It's about time: mitigating cancer-related cognitive impairments through findings from computational models of the Wisconsin Card Sorting Task.

BACKGROUND: Many cancer survivors experience cancer-related cognitive impairment (CRCI), often with significant negative consequences across various life domains. Emerging evidence suggests that allowing additional time to process information before acting may be a useful strategy for those with CRCI to mitigate some of its impacts. The Wisconsin Card Sorting Task (WCST), a measure of general cognition, has shown that for some cancer survivors, longer task completion time facilitates similar task performance outcomes to control populations concerning perseveration errors; a key performance metric of the WCST. However, assessing if this strategy may be useful, as well as determining for whom it may be useful, with regard to strengths and weaknesses among select cognitive domains, is challenging due to factors such as the problem of task impurity. Accordingly, this study provides an initial computational and experimental assessment of whether additional time to process information before acting is a useful strategy for those with CRCI. METHODS: We simulated individual cognitive differences observed in humans by varying contributions of executive functioning components (updating, shifting, inhibition) to yield 48 distinct computational models of the WCST. Our main manipulation was then to provide these models with more or less time (at three levels of 20, 40 and 60 cycles) before models executed an action to sort a given card. We compared the number of perseveration errors on the WCST produced by the computational models. Additionally, we determined models that simulated the performance of cancer survivors on the WCST by comparing the number of perseveration errors produced by the models to human data. RESULTS: Additional processing time resulted in the models producing significantly fewer perseveration errors, supporting our hypothesis. In addition, 8 unique models simulated the performance of cancer survivors on the WCST. Additional time appeared to have a positive influence on performance primarily by mitigating the impacts of severe inhibition impairments. For more severe global executive function impairments, a substantial amount of additional time was required to mitigate the impacts of the impairments. For the most severe impairments, additional time was unable to adequately mitigate the impact on performance. CONCLUSION: Additional processing time may be a useful strategy to rectify perseveration errors among cancer survivors with CRCI. Our findings have implications for the development of practical strategies, such as workload and deadline management in occupational settings, which may mitigate the negative effects of CRCI.

The impact of reward and punishment sensitivity on memory and executive performance in individuals with amnestic mild cognitive impairment.

Amnestic mild cognitive impairment (aMCI) is defined by memory impairment but executive function (EF) deficits could be also a common feature. This study examined the underlying neurocognitive processes associated with executive function (EF) deficits in patients with aMCI using the Wisconsin Card Sorting Test (WCST) and computational modeling. Forty-two patients with aMCI and thirty-eight matched Controls performed the WSCT and underwent neurocognitive assessment. The Attentional Learning Model was applied the WCST. Patients with aMCI demonstrated deficits in feedback-learning. More specifically, patients showed increased Reward-Sensitivity and reduced Punishment-Sensitivity. These alterations were associated with poor WSCT performance and deficits in EF and Memory. Goal-directed deficits in aMCI, as observed in the WCST, are associated with difficulties in updating attention after feedback as its changes too rapidly following positive feedback and too slowly following negative feedback. Consequently, memory and EF deficits interact and reinforce each other generating performance deficits in patients with aMCI.

A meta-cognitive Wisconsin Card Sorting Test in people with schizophrenia and bipolar disorder: Self-assessment of sorting performance.

People with serious mental illness have challenged self-awareness, including momentary monitoring of performance. A core feature of this challenge is in the domain of using external information to guide behavior, an ability that is measured very well by certain problem-solving tasks such as the Wisconsin Card Sorting Test (WCST) . We used a modified WCST to examine correct sorts and accuracy decisions regarding the correctness of sort. Participants with schizophrenia (n = 99) or bipolar disorder (n = 76) sorted 64 cards and then made judgments regarding correctness of each sort prior to feedback. Time series analyses examined the course of correct sorts and correct accuracy decisions by examining the momentary correlation and lagged correlation on the next sort. People with schizophrenia had fewer correct sorts, fewer categories, and fewer correct accuracy decisions (all p<.001). Positive response biases were seen in both groups. After an incorrect sort or accuracy decision, the groups were equally likely to be incorrect on the next sort or accuracy decision. Following correct accuracy decisions, participants with bipolar disorder were significantly (p=.003) more likely to produce a correct sort or accuracy decision. These data are consistent with previous studies implicating failures to consider external feedback for decision making. Interventions aimed at increasing consideration of external information during decision making have been developed and interventions targeting use of feedback during cognitive test performance are in development.

Does cognitive learning potential measured with the dynamic Wisconsin Card Sorting Test predict rehabilitation outcome in elderly patients post-stroke?

OBJECTIVE: To determine whether cognitive learning potential measured with the dynamic Wisconsin Card Sorting Test has added value in predicting rehabilitation outcome in elderly patients post-stroke after controlling for age, ADL independence at admission, global cognitive functioning and depressive symptoms. METHODS: Participants were patients with stroke admitted to a geriatric rehabilitation unit. ADL independence (Barthel Index) at discharge was used as measure for rehabilitation outcome. Predictor variables included age, ADL independence at admission, global cognitive functioning (Montreal Cognitive Assessment), depressive symptoms (Geriatric Depression Scale) and cognitive learning potential measured with the dWCST. RESULTS: Thirty participants were included. Bivariate analyses showed that rehabilitation outcome was significantly correlated with ADL independence at admission (r = 0.443, p = 0.014) and global cognitive functioning (r = 0.491, p = 0.006). Regression analyses showed that the dWCST was not an independent predictor of rehabilitation outcome. ADL independence at admission was the only significant predictor of rehabilitation outcome (beta = 0.480, p = 0.007). CONCLUSIONS: Cognitive learning potential, measured with the dWCST has no added value in predicting rehabilitation outcome in elderly patients post-stroke. ADL independence at admission was the only significant predictor of rehabilitation outcome. REGISTRATION NUMBER NETHERLANDS TRIAL REGISTER: Trial NL7947.

Spanish normative studies (NEURONORMA-Plus project): norms for the Wisconsin Card Sorting Test, the Modified Taylor Complex Figure, and the Ruff-Light Trail Learning Test.

OBJECTIVE: The present study aims to provide norms and age-, education-, and sex-adjusted data for the Wisconsin Card Sorting Test (WCST), the Modified Taylor Complex Figure (MTCF), and the Ruff-Light Trail Learning Test (RULIT) as part of the NEURONORMA-Plus project. METHODS: We recruited 308 cognitively healthy individuals aged between 18 and 92 years. Tables are provided to convert raw scores to age-adjusted scaled scores, as well as adjustments for education and sex after applying independent regression models in 2 age groups (< 50 and ≥ 50 years). RESULTS: Older age had a negative effect on performance in both age groups. We observed a positive effect of education on WCST performance in the younger group (< 50 years), and on all MTCF measures (with the exception of the recognition task) in the older group (≥ 50 years). Education had no impact on performance in the RULIT, although sex did, with a small but significant effect whereby young men showed higher performance for one variable. CONCLUSION: The normative data provided can contribute to the clinical interpretation of performance in these tests in the Spanish population.

Predicting normative data in healthy individuals on the computerized wisconsin card sorting test using regression models.

BACKGROUND: Computerized neuropsychological tests provide advantages to clinicians with cost, administration, and time. However, studies have pointed out performance differences between manual and computerized versions of some neuropsychological tests. One of these is the Wisconsin Card Sorting Test (WCST). Due to the performance difference, the normative data of manual tests cannot be used for their computerized versions. Therefore, normative data searches are needed for computerized versions. OBJECTIVE: This study aimed to determine the norm values of WCST-CV in a healthy sample. METHODS: 422 healthy adults aged 18-78 participated in this study. WCST-CVsub-scores are modeled by Regression Analysis based on Age and Education level to generate normative data. Among the 13 WCST scores, the regression models for WCST 2, WCST 3, WCST 4, WCST 10, and WCST 11 are significant. WCST 2, WCST 4, and WCST 11 scores are estimated with Ordinary Least Squares (OLS). However, WCST 3 and WCST 10 scores are estimated with Weighted Least Squares (WLS) due to the violation of the homoscedasticity assumption. RESULTS: The regression results show that p-values calculated from error increase as age and education level increase. CONCLUSION: As a result of our research, norm values between 18-78 years of age were produced using RA. It was determined that gender was not significant for any sub-score. Therefore, only age and education level from socio-demographic variables were included in the model.

Proteomic association with age-dependent sex differences in Wisconsin Card Sorting Test performance in healthy Thai subjects.

Sex differences in cognitive function exist, but they are not stable and undergo dynamic change during the lifespan. However, our understanding of how sex-related neural information transmission evolves with age is still in its infancy. This study utilized the Wisconsin Card Sorting Test (WCST) and the label-free proteomics method with bioinformatic analysis to investigate the molecular mechanisms underlying age-related sex differences in cognitive performance in 199 healthy Thai subjects (aged 20-70 years), as well as explore the sex-dependent protein complexes for predicting cognitive aging. The results showed that males outperformed females in two of the five WCST sub-scores: %Corrects and %Errors. Sex differences in these scores were related to aging, becoming noticeable in those over 60. At the molecular level, differently expressed individual proteins and protein complexes between both sexes are associated with the potential N-methyl-D-aspartate type glutamate receptor (NMDAR)-mediated excitotoxicity, with the NMDAR complex being enriched exclusively in elderly female samples. These findings provided a preliminary indication that healthy Thai females might be more susceptible to such neurotoxicity, as evidenced by their cognitive performance. NMDAR protein complex enrichment in serum could be proposed as a potential indication for predicting cognitive aging in healthy Thai females.

Measuring cognitive flexibility in anorexia nervosa: Wisconsin Card Sorting Test versus cued task-switching.

PURPOSE: The Wisconsin Card Sorting Test (WCST) is the most common measure of cognitive flexibility in anorexia nervosa (AN), but task-switching paradigms are beginning to be utilized. The current study directly compared performance on a cued task-switching measure and the WCST to evaluate their association in participants with a lifetime diagnosis of AN, and to assess which measure is more strongly associated with clinical symptoms. METHODS: Forty-five women with a lifetime diagnosis of AN completed the WCST, cued color-shape task-switching paradigm, Anti-saccade Keyboard Task, Running Memory Span, Eating Disorder Examination Questionnaire, Depression Anxiety Stress Scales short form and Eating Disorder Flexibility Index. RESULTS: There was no evidence of a significant association between WCST perseverative errors and cued task-switching switch costs. Results suggest lower working memory capacity is a determinant of higher perseverative error rate. When controlling for mood variables, neither cognitive flexibility measure was a significant independent predictor of symptom severity. CONCLUSIONS: Results provide support for previous suggestions that WCST perseverative errors could occur due to difficulties with working memory, sensitivity to feedback, and issues with concept formation. Cued task-switching paradigms may provide a useful measure of cognitive flexibility for future eating disorders research by reducing task-specific confounds. LEVEL OF EVIDENCE: Level III Case-control analytic study.

Examining the validity of eye tracking during the computerized Wisconsin card sorting test in a sample of stroke patients and healthy controls.

INTRODUCTION: Each year, approximately 50,000 Canadians, one million Americans, and millions of people worldwide are hospitalized for stroke. Cognitive impairment is common after experiencing a stroke and is known to affect functioning on daily tasks. While neuropsychological assessments are often employed to assess cognitive abilities and make inferences about functional capabilities, there is growing interest in integrating contemporary technologies to augment assessment. Eye tracking allows previously overlooked information, such as overt visual attention based on fixations and saccades, to be quantified to help elucidate how responses are made during testing. METHOD: The current study investigated the validity of eye tracking during completion of the computerized Wisconsin Card Sorting Test (cWCST), a common test of higher level cognition, in a sample of inpatients recovering from stroke (n= 41) and a control group of healthy individuals (n = 46). RESULTS: Results provided supporting evidence for the construction, criterion, and ecological validity of eye tracking on the cWCST with inpatients recovering from a stroke. Specifically, eye tracking metrics differentiated between inpatients and controls; fixations on cWCST areas of interest differed between type of response (conceptual versus non-conceptual); and average time per fixation predicted functional status early after a stroke as well as recovery during inpatient rehabilitation, above-and-beyond cWCST scores. Time spent on testing negated the effects of fixation and saccade counts for predicting cWCST performance, due to the substantial overlap in variance. CONCLUSION: Current findings of this preliminary study provided support for the validity of eye tracking, integrated with the cWCST, for inpatients recovering from a stroke. Implications and areas for future research are discussed.

Heroin use and neuropsychological impairments: comparison of intravenous and inhalational use.

BACKGROUND AND OBJECTIVES: Injection and inhalational heroin use are associated with different levels of brain exposure to heroin and its metabolites and differences in the severity of dependence, which might lead to differential impacts on neuropsychological functions. We examined the difference and the magnitude of difference in the neuropsychological functions between inhalational and injection heroin-dependent subjects and also compared them with healthy controls. METHODS: The study sample comprised three groups: 73 subjects with injection heroin dependence, 74 with inhalational heroin dependence, and 75 healthy controls (HC). We excluded patients with HIV, head injury, epilepsy, and severe mental illness. Neuropsychological assessments were done by Standard Progressive Matrices, Wisconsin Card Sorting Test (WCST), Iowa Gambling Task, Trail-Making Tests A and B (TMT), and Verbal and Visual Memory 1 and 2 Backtests (NBT). We estimated independent effects of the groups on various neuropsychological test parameters, adjusted for age and duration of dependence. RESULTS: In the WCST, the inhalational heroin-dependent group took more trials to complete the first category and had higher scores in the failure to maintain set than controls. The intravenous group had higher total errors than controls in verbal working memory tests and Visual Working Memory 2 Backtest. This group scored higher commission errors in the Verbal 2 Backtest than the controls. The two groups of heroin users differed in failure to maintain set and Verbal Working Memory 2 Backtests. The effect sizes of the group differences were modest. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Either route of heroin use is associated with cognitive impairments; inhalational and injection use involve different cognitive domains.

Cognitive flexibility assessment with a new Reversal learning task paradigm compared with the Wisconsin card sorting test exploring the moderating effect of gender and stress.

Cognitive flexibility plays a crucial role in psychological health and this research aimed to investigate its assessment. We developed a novel Reversal learning task (RLT) paradigm adding pure reward (+ 100 points, 0) and punishment (- 100 points, 0) conditions to the classic reward-punishment condition (+ 100, - 100); we also analyzed the RLT convergent validity with approach-avoidance questionnaires (BIS-BAS and Approach-Avoidance Temperament questionnaire) and the Wisconsin card sorting test (WCST) scores through a Principal component analysis. In a sample of 374 participants, we found that these three conditions differently assess flexibility and that high RLT reward sensitivity in the punishment condition (0; - 100) is related with high BAS reward responsiveness. Moreover, we found that RLT and WCST flexibility scores, although associated, detect different facets of cognitive flexibility. Finally, in a second sample (N = 172), we explored the impact of stress, moderated by gender, on RLT and WCST. Whereas, WCST was not impacted by these variables, in RLT stressed women showed increased perseverative errors in punishment condition (- 100, 0) and reduced punishment sensitivity in reward condition (+ 100, 0).Overall, our newly developed RLT paradigm and the WCST seem to provide different ways to assess cognitive flexibility and to be differently affected by moderators, such as gender and stress.

Impairment of autonomic emotional response for executive function in children with ADHD: A multi-modal fNIRS and pupillometric study during the Wisconsin Card Sorting Test.

OBJECTIVE: Children with attention deficit hyperactivity disorder (ADHD) often experience difficulties with emotional control and a consequent inability to perform tasks. To clarify the effects of emotional behavior on cognitive functions, we aimed to determine the association between emotional changes and executive functions in children with ADHD by measuring the pupil diameter changes associated with emotional changes. PARTICIPANTS AND METHODS: This study included 14 children with ADHD and 10 typically developing children (TDC) aged between 10 and 16 years. During the Wisconsin Card Sorting Test (WCST), which is related to context formation and task switching among executive functions, changes in pupil diameter and frontal oxygenated hemoglobin (oxy-Hb) using functional near-infrared spectroscopy (fNIRS) were recorded simultaneously. Pupil diameter changes during "cognitive shift" and "consecutive correction" were compared between both groups. RESULTS: During cognitive shift, the pupils of children with ADHD contracted, whereas those of the TDC were mydriatic. During consecutive correction, the pupils of children with ADHD were mydriatic, whereas those of the TDC tended to contract. These results correlated with WCST performance. Moreover, during cognitive shifts, changes in bilateral frontal blood flow were increased in TDC, but not in children with ADHD. CONCLUSION: The locus coeruleus-norepinephrine (LC-NE) system plays an important role in pupillary diameter response. These results suggest that the LC-NE system may be dysfunctional in children with ADHD, and the system's abnormality may lead to affective abnormalities in such patients, which results in poor performance on WCST (i.e., impaired executive functions).

Latent, genetic, and molecular genetic structure of the Wisconsin Card Sorting Test.

OBJECTIVE: The main goal of this study was to explore the latent structure and genetic basis of cognitive processes involved in the Wisconsin Card Sorting Task (WCST) within phenotypic, behavioral genetic, and molecular genetic research paradigms. METHOD: The sample used in phenotypic and behavioral genetic analyses comprised 468 twins (154 monozygotic and 80 dizygotic twin pairs), while molecular genetic analyses were performed on 404 twins from the same sample. The zygosity of most twin pairs (96.8%) was determined via deoxyribonucleic acid (DNA) analysis of buccal swabs. Trained researchers administered the Wisconsin Card Sorting Test (WCST; Heaton et al., 1993) to the entire sample. RESULTS: A phenotypic factor analysis of WCST variables suggested a single-factor solution. Overall heritability ranged from 0.19 to 0.23 across different measures of the WCST. The presence of a single general genetic factor, which could be identified from different measures of the WCST, indicated the unity of various WCST indicators and the existence of a common basic ability. Performance on the WCST did not reveal significant differences between the three genotypes on catechol-O-methyltransferase (COMT) and dopamine receptor D2 (DRD2). Carriers of the brain-derived neurotrophic factor (BDNF) Met + genotype exhibited better performance in cognitive functions in comparison to the BDNF Met- genotype. CONCLUSIONS: This study highlighted similarities in the phenotypic and genetic structures of the WCST, suggesting one general factor underlying different cognitive functions. The BDNF Met + genotype showed significant main effects on different WCST measures. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Normative scores of the Wisconsin Card Sorting Test in a sample of the adult Portuguese population.

OBJECTIVES: The Wisconsin Card Sorting Test (WCST) is a neuropsychological instrument that is widely used for assessment of executive functioning in both clinical and research settings. The aim of this study was to provide the normative scores for the WCST in a sample of Portuguese healthy adults. METHODS: The data was collected from archival data in a total sample of 359 individuals, 149 men (41.5%, Mage = 38.3; SD = 20.3) and 210 women (58.5%, Mage = 52.2; SD = 19.4). Descriptive statistics were calculated to describe mean scores, standard-deviation and percentiles of the WCST indexes by gender, age and education. ANOVAs were used to explore the differences between these scores in sociodemographic variables. The normative scores were adjusted for age and educational level. RESULTS: Significant statistical differences in mean scores were found in several WCST indexes, such as, total errors, perseverations, perseverative errors and conceptual level responses regarding age and education. Percentiles for WCST indexes were stratified by age group and educational level. CONCLUSIONS: Age and education are important factors explaining performance on the WCST. This is the first study focused on the development of WCST normative scores for the adult Portuguese population, which can be applied in clinical, educational and research contexts.

The utility of the Wisconsin card sorting test, 64-card version to detect noncredible attention-deficit/hyperactivity disorder.

Clinicians who evaluate patients with concerns related to attention-deficit/hyperactivity disorder (ADHD) are encouraged to include validity indicators throughout clinical assessment procedures. To date, no known previous literature has examined the Wisconsin Card Sorting Test (WCST) specifically to address noncredible ADHD, and none has attempted to identify an embedded PVT within the 64-card version. The present study sought to address these gaps in the literature with a simulation study. Sixty-seven undergraduate participants (M age = 19.30) were grouped as credible (combining healthy controls and individuals with ADHD) or noncredible (combining coached and uncoached participants simulating ADHD-related impairment) and administered a battery of neuropsychological tests. Results revealed the noncredible group performed significantly worse on several WCST-64 variables, including failure to maintain set, number of trials to first category, and total categories. Raw scores from these variables were entered as predictors as one set in a logistic regression (LR) with group membership as the outcome variable. An exponentiated equation (EE) derived from LR results yielded acceptable discriminability (area under receiver operating characteristic curve = .73) with modest sensitivity (.38) while maintaining ideal specificity (.91), generally commensurate with a standalone forced-choice memory PVT and better than an embedded attention-based PVT. These findings suggested the WCST-64 may be sensitive to noncredible performance in the context of ADHD and reiterates the importance of considering tests of various cognitive abilities in the evaluation of performance validity. Implications of these findings, limitations of the present study, and directions for future inquiry, including cross-validation in clinical samples, were discussed.

Executive functions in Parkinson's disease / Funções executivas na doença de Parkinson / Funciones ejecutivas en la enfermedad de Parkinson

The objective of this study was to investigate executive functions (EFs) in older adults with Parkinson's disease (PD). It was a cross-sectional and comparative study, composed of 62 participants divided into PD group (n = 31; M age = 75.26; SD age = 7.26) and control group (n = 31; M age = 74.03; SD age = 6.95), aged 61 to 93 years, recruited for convenience in 5 cities in the state of Rio Grande do Sul. The instruments used were a sociodemographic data questionnaire; MMSE; GDS-15; BIS-11; verbal fluency tasks (FAS and animals), DEX; WCST-64 and FDT. Descriptive analyzes and Student's t and Chi-square tests were used. The PD group had a lower performance in the WCST-64 and FDT tests compared to controls, indicating worse performance in tasks that required reasoning, cognitive flexibility and processing speed, in addition, showed difficulties in performing tasks that require EF (DEX). (AU)

O objetivo foi investigar as funções executivas (FE) em idosos com Doença de Parkinson (DP). Estudo transversal e comparativo, composto por 62 participantes, 50% do sexo feminino, recrutados por conveniência em cinco cidades do estado do Rio Grande do Sul, e divididos em dois grupos: com DP (n = 31; Midade = 75,26; DP idade = 7,26) e grupo controle (n = 31; M idade = 74,03; DP idade = 6,95), com idade entre 61 e 93 anos. Os instrumentos utilizados foram: questionário de dados sociodemográficos, MEEM; GDS-15; BIS-11; tarefas de fluência verbal (FAS e animais); DEX; WCST-64 e FDT. Foram utilizadas análises descritivas e os testes t de Student e Qui-quadrado. O grupo com DP teve desempenho inferior nos testes WCST-64 e FDT em comparação aos controles, indicando pior desempenho nas tarefas que exigiam raciocínio, flexibilidade cognitiva e velocidade de processamento, além disso, mostraram dificuldades ao realizar tarefas que demandam FE (DEX). (AU)

El objetivo de este trabajo fue investigar las funciones ejecutivas (FE) en ancianos con enfermedad de Parkinson (EP). Se trató de un estudio transversal y comparativo, compuesto por 62 participantes, 50% mujeres, reclutados por conveniencia en cinco ciudades de la provincia de Rio Grande do Sul, y divididos en dos grupos: con EP (n = 31; M edad = 75,26; DS edad = 7,26) y grupo control (n = 31; M edad = 74,03; DS edad = 6,95). Fueron usados cuestionarios de datos sociodemográficos, MEEM, GDS-15; BIS-11; tareas de fluencia verbal (FAS y animales), DEX; WCST-64 y FDT. Se realizaron análisis descriptivos, prueba t de Student y chi-cuadrado. El grupo EP tuvo un rendimiento más bajo en las pruebas WCST-64 y FDT en comparación con el grupo control, lo que indica un peor rendimiento en tareas que requerían razonamiento, flexibilidad cognitiva y velocidad de procesamiento, además, mostró dificultades para realizar tareas que demandan FE (DEX). (AU)

Internal manipulation of perceptual representations in human flexible cognition: A computational model.

Executive functions represent a set of processes in goal-directed cognition that depend on integrated cortical-basal ganglia brain systems and form the basis of flexible human behaviour. Several computational models have been proposed for studying cognitive flexibility as a key executive function and the Wisconsin card sorting test (WCST) that represents an important neuropsychological tool to investigate it. These models clarify important aspects that underlie cognitive flexibility, particularly decision-making, motor response, and feedback-dependent learning processes. However, several studies suggest that the categorisation processes involved in the solution of the WCST include an additional computational stage of category representation that supports the other processes. Surprisingly, all models of the WCST ignore this fundamental stage and they assume that decision making directly triggers actions. Thus, we propose a novel hypothesis where the key mechanisms of cognitive flexibility and goal-directed behaviour rely on the acquisition of suitable representations of percepts and their top-down internal manipulation. Moreover, we propose a neuro-inspired computational model to operationalise this hypothesis. The capacity of the model to support cognitive flexibility was validated by systematically reproducing and interpreting the behaviour exhibited in the WCST by young and old healthy adults, and by frontal and Parkinson patients. The results corroborate and further articulate the hypothesis that the internal manipulation of representations is a core process in goal-directed flexible cognition.

Using a Meta-cognitive Wisconsin Card Sorting Test to measure introspective accuracy and biases in schizophrenia and bipolar disorder.

People with schizophrenia (SCZ) and bipolar disorder (BD) have challenges in self-evaluation of their cognitive and functional performance (introspective accuracy). They also manifest response biases, with tendencies toward overestimation. This study aimed to examine objective test performance, momentary judgments of performance, momentary confidence, and subsequent global judgments of performance on a metacognitive version of the Wisconsin Card Sorting Test (WCST). This sample included 99 participants with SCZ and 67 with BD. After each of the 64 WCST trials, participants reported whether they believed their sort was correct and how confident they were in that judgment, they then received performance feedback. After completion of the entire task, participants generated a global performance judgment. On average, the SCZ group got 31 sorts correct, reporting being correct on 49 whereas the BD group got 37 trials correct but reported being correct on 53. For participants with BD, sorting performance correlated with trial x trial accuracy judgments, confidence, and predicted global judgments. For SCZ participants, performance minimally correlated with trial x trial accuracy judgments, confidence, and global judgments, while trial x trial confidence was strongly associated with trial x trial accuracy judgments (r = 0.58). Our findings suggest that confidence in participants with BD is correlated with task performance, whereas in SCZ confidence was entirely associated with self-generated performance judgments. SCZ participants manifested challenges with utilization of feedback. Global judgments of performance were predicted by task performance and confidence for BD participants, with performance and confidence judgments occurring prior to generation of the global performance judgments.

Comparison of computerized and manual versions of the Wisconsin Card Sorting Test on schizophrenia and healthy samples.

This study aims to examine whether there is an equivalence between the two different versions of Wisconsin Card Sorting Test (WCST) regarding psychometric properties on two distinct samples: individuals diagnosed with schizophrenia and those who are healthy. A total of 504 individuals were included in the study, 243 were diagnosed with schizophrenia, and 261 were healthy individuals. Both samples were separated into two subsamples, and the individuals in each separated group were administered either WCST-C (computerized) or WCST-M (manual) version of the test. We compared statistical measures of mean and variance with the data obtained from the two samples. We carried out analyses related to parallel forms reliability and equality of variances of the tests scores produced by parallel forms of the WCST. There was no significant difference between mean values of manual and computerized versions administered for each sample. However, the patterns of variances of the obtained scores were dissimilar. According to these findings, the two versions were found to be inequivalent regarding psychometric properties. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Considerations for using the Wisconsin Card Sorting Test to assess cognitive flexibility.

The Wisconsin Card Sorting Test (WCST) is a popular neurocognitive task used to assess cognitive flexibility, and aspects of executive functioning more broadly, in research and clinical practice. Despite its widespread use and the development of an updated WCST manual in 1993, confusion remains in the literature about how to score the WCST, and importantly, how to interpret the outcome variables as indicators of cognitive flexibility. This critical review provides an overview of the changes in the WCST, how existing scoring methods of the task differ, the key terminology and how these relate to the assessment of cognitive flexibility, and issues with the use of the WCST across the literature. In particular, this review focuses on the confusion between the terms 'perseverative responses' and 'perseverative errors' and the inconsistent scoring of these variables. To our knowledge, this critical review is the first of its kind to focus on the inherent issues surrounding the WCST when used as an assessment of cognitive flexibility. We provide recommendations to overcome these and other issues when using the WCST in future research and clinical practice.