Wisconsin Card Sorting Test

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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.[1][2] The WCST was written by David A. Grant and Esta A. Berg. The Professional Manual for the WCST was written by Robert K. Heaton, Gordon J. Chelune, Jack L. Talley, Gary G. Kay, and Glenn Curtiss.

Method[edit]

Screenshot from the PEBL computerized version of the Wisconsin Card sort

A number of stimulus cards are presented to the participant. The participant is told to match the cards, but not how to match; however, he or she is told whether a particular match is right or wrong. 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. 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.

This image shows the four lobes of the human brain: the frontal lobe (red), the parietal lobe (orange), the temporal lobe (green), and the occipital lobe (yellow). Also shown are the insular cortex (purple), the brain stem (black), and the cerebellum (blue).
This image shows a midsagittal cross-section of a human brain. The portion in color is the left frontal lobe, destroyed in Phineas Gage's accident.

Clinical use[edit]

Since 1948, the test was used by neuropsychologists, neurologists and psychiatrists in patients with acquired brain injury, neurodegenerative disease, or mental illness such as schizophrenia. It considered a speculative test, not conclusive, to measure frontal lobe dysfunction. When administered, the WCST allows the clinician speculate to the following "frontal" lobe functions: strategic planning, organized searching, utilizing environmental feedback to shift cognitive sets, directing behavior toward achieving a goal, and modulating impulsive responding. The test can be administered to those from 6.5 years to 89 years of age. The WSCT, relies upon a number of cognitive functions including attention, working memory, and visual processing.

Criticism[edit]

Developed in 1948, the WCST test is supposed to specifically measure an individual's competence in abstract reasoning, and the ability to change problem-solving strategies when needed.[3] In this test, a number of cards are presented to the participants. The figures on the cards differ with respect to color, quantity, and shape.[4] 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. 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)[5][6] [7][8]

Flaws in Testing[edit]

It is important to remember that a single test, such as the WCST, cannot be used to measure the effects of a frontal lobe injury, or the aspects of cognitive function it may affect, such as working memory; a variety of tests must be used. A subject may be good at one task but show dysfunction in executive function overall. Similarly, test results can be made misleading after testing the same individual over a long period of time. The subject may get better at a task, but not because of an improvement in executive cognitive function. He/she may have simply learned some strategies for doing this particular task that made it no longer a good measurement tool.[9]

Patients with damaged frontal lobes often complain of minimal to substantial memory loss, even though when such patients are tested using standard memory tests, they often score within normal. The disparity could be the result of the limits of these standardized tests.[10] Just as likely, the scientific community may not be comparing the right groups of people. Little is understood about frontal lobe functions facilitating memory, but what is clear is that more in-depth research of brain injury patients is needed. Because most research compares those with brain injuries (whether frontal lobe or not) and those without, the scientific community is unsure whether certain memory impairment is specific to frontal lobe injuries, or just traumatic brain injuries in general. There are many factors to consider when examining the effects of a traumatic brain injury, such as the nature of the injury as well as its cause; but the severity of the injury seems to be most important in affecting memory impairment specific to frontal lobe damage. Those patients suffering a mild traumatic brain injury with frontal lobe damage seem to be only slightly affected, if affected at all.

Frontal lobe injuries have been shown to cause decreased ability in combining events that are temporally separated (separated by time), as well as recalling information in its correct context. However, standardized testing may mask or exaggerate a possible impairment because the patients are strictly regulated, as are their discretionary behaviors. Many times, these are behaviors thought to be directly related to disorders of the frontal lobe, when is not, and these patients are suffering from a different problem entirely, such as paying attention, anxiety, sleep disorder, etc.

Conclusion[edit]

Therefore, the main conclusion that can be agreed upon is that psychological tests should continuously be scrutinized; as society progresses, better tests should be designed. Without the proper tests to assess traumatic brain injury patients with frontal lobe damage in particular, we may be misrepresenting the functions of the frontal lobe, specifically the role it plays in memory. [11]

Legal ownership of trademark[edit]

The trademark "Wisconsin Card Sorting Test" was registered in 2000 with the United States Patent and Trademark Office (Reg. #2320931, Ser # 75-588988) by Wells Print 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 Psychological Assessment Resources, Inc., sometimes referred to as simply WCST.

References[edit]

  1. ^ Monchi, O., Petrides, M. Petre, V., Worsley, K., & Dagher, A. (2001). Wisconsin card sorting revisited: Distinct neural circuits participating in different stages of the task identified by event-related functional magnetic resonance imaging. The Journal of Neuroscience, 21(19), 7733-7741.
  2. ^ E. A. Berg. (1948). A simple objective technique for measuring flexibility in thinking J. Gen. Psychol. 39: 15-22.
  3. ^ Biederam J, Faraone S, Monutaeux M et al. (2000). "Neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder". Journal of Abnormal Psychology 109 (2): 252–65. doi:10.1037/0021-843X.109.2.252. 
  4. ^ US National Library of Medicine National Institutes of Health, 2009
  5. ^ The prefrontal cortex and cognitive control Nature Reviews Neuroscience, 1, 59-65.]
  6. ^ combined with the formal information theoretical approach to cognitive control [Koechlin, E., & Summerfield, C. (2007).
  7. ^ An information theoretical approach to prefrontal executive function. Trends in Cognitive Sciences, 11, 229-235.].
  8. ^ Brain Cogn. 2009 Dec;71(3):437-51. doi: 10.1016/j.bandc.2009.03.005. Epub 2009 Apr 17.Department of Psychology, University of Colorado at Boulder, CO, USA.
  9. ^ Kane, M.J. & Engle, R.W. (2002). "The role of prefontal cortex in working-memory capacity,executive attention, and general fluid intelligence: An individual-differences perspective." Psychonomic Bulletin & Review 9(4), 637-671. Retrieved from http://psychology.gatech.edu/renglelab/Publications/2002/The%20role%20of%20prefrontal%20cortex%20in%20working-memory%20capacity.pdf
  10. ^ Kim, J.S., Kim, O.L., Seo, W.S., Koo, B.H., Joo,Y., & Bai, D.S. (2009). "Memory Dysfunctions after Mild and Moderate Traumatic Brain Injury : Comparison between Patients with and without Frontal Lobe Injury. " Journal of Korean Neurosurgical Society, 46(5), 459-467. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796352/
  11. ^ Kim, J.S., Kim, O.L., Seo, W.S., Koo, B.H., Joo,Y., & Bai, D.S. (2009). "Memory Dysfunctions after Mild and Moderate Traumatic Brain Injury : Comparison between Patients with and without Frontal Lobe Injury. " Journal of Korean Neurosurgical Society, 46(5), 459-467. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796352/

Further reading[edit]