Wisconsin card sort

The Wisconsin Card Sorting Test (WCST) is a neuropsychological test of "set-shifting", i.e. the ability to display flexibility in the face of changing schedules of reinforcement.

Method

Initially, a number of stimulus cards are presented to the participant. The participant is not told how to match the cards; however, he or she is told whether a particular match is right or wrong. The mistakes made during this learning process, are analyzed to arrive at a score.

The original WCST used paper cards and was carried out with the experimenter on one side of the desk facing the participant on the other. [E. A. Berg. (1948). A simple objective technique for measuring flexibility in thinking J. Gen. Psychol. 39: 15-22.] Since the early 1990s, however, computerized versions of the task have been available, the most recent version being the Microsoft Windows-compatible version 4.0. [Psychological Assessment Resources. Computerised Wisconsin Card Sort Task Version 4 (WCST). Psychological Assessment Resources; 2003.] The latter has the advantage of automatically scoring the test, which was quite complex in the manual version. The test takes approximately 12-20 minutes to carry out and generates a number of psychometric scores, including numbers, percentages, and percentiles of: categories achieved, trials, errors, and perseverative errors.

Clinical use

Clinically, the test is widely used by neuropsychologists, clinical psychologists, neurologists and psychiatrists in patients with acquired brain injury, neurodegenerative disease, or mental illness such as schizophrenia. Although successful completion of the test relies upon a number of intact cognitive functions including attention, working memory, and visual processing, it is loosely termed a "frontal lobe" test on the basis that patients with any sort of frontal lobe lesion generally do poorly at the test. In particular, patients with lesions of the dorsolateral frontal lobe make a higher number of perseverative errors than control participants. [Milner B. Effect of Different Brain Lesions on Card Sorting. Archives of Neurology 1963; 9: 90-100.] A recent factor analysis of the WCST has shown these perseverative errors to be the most useful outcome measure in assessing caseness. [Greve KW, Stickle TR, Love J, Bianchini KJ, Stanford MS. Latent structure of the Wisconsin Card Sorting Test: a confirmatory factor analytic study. Archives of Clinical Neuropsychology 2005; 20: 355-364.] A more sophisticated description of deficits of this type is "executive dysfunction".

Use in research

The WCST has been used in neuroimaging paradigms such as PET and fMRI. As predicted by the acquired brain injury literature, early PET studies have shown the task involves significant activation of the dorsolateral prefrontal cortex. [Berman KF, Ostrem JL, Randolph C et al. Physiological activation of a cortical network during performance of the Wisconsin Card Sorting Test: a positron emission tomography study. Neuropsychologia 1995; 33: 1027-1046.] [Cabeza R, Nyberg L. Imaging cognition II: An empirical review of 275 PET and fMRI studies. J Cogn Neurosci 2000; 12: 1-47.] . However, more recent fMRI studies have shown that the ventrolateral prefrontal cortex (Konishi et al., 1998, Nature Neuroscience) together with the caudate nucleus (Monchi et al., 2001, J. Neuroscience) may be the regions most important for the set-shifting process required in the WCST. The test's use in neurodegenerative diseases such as motor neurone disease has identified at least a subgroup of these patients for whom there is some subtle degree of cognitive dysfunction, in contrast to the traditional view that these were pure disorders of the motor system.

The test is also widely used in research into schizophrenia e.g. [Cannon TD, Glahn DC, Kim J, Van Erp TG, Karlsgodt K, Cohen MS, Nuechterlein KH, Bava S, Shirinyan D., Dorsolateral Prefrontal Cortex Activity During Maintenance and Manipulation of Information in Working Memory in Patients With Schizophrenia, Arch Gen Psychiatry 2005;62:1071-1080.] [Rossi A, Daneluzzo E, Tomassini A, Struglia F, Cavallaro R, Smeraldi E, Stratta P., The effect of verbalization strategy on Wisconsin Card Sorting Test performance in schizophrenic patients receiving classical or atypical antipsychotics. BMC Psychiatry. 1290 Jan 26;6:3.]

Legal Ownership of Trademark

The trademark "Wisconsin Card Sorting Test" was registered in the year 2000 with the United States patent and Trademark Office (Reg. #2320931, Ser # 75-588988) by Wells Printing and Digital Services of Madison, Wisconsin. Although filed in 1998, the trademark application states the mark has been in use in commerce since at least 1970. The trademark covers "psychological testing materials, namely printed tests, printed cards, and printed instruction manuals in the field of psychological evaluation." This trademark does not cover the computer implementation of the test, distributed by PAR Inc., sometimes referred to as simply WCST.

References

External links

* A free implementation of the Wisconsin Card Sort Task is available as part of the [http://pebl.sourceforge.net PEBL Project] .