Multiple Levels of Control Processes for Wisconsin Card Sorts: An Observational Study

Habits, Goals, and Behavioral Signs of Cognitive Perseveration on Wisconsin Card-Sorting Tasks

Wisconsin card-sorting tasks provide unique opportunities to study cognitive flexibility and its limitations, which express themselves behaviorally as perseverative errors (PE). PE refer to those behavioral errors on Wisconsin card-sorting tasks that are committed when cognitive rules are maintained even though recently received outcomes demand to switch to other rules (i.e., cognitive perseveration). We explored error-suppression effects (ESE) across three Wisconsin card-sorting studies. ESE refer to the phenomenon that PE are reduced on repetitive trials compared to non-repetitive trials. We replicated ESE in all three Wisconsin card-sorting studies. Study 1 revealed that non-associative accounts of ESE, in particular the idea that cognitive inhibition may account for them, are not tenable. Study 2 suggested that models of instrumental learning are among the most promising associative accounts of ESE. Instrumental learning comprises goal-directed control and the formation of corresponding associative memories over and above the formation of habitual memories according to dual-process models of instrumental learning. Study 3 showed that cognitive, rather than motor, representations of responses should be conceptualized as elements entering goal-directed instrumental memories. Collectively, the results imply that ESE on Wisconsin card-sorting tasks are not only a highly replicable phenomenon, but they also indicate that ESE provide an opportunity to study cognitive mechanisms of goal-directed instrumental control. Based on the reported data, we present a novel theory of cognitive perseveration (i.e., the 'goal-directed instrumental control' GIC model), which is outlined in the Concluding Discussion.

Functional Brain Network Analysis of Knowledge Transfer While Engineering Problem-Solving

As a complex cognitive activity, knowledge transfer is mostly correlated to cognitive processes such as working memory, behavior control, and decision-making in the human brain while engineering problem-solving. It is crucial to explain how the alteration of the functional brain network occurs and how to express it, which causes the alteration of the cognitive structure of knowledge transfer. However, the neurophysiological mechanisms of knowledge transfer are rarely considered in existing studies. Thus, this study proposed functional connectivity (FC) to describe and evaluate the dynamic brain network of knowledge transfer while engineering problem-solving. In this study, we adopted the modified Wisconsin Card-Sorting Test (M-WCST) reported in the literature. The neural activation of the prefrontal cortex was continuously recorded for 31 participants using functional near-infrared spectroscopy (fNIRS). Concretely, we discussed the prior cognitive level, knowledge transfer distance, and transfer performance impacting the wavelet amplitude and wavelet phase coherence. The paired t-test results showed that the prior cognitive level and transfer distance significantly impact FC. The Pearson correlation coefficient showed that both wavelet amplitude and phase coherence are significantly correlated to the cognitive function of the prefrontal cortex. Therefore, brain FC is an available method to evaluate cognitive structure alteration in knowledge transfer. We also discussed why the dorsolateral prefrontal cortex (DLPFC) and occipital face area (OFA) distinguish themselves from the other brain areas in the M-WCST experiment. As an exploratory study in NeuroManagement, these findings may provide neurophysiological evidence about the functional brain network of knowledge transfer while engineering problem-solving.

The Reliability of the Wisconsin Card Sorting Test in Clinical Practice

The Wisconsin Card Sorting Test (WCST) represents the gold standard for the neuropsychological assessment of executive function. However, very little is known about its reliability. In the current study, 146 neurological inpatients received the Modified WCST (M-WCST). Four basic measures (number of correct sorts, categories, perseverative errors, set-loss errors) and their composites were evaluated for split-half reliability. The reliability estimates of the number of correct sorts, categories, and perseverative errors fell into the desirable range (rel ≥ .90). The study therefore disclosed sufficiently reliable M-WCST measures, fostering the application of this eminent psychological test to neuropsychological assessment. Our data also revealed that the M-WCST possesses substantially better psychometric properties than would be expected from previous studies of WCST test-retest reliabilities obtained from non-patient samples. Our study of split-half reliabilities from discretionary construed and from randomly built M-WCST splits exemplifies a novel approach to the psychometric foundation of neuropsychology.

Toward a Computational Neuropsychology of Cognitive Flexibility

Cognitive inflexibility is a well-documented, yet non-specific corollary of many neurological diseases. Computational modeling of covert cognitive processes supporting cognitive flexibility may provide progress toward nosologically specific aspects of cognitive inflexibility. We review computational models of the Wisconsin Card Sorting Test (WCST), which represents a gold standard for the clinical assessment of cognitive flexibility. A parallel reinforcement-learning (RL) model provides the best conceptualization of individual trial-by-trial WCST responses among all models considered. Clinical applications of the parallel RL model suggest that patients with Parkinson's disease (PD) and patients with amyotrophic lateral sclerosis (ALS) share a non-specific covert cognitive symptom: bradyphrenia. Impaired stimulus-response learning appears to occur specifically in patients with PD, whereas haphazard responding seems to occur specifically in patients with ALS. Computational modeling hence possesses the potential to reveal nosologically specific profiles of covert cognitive symptoms, which remain undetectable by traditionally applied behavioral methods. The present review exemplifies how computational neuropsychology may advance the assessment of cognitive flexibility. We discuss implications for neuropsychological assessment and directions for future research.

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.

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.

A Computational Study of Executive Dysfunction in Amyotrophic Lateral Sclerosis

Executive dysfunction is a well-documented, yet nonspecific corollary of various neurological diseases and psychiatric disorders. Here, we applied computational modeling of latent cognition for executive control in amyotrophic lateral sclerosis (ALS) patients. We utilized a parallel reinforcement learning model of trial-by-trial Wisconsin Card Sorting Test (WCST) behavior. Eighteen ALS patients and 21 matched healthy control participants were assessed on a computerized variant of the WCST (cWCST). ALS patients showed latent cognitive symptoms, which can be characterized as bradyphrenia and haphazard responding. A comparison with results from a recent computational Parkinson's disease (PD) study (Steinke et al., 2020, J Clin Med) suggests that bradyphrenia represents a disease-nonspecific latent cognitive symptom of ALS and PD patients alike. Haphazard responding seems to be a disease-specific latent cognitive symptom of ALS, whereas impaired stimulus-response learning seems to be a disease-specific latent cognitive symptom of PD. These data were obtained from the careful modeling of trial-by-trial behavior on the cWCST, and they suggest that computational cognitive neuropsychology provides nosologically specific indicators of latent facets of executive dysfunction in ALS (and PD) patients, which remain undiscoverable for traditional behavioral cognitive neuropsychology. We discuss implications for neuropsychological assessment, and we discuss opportunities for confirmatory computational brain imaging studies.

Cognitive impairment in patients with Neuro-Sjögren

OBJECTIVE

Extraglandular neurological manifestations of Sjögren's syndrome are increasingly recognized, defining the disease entity of Neuro-Sjögren. Neuropsychological assessment of patients with Sjögren's syndrome has hitherto been performed on predominantly rheumatological cohorts. These studies revealed a wide variety of prevalence rates for cognitive impairment (22-80%), while variable cut-off criteria for detection of cognitive impairment were applied. Attentional functions have not yet been thoroughly investigated in these patients, although they clearly represent relevant aspects of cognitive functioning in daily life.

METHODS

We therefore conducted extensive neuropsychological assessment based on two neuropsychological test batteries [i.e., the extended German version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-PLUS), and the test battery for attentional performance (TAP) as a well-established assessment of attentional functions in the German-speaking part of Europe].

RESULTS

Sixty-four patients with Neuro-Sjögren, who were treated at our university hospital between December 2016 and January 2019, were included. Evidence for the presence of cognitive impairment was found in 55% of patients with Neuro-Sjögren. The degree of cognitive impairment ranged from mild (38%) to severe (17%). Attentional and mnemonic subtests showed pronounced cognitive impairment in patients with Neuro-Sjögren.

INTERPRETATION

Our results suggest that a substantial proportion of patients with Neuro-Sjögren suffer from cognitive impairment, putatively as a corollary of attentional deficits, which might exert adverse effects on occupational abilities, other cognitive functions, and social role functioning.

Computational Modeling for Neuropsychological Assessment of Bradyphrenia in Parkinson's Disease

The neural mechanisms of cognitive dysfunctions in neurological diseases remain poorly understood. Here, we conjecture that this unsatisfying state-of-the-art is in part due to the non-specificity of the typical behavioral indicators for cognitive dysfunctions. Our study addresses the topic by advancing the assessment of cognitive dysfunctions through computational modeling. We investigate bradyphrenia in Parkinson's disease (PD) as an exemplary case of cognitive dysfunctions in neurological diseases. Our computational model conceptualizes trial-by-trial behavioral data as resulting from parallel cognitive and sensorimotor reinforcement learning. We assessed PD patients 'on' and 'off' their dopaminergic medication and matched healthy control (HC) participants on a computerized version of the Wisconsin Card Sorting Test. PD patients showed increased retention of learned cognitive information and decreased retention of learned sensorimotor information from previous trials in comparison to HC participants. Systemic dopamine replacement therapy did not remedy these cognitive dysfunctions in PD patients but incurred non-desirable side effects such as decreasing cognitive learning from positive feedback. Our results reveal novel insights into facets of bradyphrenia that are indiscernible by observable behavioral indicators of cognitive dysfunctions. We discuss how computational modeling may contribute to the advancement of future research on brain-behavior relationships and neuropsychological assessment.