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The cerebral correlates of different types of perseveration in the Wisconsin Card Sorting Test

¹ Department of Geriatric Neurology, Shiga Medical Center, 5-4-30 Moriyama, Moriyama-city, Shiga 524-8524, Japan
² Department of Neurology, Shiga Medical Center

Correspondence to:
Correspondence to:
Yasuhiro Nagahama
Department of Geriatric Neurology, Shiga Medical Center, 5-4-30 Moriyama, Moriyama-city, Shiga 524-8524, Japan; nagahama{at}kuhp.kyoto-u.ac.jp

Objectives: To explore the neural substrates corresponding to the perseverative errors in the Wisconsin Card Sorting Test (WCST).

Methods: The study examined the correlations between the WCST performances and the SPECT measurements of regional cerebral blood flow (rCBF) in subjects with neurodegenerative dementia. Negative non-linear correlations between the rCBF and the two different types of the perseverative errors ("stuck-in-set" and "recurrent" perseverative errors) were calculated on a voxel basis and volume-of-interest basis in the mixed groups of 72 elderly and dementia patients.

Results: The stuck-in-set perseverative error was associated with the reduced rCBF in the rostrodorsal prefrontal cortex, whereas the recurrent perseverative error was related to the left parietal activity but not to the prefrontal activity.

Conclusions: These findings augment evidence that the rostrodorsal prefrontal cortex crucially mediates attentional set shifting, and suggest that the stuck-in-set perseverative errors would be a true pathognomonic sign of frontal dysfunction. Moreover, this study shows that the recurrent perseverative errors may not be associated closely with the prefrontal function, suggesting that this error and the stuck-in-set error should be differentially estimated in the WCST.

Abbreviations: AD, Alzheimer’s disease; BA, Brodmann’s area; CT, computed tomography; fMRI, functional magnetic resonance imaging; FTD, frontotemporal lobar degeneration; FWHM, full width at half maximum; HMPAO, hexamethyl-propyleneamine oxime; MCI, mild cognitive impairment; MMSE, Mini-Mental State Examination; PFC, prefrontal cortex; Rec-PE, recurrent perseverative error; rCBF, regional cerebral blood flow; SPECT, single photon emission computed tomography; SPM, Statistical Parametric Mapping; SiS-PE, stuck-in-set perseverative error; WCST, Wisconsin Card Sorting Test; VOI, volume of interests

Keywords: Wisconsin Card Sorting Test; working memory; set-shifting

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