (WCST) is a widely used neuropsychological assessment of executive functioning. The aim of this study was to provide norm values and analyze the psychometric properties of WCST in healthy Argentinian adults aged from 18 to 89 years old (N = 235). Descriptive statistics are reported as means, standard deviations and percentiles, with the effects of age, education and gender being investigated by ANOVA, and with the effect sizes being calculated. The psychometrics were studied using the WCST structure, reliability, convergent validity, and discriminant validity, and WCST norms adjusted for age and educational level are proposed. This instrument is a reliable and valid tool for the assessment of executive functions. However, as the age- and educational-related effects were demonstrated, these characteristics need to be considered before interpreting WCST scores. Regarding gender, no differences were found. Our results expand the geographical and sociocultural applicability of WCST.

Reduced Plasma Orexin-A Concentrations are Associated with Cognitive Deficits in Anorexia Nervosa.

Orexins/hypocretins are neuropeptides implicated in numerous processes, including food intake and cognition. The role of these peptides in the psychopathology of anorexia nervosa (AN) remains poorly understood. The aim of the current study was to evaluate the associations between plasma orexin-A (OXA) concentrations and neuropsychological functioning in adult women with AN, and a matched control group. Fasting plasma OXA concentrations were taken in 51 females with AN and in 51 matched healthy controls. Set-shifting was assessed using the Wisconsin Card Sorting Test (WCST), whereas decision making was measured using the Iowa Gambling Task (IGT). The AN group exhibited lower plasma OXA levels than the HC group. Lower mean scores were obtained on the IGT in AN patients. WCST perseverative errors were significantly higher in the AN group compared to HC. In both the AN and HC group, OXA levels were negatively correlated with WCST non-perseverative errors. Reduced plasma OXA concentrations were found to be associated with set-shifting impairments in AN. Taking into consideration the function of orexins in promoting arousal and cognitive flexibility, future studies should explore whether orexin partly underpins the cognitive impairments found in AN.

Comparability of the WCST and WCST-64 in the assessment of first-episode psychosis.

The Wisconsin Card Sorting Test (WCST) was designed as a measure of executive functioning and is commonly used in the assessment of psychiatric disorders. The original WCST, consisting of 128 cards, has been criticized as being too lengthy for patients experiencing significant distress. Consequently, a shortened version consisting of a single 64-card deck (WCST-64) was created. The purpose of this study was to examine the comparability of the WCST and WCST-64 in 99 patients with first-episode psychosis. Findings showed the WCST-64 yielded a mean T score for perseverative responses (PR) that was 4.08 points lower than the corresponding variable from the WCST, and the correlation between the variables was r = .65. The mean discrepancy was only 2.34 for nonperseverative error (NPE) T scores and the correlation was also stronger, r = .82. Nearly half the sample (44%) had a T score discrepancy between the respective PR indexes that was greater than 1 SD, whereas this discrepancy was observed in only 4% of the sample for NPE. Based on a cut point of < 40T to define impaired versus normal performance for PR, 80% of the sample received the same classification. These findings suggest that NPE scores may be comparable across both tests. Conversely, whereas the PR score from the WCST-64 and WCST can be used as a gross measure of impairment, this score should not be used interchangeably to characterize the severity of perseverative tendencies in first-episode patients on a case-by-case basis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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-BLRE-can be extended to pediatric populations. The classification accuracy for FMS and S-BLRE 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-BLRE 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-BLRE distribution at 3.68 produces good specificity (.90-.92) but variable sensitivity (.06-.38). Passing or failing FMS or S-BLRE 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-BLRE 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.