Schizophrenia Research
Volume 63, Issue 3 , Pages 201-217 , 1 October 2003

Wisconsin Card Sorting Test performance in schizophrenia: the role of working memory

  • Marilyn Hartman

      Affiliations

    • Corresponding Author InformationCorresponding author. Tel.: +1-919-962-3987; fax: +1-919-962-2537
    • Psychology Department, University of North Carolina, Davie Hall CB #3270, Chapel Hill, NC 27599-3270, USA
  • ,
  • Mareah C Steketee

      Affiliations

    • Psychology Department, University of North Carolina, Davie Hall CB #3270, Chapel Hill, NC 27599-3270, USA
    • John Umstead Hospital, Butner, NC, USA
  • ,
  • Susan Silva

      Affiliations

    • University of North Carolina Hospitals, Chapel Hill, NC, USA
    • Duke University Medical Center, Durham, NC, USA
  • ,
  • Kristi Lanning

      Affiliations

    • University of North Carolina Hospitals, Chapel Hill, NC, USA
  • ,
  • Candace Andersson

      Affiliations

    • University of North Carolina Hospitals, Chapel Hill, NC, USA

Received 25 January 2002 ,Revised 25 June 2002 ,Accepted 28 June 2002.

References 

  1. American Psychiatric Association . DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. 4th ed.. Washington, DC: American Psychiatric Association; 1994;
  2. Artiges E, Salamé P, Recasens C, Poline J-B, Attar-Levy D, de la Raillere A, et al. Working memory control in patients with schizophrenia: a PET study during a random number generation task. Am. J. Psychiatry. 2000;157:1517–1519
  3. Baddeley A. Working Memory. London: Clarendon Press; 1986;
  4. Bellack AS, Mueser KT, Morrison RL, Tierney A, Podell K. Remediation of cognitive deficits in schizophrenia. Am. J. Psychiatry. 1990;147:1650–1655
  5. Berdia S, Metz JT. An artificial neural network simulating performance of normal subjects and schizophrenics on the Wisconsin Card Sorting Test. Artif. Intell. Med. 1998;13:123–138
  6. Berman KF, Zec RF, Weinberger DR. Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. Arch. Gen. Psychiatry. 1986;43:126–135
  7. Berman KF, Ostrem JL, Randolph C, Gold J, Goldberg TE, Coppola R, 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
  8. Brebion G, Amador X, Smith MJ, Gorman JM. Memory impairment and schizophrenia: the role of processing speed. Schizophr. Res. 1998;30:31–39
  9. Brebion G, Smith MJ, Gorman JM, Maslaspina D, Sharif Z, Amador X. Memory and schizophrenia: differential link of processing speed and selective attention with two levels of encoding. J. Psychiatr. Res. 2000;34:121–127
  10. Cabeza R, Nyberg L. Imaging cognition II: an empirical review of 275 PET and fMRI studies. J. Cogn. Neurosci. 2000;12:1–47
  11. Carter C, Roberson L, Nordahl T, Chaderjian M, Kraft L, O'Shora-Celaya L. Spatial working memory deficits and their relationship to negative symptoms in unmedicated schizophrenia patients. Biol. Psychiatry. 1996;40:930–932
  12. Carter CS, Perlstein W, Ganguli R, Brar J, Mintun M, Cohen JD. Functional hypofrontality and working memory dysfunction in schizophrenia. Am. J. Psychiatry. 1998;155:1285–1287
  13. Cohen J, O'Reilly R. A preliminary theory of the interactions between prefrontal cortex and hippocampus that contribute to planning and prospective memory. In:  Brandimonte M,  Einstein GO,  McDaniel MA editor. Prospective Memory: Theory and Applications. Mahwah, NJ: Erlbaum; 1995;p. 267–295
  14. Condray R, Steinhauer SR, van Kammen DP, Kasparek A. Working memory capacity predicts language comprehension in schizophrenic patients. Schizophr. Res. 1996;20:1–13
  15. Daneluuzo E, Bustini M, Stratta P, Casacchia M, Rossi A. Schizotypal personality questionnaire and Wisconsin Card Sorting Test in a population of DSM-III-R schizophrenic patients and control subjects. Compr. Psychiatry. 1998;39:143–148
  16. Dehaene S, Changeux JP. The Wisconsin Card Sorting Test: theoretical analysis and modeling in a neuronal network. Cereb. Cortex. 1991;1:62–79
  17. Delahunty A, Morice R, Frost B. Specific cognitive flexibility rehabilitation in schizophrenia. Psychol. Med. 1993;23:221–227
  18. Drewe EA. The effect of type and area of brain lesion on Wisconsin Card Sorting Test performance. Cortex. 1974;10:169–170
  19. Dunn LM, Dunn LM. Manual for Forms L and M: Peabody Picture Vocabulary Test-Revised. Circle Pines, MN: American Guidance Service; 1981;
  20. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders. New York: New York Psychiatric Institute, Biomedical Research Division; 1996;
  21. Fleming K, Goldberg TE, Binks S, Randolph C, Gold JM, Weinberger DR. Visuospatial working memory in patients with schizophrenia. Biol. Psychiatry. 1997;41:43–49
  22. Franke P, Maier W, Hain C, Klingler T. Wisconsin Card Sorting Test: an indicator of vulnerability to schizophrenia. Schizophr. Res. 1992;6:243–249
  23. Glahn D, Cannon T, Gur R, Ragland D, Gur R. Working memory constrains abstraction in schizophrenia. Biol. Psychiatry. 1999;47:34–42
  24. Gold JM, Carpenter C, Randolph C, Goldberg TE, Weinberger DR. Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Arch. Gen. Psychiatry. 1997;54:159–165
  25. Goldberg TE, Weinberger DR, Berman KF, Pliskin NH, Podd MH. Further evidence of dementia of the prefrontal type in schizophrenia: a controlled study of teaching the Wisconsin Card Sorting Test. Arch. Gen. Psychiatry. 1987;44:1008–1014
  26. Goldman RS, Axelrod BN, Tompkins LM. Effect of instruction cues on schizophrenia patients’ performance on the Wisconsin Card Sorting Test. Am. J. Psychiatry. 1992;149:1718–1822
  27. Goldman-Rakic PS. Circuitry of primate prefrontal cortex and regulation of behavior by representational memory. In:  Plum F editors. Handbook of Physiology, the Nervous System, Functions of the Brain. Bethesda, MD: American Physiological Society; 1987;p. 373–417
  28. Grant DA, Berg EA. A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card-sorting problem. J. Exp. Psychol. 1948;38:404–411
  29. Green MF, Satz P, Ganzell S, Vaclav JF. Wisconsin Card Sorting Test performance in schizophrenia: remediation of a stubborn deficit. Am. J. Psychiatry. 1992;149:62–67
  30. Hartman M, Bolton E, Fehnel SE. Accounting for age differences on the Wisconsin Card Sorting Test: decreased working memory, not inflexibility. Psychol. Aging. 2001;16:385–399
  31. Hartman, M., Steketee, M., Silva, S., Lanning, K., McCann, H., in press. Slowing of working memory in schizophrenia. Schizophr. Res.
  32. Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtiss G. Wisconsin Card Sorting Test Manual: Revised. Odessa, FL: Psychological Assessment Resources; 1993;
  33. Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology. 1998;12:426–445
  34. Huguelet P, Zanello A, Nicastro R. A study of visual and auditory verbal working memory in schizophrenia patients compared to healthy subjects. Eur. Arch. Psychiatr. Clin. Neurosci. 2000;250:79–85
  35. Javitt DC, Strous RD, Cowan N. Impaired precision, but normal retention, of auditory sensory (“echoic”) memory information in schizophrenia. J. Abnorm. Psychol. 1997;106:315–324
  36. Keefe RSE. Working memory dysfunction and its relevance in schizophrenia. In:  Sharma T,  Harvey PD editor. Cognitive Functioning in Schizophrenia. Oxford: Oxford Univ. Press; 2000;p. 16–49
  37. Keefe RSE, Roitman SEL, Harvey PD, Blum CS, DuPre RL, Prieto DM, et al. A pen-and-paper human analogue of a monkey prefrontal cortex activation task: spatial working memory in patients with schizophrenia. Schizophr. Res. 1995;17:25–33
  38. Kern RS, Wallace CJ, Hellman SG, Womack LM, Green MF. A training procedure for remediating WCST deficits in chronic psychotic patients: an adaptation of errorless learning principles. J. Psychiat. Res. 1996;30:283–294
  39. Kimberg DY, Farah MJ. A unified account of cognitive impairments following frontal lobe damage: the role of working memory in complex, organized behavior. J. Exp. Psychol. 1993;122:411–428
  40. Koren D, Seidman LJ, Harrison RH, Lyons MJ, Kremen WS, Caplan B, et al. Factor structure of the Wisconsin Card Sorting Test: dimensions of deficit in schizophrenia. Neuropsychology. 1998;12:289–302
  41. McDowell JE, Clementz BA. Ocular-motor delayed-response task performance among schizophrenia patients. Biol. Psychiatry. 1996;34:67–71
  42. Metz JT, Johnson MD, Pliskin NH, Luchins DJ. Maintenance of training effects on the Wisconsin Card Sorting Test by patients with schizophrenia or affective disorders. Am. J. Psychiatry. 1994;151:120–122
  43. Milner B. Effects of different brain lesions on card sorting. Arch. Neurol. 1963;9:90–100
  44. Morice R, Delahunty A. Frontal/executive impairments in schizophrenia. Schizophr. Bull. 1996;22:125–137
  45. Nelson HE. A modified card sorting test sensitive to frontal lobe deficits. Cortex. 1976;12:313–324
  46. Northern California Neurobehavioral Group . Manual for Cognistat (The Neurobehavioral Cognitive Status Examination). Fairfax, CA: Northern California Neurobehavioral Group; 1995;
  47. Öhman A, Nordby H, d'Elia G. Orienting and schizophrenia: stimulus significance, attention, and distraction in a signaled reaction time task. J. Abnorm. Psychol. 1986;95:326–334
  48. Olejnik S, Li J, Supattathum S, Huberty CJ. Multiple testing and statistical power with modified Bonferroni procedures. J. Educ. Behav. Statistics. 1997;22:389–406
  49. Park S. Association of an occulomotor delayed response task and the Wisconsin Card Sort Test in schizophrenia patients. Int. J. Psychophysiol. 1997;27:147–151
  50. Park S, Holzman PS. Schizophrenics show working memory deficits. Arch. Gen. Psychiatry. 1992;49:563–568
  51. Park S, Holzman PS. Association of working memory deficit and eye tracking dysfunction in schizophrenia. Schizophr. Res. 1993;11:55–61
  52. Park S, Puschel J, Sauter BH, Rentsch M, Hell D. Spatial working memory deficits and clinical symptoms in schizophrenia: a 4-month follow-up study. Biol. Psychiatry. 1999;46:392–400
  53. Perry W, Potterat EG, Braff DL. Self-monitoring enhances Wisconsin Card Sorting Test performance in patients with schizophrenia: performance is improved by simply asking patients to verbalize their sorting strategy. J. Int. Neuropsychol. Soc. 2001;7:344–352
  54. Salamé P, Danion J-M, Peretti S, Cuervo C. The state of functioning of working memory in schizophrenia. Schizophr. Res. 1998;30:11–29
  55. Salthouse TA. The processing-speed theory of adult age differences in cognition. Psychol. Rev. 1996;103:403–428
  56. Saoud M, Hueber T, Mandran H, Dalery J, d’Amato T. Olfactory identification deficiency and WCST performance in men with schizophrenia. Psychiatry Res. 1998;81:251–257
  57. Schneider W. Micro Experimental Laboratory: an integrated system for IBM PC compatibles. Behav. Res. Methods Instrum. Comput. 1988;20:206–217
  58. Seidman LJ, Yurgelun-Todd D, Kremen WS, Woods BT, Goldstein JM, Faraone SV, et al. Relationship of prefrontal and temporal lobe MRI measures to neuropsychological performance in chronic schizophrenia. Biol. Psychiatry. 1994;35:235–246
  59. Snitz BE, Curtis CE, Zald DH, Katsanis J, Iacono WG. Neuropsychological and oculomotor correlates of spatial working memory performance in schizophrenia patients and controls. Schizophr. Res. 1999;38:37–50
  60. Spindler KA, Sullivan EV, Menon V, Lim KO, Pfefferbaum A. Deficits in multiple systems of working memory in schizophrenia. Schizophr. Res. 1997;26:1–10
  61. Stone M, Gabrieli JDE, Stebbins GT, Sullivan EV. Working and strategic memory deficits in schizophrenia. Neuropsychology. 1998;12:278–288
  62. Stratta P, Mancini F, Mattei P, Casacchia M, Rossi A. Information processing strategy to remediate Wisconsin Card Sorting Test performance in schizophrenia: a pilot study. Am. J. Psychiatry. 1994;151:915–918
  63. Stratta P, Daneluzzo E, Prosperini P, Bustini M, Mattei P, Rossi A. Is Wisconsin Card Sorting Test performance related to ‘working memory’ capacity?. Schizophr. Res. 1997;27:11–19
  64. Stratta P, Daneluzzo E, Prosperini P, Bustini M, Marinangeli MG, Rossi A. Spatial working memory assessment by a visual-manual delayed response task: a controlled study in schizophrenia. Neurosci. Lett. 1999;275:9–12
  65. Stuss DT, Benson DF, Kaplan EF, Weir WS, Naeser MA, Lieberman I, et al. The involvement of orbitofrontal cerebrum in cognitive tasks. Neuropsychologia. 1983;21:235–248
  66. Sullivan EV, Mathalon DH, Zipursky RB, Kersteen-Tucker Z, Knight RT, Pfefferbaum A. Factors of the Wisconsin Card Sorting Test as measures of frontal-lobe function in schizophrenia and in chronic alcoholism. Psychiatry Res. 1993;46:175–199
  67. Van der Does AJW, Van den Bosch RJ. What determines Wisconsin Card Sorting performance in schizophrenia?. Clin. Psychol. Rev. 1992;12:567–583
  68. Weinberger DR, Berman KF, Zec RF. Physiologic dysfunction of dorsolateral prefrontal cortex in Schizophrenia. Arch. Gen. Psychiatry. 1986;43:114–124

PII: S0920-9964(02)00353-5

doi: 10.1016/S0920-9964(02)00353-5

Schizophrenia Research
Volume 63, Issue 3 , Pages 201-217 , 1 October 2003