Cognitive flexibility in neurological disorders: Cognitive components and event-related potentials
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Performance deficits on the Wisconsin Card Sorting Test (WCST) in patients with prefrontal cortex (PFC) lesions are traditionally interpreted as evidence for a role of the PFC in cognitive flexibility. However, WCST deficits do not occur exclusively after PFC lesions, but also in various neurological and psychiatric disorders. We propose a multi-component approach that can accommodate this pattern of omnipresent WCST deficits: the WCST is not a pure test of cognitive flexibility, but relies on the effective functioning of multiple dissociable cognitive components. Our review of recent efforts to decompose WCST performance deficits supports this view by revealing that WCST deficits in different neurological disorders can be attributed to alterations in different components. Frontoparietal changes underlying impaired set shifting seem to give rise to WCST deficits in patients with amyotrophic lateral sclerosis, whereas the WCST deficits associated with primary dystonia and Parkinson's disease are rather related to frontostriatal changes underlying deficient rule inference. Clinical implications of these findings and of a multi-component view of WCST performance are discussed.
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Different aspects of cognitive flexibility may be impaired across neurological disorders; frontoparietal changes affecting set-shifting characterize ALS, while frontostriatal changes affecting rule inference are seen in primary dystonia and Parkinson disease.
“Across neurological disorders, different aspects of cognitive flexibility may be impaired. For example, frontoparietal changes affecting set-shifting ability characterize patients with amyotrophic lateral sclerosis, whereas frontostriatal changes affecting rule inference are seen in primary dystonia and Parkinson disease103.”
From Cognitive and behavioural flexibility: Neural mechanisms and clinical considerations (2021) · cites this paper as [103]
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- Authors
- Lange, F., Seer, C., & Kopp, B.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Lange, Florian
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 83
- Pages
- 496-507
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W2751367599
- Cited by
- 84
- References
- 163
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 8 · 2023: 7 · 2022: 9 · 2021: 11 · 2020: 13 · 2019: 11 · 2018: 7
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- green
- lirias.kuleuven.be
- Licence
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion, cc-by-nc-nd)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, other-oa)
- Funders
- Horizon 2020 (665501)
- Fonds Wetenschappelijk Onderzoek
- KU Leuven
- Horizon 2020 Framework Programme
- Studienstiftung des Deutschen Volkes
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- cognitive flexibility, Wisconsin Card Sorting Test, event-related potentials, set-shifting, rule inference, amyotrophic lateral sclerosis, primary dystonia, Parkinson's disease, prefrontal cortex lesions, frontostriatal dysfunction
- MeSH terms
- Cognition Disorders, Electroencephalography, Evoked Potentials, Humans, Nervous System Diseases, Neuropsychological Tests
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