No deficit in Wisconsin Card Sorting Test performance of schizophrenic patients' first-degree relatives

doi:10.1016/S0920-9964(97)00047-9

Schizophrenia Research

Volume 26, Issues 2–3, 29 August 1997, Pages 147-151

https://doi.org/10.1016/S0920-9964(97)00047-9 Get rights and content

Abstract

The Wisconsin Card Sorting Test (WCST) was administered to 92 schizophrenic patients, 25 first-degree relatives and 60 normal subjects in order to investigate whether this task could be considered a trait marker of vulnerability to schizophrenia. The schizophrenic patients performed significantly worse than either their relatives or normal subjects, but unaffected relatives did not differ from controls. Our results suggest that WCST performance is more likely a feature inherent to the disease process rather than an index of the genetic susceptibility to the illness.

Introduction

The Wisconsin Card Sorting Test (WCST) is the most commonly used measure of executive functions in terms of concept formation, planning and cognitive flexibility, primarily involved in goal-directed behaviors. A large body of literature has consistently shown impairment of schizophrenics on this task (Goldberg and Gold, 1995; Keefe, 1995) which has been significantly associated with vocational disability (Jaeger et al., 1992; Lysaker et al., 1995).

Even though it has been considered a cognitive state marker of schizophrenia, this task has also been proposed as an indicator of vulnerability (i.e., trait marker) to the illness (for a review see Kremen et al., 1994). But to be so, such a trait marker should also show substantial genetic influence and occur with abnormally high frequency in populations at high risk for schizophrenia (Nuechterlein et al., 1992). However, the issue of the state versus trait marker has not yet been resolved: in fact, no agreement can be found in WCST studies of high risk-groups for schizophrenia (Goldberg et al., 1990; Franke et al., 1992; Roxborough et al., 1993; Scarone et al., 1993; Keefe et al., 1994; Faraone et al., 1995).

We therefore undertook this study to evaluate the WCST performances pattern in schizophrenic patients and in their first-degree relatives compared with normal subjects.

Section snippets

Method

The subjects were 92 patients (62 men and 30 women: mean age 31.31 years, SD 7.44; educational level 10.23 years, SD 3.35) consecutively admitted to an acute-care facility at the time of the study, who met the DSM-III-R criteria for schizophrenia. The first-degree relatives of the patients were selected only if they were willing to co-operate with the explained procedures of the study; this eventually resulted in a sample of 25 first-degree relatives—19 siblings, three parents, three offspring

Results

Table 1 shows the mean raw values and the two-way ANOVA results for the WCST indexes according to the diagnostic categories and sex. The diagnosis shows a significant effect, with the schizophrenic patients performing worse on all indexes but not on the failure to maintain set. Sex did not show significant effects, nor were interactions observed.

A one-way ANOVA of demographic variables such as age and educational level showed significant differences between the groups (age: F=2.95, p<0.05;

Discussion

Our data are in agreement with a large part of the previous literature reporting impairment of schizophrenic patients on executive functions such as those evaluated by WCST, but the relevant finding of this study is the lack of a significant difference in this neuropsychological performance between first-degree relatives and normal subjects; this no longer supports the hypothesis that this task can be considered an index of the genetic susceptibility to the disease. This observation is in

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In the cognitive domain, research on endophenotypes has mostly focused on higher cognitive functions (e.g. WCST) (Allen et al., 2009), which often depend on a variety of sub-functions, in the case of the WCST on mental flexibility, executive functioning, and working memory (Eling et al., 2008; Hartman et al., 2003). This variety in sub-functions might: (i) complicate the understanding of underlying brain mechanisms, (ii) result in heterogeneous findings along the schizophrenia spectrum (Jahshan and Sergi, 2007; Stratta et al., 1997; Thurston-Snoha and Lewine, 2007), and (iii) may explain why WCST deficits might also be found in other psychiatric (Martin et al., 1991; Waford and Lewine, 2010), and neurological (Paolo et al., 1996) conditions. We suggest that visual tasks tap into fewer and simpler mechanisms yielding better signal to noise ratios and, hence, less performance variability.
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In examinations of the factor structure of WCST deficits in schizophrenia, perseveration (which is the behavioral result of a lack of appropriate set switching) has been found to be the most diagnostically useful and characteristic WCST feature distinguishing schizophrenia subjects from controls (Koren e al., 1998). However, a number of studies have not found that subjects with schizophrenia make significantly more perseverative errors on the WCST than do healthy controls (Braff et al., 1991; Mattes et al., 1991; Saykin et al., 1994; McGrath et al., 1997; Stratta et al., 1997). Declarative memory (the retrieval of factual information) is one of the most consistent and severe cognitive deficits in schizophrenia (Cirillo and Seidman, 2003; Reichenberg and Harvey, 2007).
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No deficit in Wisconsin Card Sorting Test performance of schizophrenic patients' first-degree relatives

Abstract

Introduction

Section snippets

Method

Results

Discussion

Schizophrenia Research

Schizophrenia Research

Schizophrenia Research

Psychiatry Research

Psychiatry Research

Neuropsychologia

Schizophrenia Research

Schizophrenia Research

Neuropsychological functioning in siblings discordant for schizophrenia and healthy volunteers

Archives of General Psychiatry

Neuropsychological functions among the nonpsychotic relatives of schizophrenic patients: a diagnostic efficiency analysis

Journal of Abnormal Psychology

Smooth pursuit eye movements and neuropsychological test in schizophrenic patients: possible involvement of attentional components

European Archives of Psychiatry and Clinical Neuroscience

Neuropsychological assessment of monozygotic twins discordant for schizophrenia

Archives of General Psychiatry