Reliability and construct validity of the Paired-Associate Recognition Test: A test of declarative memory using Wisconsin Card Sorting stimuli.

The Paired-Associate Recognition Test (PART) was developed to test declarative memory using Wisconsin Card Sorting Test (WCST) stimuli, for use in physiologic neuroimaging studies of memory and executive function in schizophrenia. PART was administered to 55 healthy adults (30 male, 25 female) to establish reliability and construct validity. Reliability results indicate that PART performance was stable across trials and internally consistent. Convergent validity was confirmed by significant correlations between PART and standard measures of visual recall, and by PART loading on a memory factor. Divergent validity was established through low correlations between PART and WCST, and by a loading of WCST on a separate factor. Overall results indicate that PART can be administered reliably and that it requires declarative memory processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frontotemporal cerebral blood flow change during executive and declarative memory tasks in schizophrenia: A positron emission tomography study.

Schizophrenia affects prefrontal and temporal-limbic networks. These regions were examined by contrasting regional cerebral blood flow (rCBF) during executive (Wisconsin Card Sorting Test [WCST]), and declarative memory tasks (Paired Associate Recognition Test [PART]). The tasks, and a resting baseline, were administered to 15 patients with schizophrenia and 15 healthy controls during 10 min positron emission tomography 1?O-water measures of rCBE Patients were worse on both tasks. Controls activated inferior frontal, occipitotemporal, and temporal pole regions for both tasks. Similar results were obtained for controls matched to level of patient performance. Patients showed no activation of hypothesized regions during the WCST and activated the dorsolateral prefrontal cortex during the PART. On the PART, occipitotemporal activation correlated with better performance for controls only. Better WCST performance correlated with CBF increase in prefrontal regions for controls and in the parahippocampal gyrus for patients. Results suggest that schizophrenia may involve a breakdown in the integration of a frontotemporal network that is responsive to executive and declarative memory demands in healthy individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PET regional cerebral blood flow change during working and declarative memory: relationship with task performance

Functional and anatomical relationships between working and declarative memory were investigated by contrasting regional cerebral blood flow (rCBF) change during standard working (Wisconsin Card Sorting Test, WCST) and declarative memory (Paired Associate Recognition Test, PART) tasks using identical stimulus-response modalities. The tasks and a resting baseline were administered to 30 participants (16 men, 14 women) during successive 10-min positron emission tomography 15O-water measures of rCBF. For both tasks, rCBF increased over baseline in inferior frontal and occipitotemporal regions, with more consistent dorsolateral prefrontal activation for WCST than PART. Additional orbitofrontal increases and dorsomedial decreases were seen for the PART. Activation patterns diverged when performance was considered. For the WCST, high performers activated dorsolateral and inferior frontal regions, whereas top PART performers activated only the occipitotemporal region. These results suggest operation of a frontotemporal network subserving both types of memory function that becomes more focal as performance increases.     

PET regional cerebral blood flow during working and declarative memory: Relationship with task performance.

Functional and anatomical relationships between working and declarative memory were investigated by contrasting regional cerebral blood flow (rCBF) change during standard working (Wisconsin Card Sorting Test, WCST) and declarative memory (Paired Associate Recognition Test, PART) tasks using identical stimulus-response modalities. The tasks and a resting baseline were administered to 30 participants (16 men, 14 women) during successive 10-min positron emission tomography –2–5O-water measures of rCBF. For both tasks, rCBF increased over baseline in inferior frontal and occipitotemporal regions, with more consistent dorsolateral prefrontal activation for WCST than PART. Additional orbitofrontal increases and dorsomedial decreases were seen for the PART. Activation patterns diverged when performance was considered. For the WCST, high performers activated dorsolateral and inferior frontal regions, whereas top PART performers activated only the occipitotemporal region. These results suggest operation of a frontotemporal network subserving both types of memory function that becomes more focal as performance increases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Paranoid schizophrenia: non-specificity of neuropsychological vulnerability markers

During stages of remission, patients with paranoid schizophrenia seldom show severe attentional or information-processing dysfunctions, except in cases of long-term chronicity. The diagnostic specificity of four putative psychological vulnerability indicators of schizophrenia - the Span of Apprehension, the degraded stimulus Continuous Performance Test (dsCPT), the degraded stimulus visual backward masking task and the Wisconsin Card Sorting Test (WCST) - was examined in a group of patients with paranoid schizophrenia. Since no single test seems to identify all patients, the use of a combination of measures may be a useful strategy. Accordingly, the four tests were administered to 18 paranoid schizophrenic patients, 18 depressed patients and 18 normal subjects. Paranoid schizophrenic patients could be distinguished from normal subjects primarily on the basis of their performance on the backward masking task and secondarily by the dsCPT and the WCST. Paranoid schizophrenic and depressed patients could be differentiated to some extent by their performance on an information-mask condition of the backward masking task. Thus, of the four measures studied, only the degraded stimulus backward masking appeared to be a specific indicator of paranoid schizophrenia.     

The resting and activation issue of hypofrontality: a single photon emission computed tomography study in neuroleptic-naive and neuroleptic-free schizophrenic female patients

BACKGROUND: Functional neuroimaging findings of "hypofrontality" in schizophrenic patients is still controversial, due to the heterogeneity of methods and patient samples. This study tries to prevent some of these concerns by studying neuroleptic-naive (NN) and neuroleptic-free (NF) young female patients both in resting conditions and during a frontal cognitive activation task. METHODS: Regional cerebral blood flow (rCBF) was studied at rest and during the Wisconsin Card Sorting Test (WCST) in 25 young acute unmedicated schizophrenic female patients (14 NN and 11 NF) and 15 female controls, using single photon emission computed tomography. RESULTS: The schizophrenic and control groups did not differ in rCBF during the baseline condition, but the schizophrenic group failed to activate the frontal lobe during the WCST condition. In addition, the left anterior temporal rCBF at rest correlated with the Scale for the Assessment of Positive Symptoms total score. CONCLUSIONS: The results suggest that hypofrontality in young acute unmedicated schizophrenic patients is a result of an inability to activate frontal regions during cognition, rather than a baseline decrease in frontal activity. Furthermore, positive symptoms seem to be associated with left temporal cortex activity.     

Differential aspects of conceptual processing in the Category Test and Wisconsin Card Sorting Test

Ninety-six veterans from neuropsychiatric wards were administered the Category Test (CT), Wisconsin Card Sorting Test (WCST), and a series of concept formation tests assessing attribute identification and rule learning. The CT and WCST shared only 30% common variance, and related to different facets of concept formation. The WCST was associated with attribute identification, which entails discrimination of relevant features, while the CT was more related to rule learning, which assesses the deduction of classification rules. The CT and WCST should not be regarded as similar measures of one construct such as "abstraction." Use of discrete scores from each test can help assess different aspects of concept formation.     

Wisconsin Card Sorting Test performance in relapsing-remitting and chronic-progressive multiple sclerosis.

The Wisconsin Card Sorting Test (WCST), a measure of concept formation and set-shifting capacity, was administered to two groups of multiple sclerosis (MS) patients defined by relapsing-remitting (n?=?36) or chronic-progressive (n?=?33) clinical courses. The performance of each group was compared with an age and education-matched control group of chronic back pain patients. The chronic-progressive patients achieved fewer conceptual categories due to a significantly greater number of perseverative responses than control patients, whereas the relapsing-remitting group was unimpaired on the WCST relative to the control group. A stepwise multiple regression analysis suggested that these performance differences were related to clinical course and not to length of illness or degree of physical disability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the Wisconsin Card Sorting Test: Dimensions of deficit in schizophrenia.

The aim of this study was to explore the factorial structure of the Wisconsin Card Sorting Test (WCST) and to identify the dimensions of deficit in schizophrenia. WCST scores in patients with schizophrenia and schizophrenia-related psychosis (n?=?292), 1st degree relatives of schizophrenic patients (n?=?91), and normal controls (n?=?141) were subjected to a principal factor analysis followed by orthogonal rotation. This led to 3 factors, perseveration, failure to maintain set, and idiosyncratic sorting. The detected factor structure was found to be invariant across the schizophrenic and control subsamples. Moreover, it replicated previous findings from 2 smaller samples. Only perseverations and, to a lesser degree, idiosyncratic sorting appeared to differentiate schizophrenic patients from comparisons. Only perseveration had good sensitivity and specificity, as well as the most robust significant correlations with estimates of IQ, attention, and other measures of executive functioning. Thus, perseveration appears to be the most diagnostically useful and characteristic WCST feature of schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examination of age-related deficits on the Wisconsin Card Sorting Test.

Adult age differences in Wisconsin Card Sorting Test (WCST) measures were examined before and after statistical control of age-related differences in measures of feedback usage, working memory, and perceptual-comparison speed. The proportion of age-related variance associated with a summary measure of WCST performance was greatly reduced after controlling for measures of feedback usage, working memory, and perceptual-comparison speed. Furthermore, the age-related variance associated with the feedback-usage measure was reduced after controlling for working memory and perceptual-comparison speed measures. These results are consistent with the idea that age-related performance differences in the WCST are partially mediated by adult age differences in feedback usage and that age differences in feedback usage are mediated by age differences in working memory, which are in turn mediated by age-related reductions in processing speed, indexed by measures of perceptual-comparison speed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of psychopathology on visual discrimination.

"Perceptual and motor aspects of the Bender-Gestalt Test performance were compared for 4 groups of Ss: 10 student nurses, 10 acute schizophrenic patients, 10 chronic schizophrenic patients, and 10 patients hospitalized for neurological reasons… . After the Ss had obtained equal experiences with the Bender designs by reproducing them under memory and copy conditions, a perceptual multiple-choice test was administered under memory and matching conditions. Results indicate that there are marked differences in perceptual accuracy between the 4 groups: the control population was most accurate, with the acute schizophrenic, chronic schizophrenic, and neurological patients less proficient in that order." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Test anxiety and intellectual performance.

High school students were administered 2 anxiety scales, the Test Anxiety Scale and a Need for Achievement scale. Scores on these tests were related to scores on the School and College Ability Test (SCAT). Test anxiety was found to be negatively correlated with SCAT scores. The negative correlations obtained tended to be larger for female than for male Ss. The Need for Achievement scale showed only a slight tendency to correlate negatively with SCAT scores. The results were interpreted as being consistent with the conception of anxiety as an interfering nonintellectual influence on intellectual performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of cigarette smoking and smoking deprivation on Wisconsin Card Sorting Test performance.

Wisconsin Card Sorting Test (WCST) performance was assessed in 24 heavy smokers and 12 nonsmokers recruited from universities in the US and Japan. Half of the smokers performed the WCST after abstaining from tobacco for 12 hrs, whereas the remaining smokers smoked a cigarette of their preferred brand immediately before the test. Nonsmokers did not smoke. The WCST was administered by computer, first with standard instructions and then a 2nd time with abbreviated instructions that specified the 3 sorting criteria. Results from the 2nd run indicated that abstinent smokers made significantly more perseverative responses and errors than did nonsmokers or smoking smokers. Results expand on previous findings of effects of smoking deprivation on human cognitive performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abnormal saccadic distractibility in patients with schizophrenia: a 99mTc-HMPAO SPET study

Recent research has shown that some patients with schizophrenia have a severe impairment in the suppression of reflexive saccadic eye movements in the ANTI-saccade task. This saccadic distractibility has previously been found in patients with lesions of dorsolateral prefrontal cortex, implicating an abnormality of prefrontal cortex. The objective of the present study was to determine the contribution of these and other areas to the ANTI-saccadic abnormality in schizophrenia by functional neuroimaging. Using 99mtechnetium-HMPAO high resolution multidetector single-photon emission tomography, regional cerebral blood flow (rCBF) during performance of the ANTI-saccade eye-movement task was compared, by statistical parametric mapping, in ten male schizophrenic patients on stable antipsychotic medication who had a high distractibility error rate on the task, and eight similar patients who had normal distractibility error rates. Compared with the normal error group, the patients with high error rates showed significantly decreased rCBF bilaterally, in the anterior cingulate, insula, and in left striatum. These same patients also had increased perseverative errors on the Wisconsin Card Sort Test.     

The behaviors of AIDS patients toward their nurses

The purpose of this study is to clarify which psychiatric symptoms affect the results in the Wisconsin Card Sorting Test (WCST) in schizophrenic patients. In a six month period, we selected 29 schizophrenic volunteers in a large psychiatric teaching hospital in Taiwan according to DSM-III-R. The psychiatrists and psychologists collected basic data and evaluated every volunteer's psychiatric symptoms using the Positive and Negative Syndrome Scale (PANSS) and the computerized Wisconsin Card Sorting Test (WCST) in three days. Twenty-four schizophrenic volunteers completed all examinations. We used SPSS 7.0 for Windows for data analysis. The results showed significant, positive correspondence between the WCST categories (1) trial to complete first category and the respective PANSS categories(1) G15. Preoccupation. Furthermore, the results which used stepwise analysis multiple regression showed P3 halluciatory behavior, N4. apathetic/social withdrawal positive scales, and S5 grandiosity in the PANSS could predict categories completed in the WCST; disorientation, N2. emotional withdrawal, and Positive scales in the PANSS could predict Perseverative Responses in the WCST; N4, Apathetic/Social Withdrawal in the PANSS could predict Number of Errors, and Percent Conceptual Level Responses in the WCST. Furthermore, G15. Preoccupation in the PANSS could predict Trial to Complete First Category in the WCST. Only Positive scales in the subscales of the PANSS could predict the results of WCST.     

Brain activations in schizophrenia during a graded memory task studied with functional neuroimaging

BACKGROUND: Functional neuroimaging experiments have implicated prefrontal cortex (PFC) in memory processes. Several studies of schizophrenic patients have shown failure of activation in the dorsolateral region of PFC (DLPFC). We used a graded memory challenge to characterize functional neuroanatomical differences between schizophrenic and control subjects. The graded manipulation of task demands enabled us to assess group differences in the context of normal and abnormal psychological task performance. METHODS: Memory-related activity was assessed using positron emission tomography in schizophrenic patients and age-matched controls during performance of a graded memory task. Subjects underwent scanning while learning and recalling word lists of variable length. RESULTS: We used a model that assessed linear and nonlinear effects of memory load. Nonlinear group differences in DLPFC activation were observed. Controls showed a steepening slope of DLPFC increase as task demands increased. By contrast, schizophrenic subjects showed initial DLPFC increases that fell away with increasing memory load. The DLPFC response in schizophrenic subjects was closely related to measured task performance. In addition, schizophrenic subjects failed to show task-related decreases in activity in the left superior temporal and inferior parietal gyrus. CONCLUSIONS: Patients with schizophrenia showed a failure in DLPFC activation only in the face of diminished performance measures, suggesting that a full characterization of task-related changes in DLPFC activation must consider performance levels. However, striking failures of deactivation in superior temporal and inferior parietal regions were independent of task performance, possibly reflecting a core abnormality of the condition.     

A constant current source for extracellular microiontophoresis

There is evidence that some schizophrenic patients have deficits on tests of cognitive function, particularly tests of executive function, including the Wisconsin Card Sorting Test (WCST) and the Trail-making Test, Part B. This study was conducted to determine the generalizability of these findings across the schizophrenia spectrum to schizotypal personality disorder (SPD). Forty DSM-III SPD patients, 56 nonschizophrenia-related other personality disorder (OPD) patients, and 32 normal volunteers from two medical centers performed tests of executive function such as the WCST, Trail-making Part B, Stroop Word-Color Test, and Verbal Fluency, as well as tests of more general intellectual functioning such as the Wechsler Intelligence Scale-Revised Vocabulary and Block Design subtests, and Trail-making Part A. SPD patients performed more poorly on the WCST and on Trail-making Part B than did OPD patients or normal subjects; the groups did not differ on tests of general intellectual functioning. SPD patients may share some of the cognitive deficits observed in schizophrenia.     

Light and electron microscopic evidence for topographic and monosynaptic projections from neurons in the ventral medulla to noradrenergic dendrites in the rat locus coeruleus

Mental diseases such as schizophrenia are being modeled by artificial neural networks in an attempt to understand the underlying neuropathological processes. We studied hospitalized psychiatric patients that met the DSM-IIIR criteria for schizophrenia (N=19), and normal subjects with no psychiatric history (N=18). Performance on the Wisconsin Card Sorting Test (WCST) by schizophrenic patients was poorer than normal subjects as estimated by various scoring measurements. We then modeled an artificial neural network, motivated by biological considerations, that is able to simulate performance of normals and schizophrenics on the WCST. In order to model the complex nature of the WCST, we designed novel learning rules based on non-associative learning paradigms. We found that there must be a minimum amount of noise, or inherent synaptic instability, for our model to perform similar to schizophrenics.     

Spatial working memory deficits in the relatives of schizophrenic patients

BACKGROUND: Studies in nonhuman primates provide evidence that intact spatial working memory depends on the integrity of specific areas in the prefrontal cortex. Patients with schizophrenia have been shown to be impaired on spatial working memory tasks. Relatives of schizophrenic patients show a range of cognitive deficits in the absence of clinical symptoms (eg, thought disorder, eye tracking dysfunctions). We predicted that a significant proportion of relatives of schizophrenic patients would show deficits in working memory as measured by a delayed response task. METHODS: In experiment 1, we tested 18 schizophrenic patients, 15 first-degree relatives of schizophrenic patients, and 18 normal control subjects on an oculomotor delayed response task. In experiment 2, we assessed the performance of another group of 12 first-degree relatives of schizophrenic patients and 16 different normal control subjects on a visual-manual delayed response task. RESULTS: Relatives of schizophrenic patients showed significant deficits in working memory on both the oculomotor and visual-manual delayed response tasks. CONCLUSIONS: Some relatives of schizophrenic patients are impaired on tasks that tap spatial working memory and that implicate the prefrontal system. The delayed response paradigm may be useful in elucidating the multidimensionality of the schizophrenic phenotype.     

Sex differences in olfactory identification and Wisconsin Card Sorting performance in schizophrenia: relationship to attention and verbal ability

We investigated the hypothesis that different prefrontal brain systems (i.e., dorsal vs. ventral) and sex contribute differentially to cognitive deficit in schizophrenia. Performance was assessed among clinically stable, chronic schizophrenic outpatients and matched normal control subjects on olfactory identification [on the University of Pennsylvania Smell Identification Test (UPSIT)] and on executive functions [using the Wisconsin Card Sorting Test (WCST)]. Patients were impaired on both tests compared to controls, and male schizophrenics were impaired on the WCST compared to female schizophrenics. The pattern of results suggests that gender differences on the UPSIT are mildly accentuated in schizophrenia. The data support our previous study indicating that UPSIT performance is largely independent of the executive or attentional deficits typically associated with schizophrenia, with the exception of verbal ability. Further research with larger samples is required to test the hypothesis that there is a severely impaired subgroup of male patients with diffuse prefrontal dysfunctions.