The DOI matches its Crossref record; 51 of the 51 references it cites were found in a registry or an index; none of the 55 sources its claims cite is checked for support yet.
Digit Symbol Substitution Test: The Case for Sensitivity Over Specificity in Neuropsychological Testing
Open accessAbstract
Purpose/Background: Development of the Digit Symbol Substitution Test (DSST) was initiated over a century ago as an experimental tool to understand human associative learning. Its clinical utility, owing to its brevity and high discriminant validity, was first recognized in the 1940s, and now the DSST is among the most commonly used tests in clinical neuropsychology. Methods: Specific studies and articles were reviewed to illustrate what the test measures, to evaluate its sensitivity to change, and to discuss its use in clinical practice. Results: The DSST is a valid and sensitive measure of cognitive dysfunction impacted by many domains. Performance on the DSST correlates with real-world functional outcomes (eg, the ability to accomplish everyday tasks) and recovery from functional disability in a range of psychiatric conditions including schizophrenia and major depressive disorder. Importantly, the DSST has been demonstrated to be sensitive to changes in cognitive functioning in patients with major depressive disorder and offers promise as a clinical decision-making tool for monitoring treatment effects in this and other disorders affecting cognition. Implications/Conclusions: The DSST is sensitive to the presence of cognitive dysfunction as well as to change in cognitive function across a wide range of clinical populations but has low specificity to determine exactly which cognitive domain has been affected. However, the DSST offers a practical and effective method to monitor cognitive functions over time in clinical practice.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
The Digit Symbol Substitution Test (DSST) is a brief, widely used paper-and-pencil measure that is sensitive to cognitive dysfunction and change across many clinical populations, including major depressive disorder (MDD). It is polyfactorial and has low specificity for identifying which cognitive domain is impaired, but it may be useful for monitoring cognition over time in clinical practice.
Key findings
- The DSST is sensitive to cognitive impairment and change across psychiatric, neurologic, pharmacologic, and sleep-related conditions; in MDD, a meta-analysis of 1904 subjects across 22 studies found moderate impairment versus controls (Cohen’s d = 0.55; 95% CI, 0.34–0.75; P < 0.001).
- Vortioxetine trials in MDD reported DSST treatment effect sizes of 0.51 and 0.52 for 10 or 20 mg in one study and 0.254 for 10 to 20 mg in another; a meta-analysis found vortioxetine improved DSST-assessed cognition more than other antidepressants.
- DSST performance correlates with real-world functional outcomes: in MDD patients 6 months after hospital discharge, DSST was strongly associated with functional recovery in work, school, and housing (odds ratio nearly 20).
- The DSST is polyfactorial and sensitive but not specific: impaired performance can arise from motor speed, attention, visuoperceptual functions, associative learning, working memory, and executive functions, so it does not by itself identify the affected cognitive domain.
Methods
- Narrative review of specific studies and articles to illustrate what the DSST measures, its sensitivity to change, and its use in clinical practice.
- Evidence reviewed includes DSST studies in brain damage, schizophrenia, MDD, diabetes, sleep restriction, alcohol intoxication, and sedative/hypnotic pharmacodynamic studies.
- Main synthesis compares DSST effect sizes across patient groups and pharmacologic benchmarks, including alcohol, antihistamines, benzodiazepines, caffeine, and sleep deprivation.
Limitations
- The paper states the DSST has low specificity for determining exactly which cognitive domain has been affected and raises the question of whether a single brief cognitive assessment can be sufficient for clinically meaningful conclusions.
- The paper notes that repeated DSST administration may produce learning or practice effects, although randomized designs can overcome resulting confounding in some studies.
- Evident from the text: this is a narrative review of selected studies rather than a systematic review, and it does not report a formal search strategy, inclusion criteria, or quantitative synthesis of all available DSST evidence.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Figures
Verification
Claims the paper makes
39 Not checked yet · 28 Own interpretation · 11 Sources not found · 2 No basis given · 1 Own method
In the paper
“This observation suggests that improvement with exposure occurs in part for reasons other than associative learning of the pairs.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not checked yetcites [22] Beres CA Baron A Improved digit symbol substitution by older women as a result of extended practice. J Gerontol. 1981; 36: 591– 597. 7264244 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The sensitivity of the DSST is owed, in part, to its property as a polyfactoriaI measure.28”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Sensitivity and Sensitivity to Change of the DSST
What the sources say
- Not matchedcites [28] Ryan C Butters N Didario B The relationship between abstinence and recovery of function in male alcoholics. Clin Neuropsychol. 1980; 2: 125– 134.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“These findings indicate that the executive function of strategizing or consciously exerting effort to learn the pairings is among the activities that contribute to performance on this test.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not checked yetcites [22] Beres CA Baron A Improved digit symbol substitution by older women as a result of extended practice. J Gerontol. 1981; 36: 591– 597. 7264244 source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“This finding supports the observation that the DSST is a polyfactorial test”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not matchedcites [18] Lezak MD Neuropsychological Assessment. 3rd ed New York: Oxford University Press; 1995.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Compared with placebo, triazolam significantly impaired performance on the DSST (P < 0.001) and increased beta amplitude on the EEG (P < 0.002).34”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Sensitivity and Sensitivity to Change of the DSST
What the sources say
- Not checked yetcites [34] Greenblatt DJ Gan L Harmatz JS Pharmocokinetics and pharmacodynamics of single-dose triazolam: electroencephalography compared with the Digit-Symbol Substitution Test. Br J Clin Pharmacol. 2005; 60: 244– 248. 16120062 PMC1884767 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“and that impairment in any one of the required domains (ie, motor speed associated with aging) results in performance decline.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not matchedcites [18] Lezak MD Neuropsychological Assessment. 3rd ed New York: Oxford University Press; 1995.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“In both middle-aged and older persons, diabetes mellitus type 2 has been found to be associated with an increased risk of mild cognitive impairment and dementia.30”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Sensitivity and Sensitivity to Change of the DSST
What the sources say
- Not checked yetcites [30] Dong Y Kua ZJ Khoo EY The utility of brief cognitive tests for patients with type 2 diabetes mellitus: a systematic review. J Am Med Dir Assoc. 2016; 17: 889– 895. 27461866 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“That the DSST is sensitive to age effects is well known.23”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not checked yetcites [23] Hoyer WJ Stawski RS Wasylyshyn C Adult age and digit symbol substitution performance: a meta-analysis. Psychol Aging. 2004; 19: 211– 214. 15065945 source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“This correlation of specific QEEG indices with activation in the frontal lobes supports the theory that executive functioning plays a part in DSST performance.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not matchedcites [25] Thornton KE Carmody DP Symbol Digit and the quantitative EEG. Neurotherapy. 2012; 16: 210– 222.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSST is sensitive to the presence of cognitive dysfunction as well as to change in cognitive function across a wide range of clinical populations but has low specificity to determine exactly which cognitive domain has been affected.”
§ Digit Symbol Substitution Test > Abstract > Implications/Conclusions
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 14
- Probably not a substantial claim. 16
In the paper
“In fact, deficits in processing speed as measured by DSST performance may mediate a wide range of other cognitive deficits and may further reflect a final common pathway of impairment in a range of simple and complex cognitive processes that are likely to include working memory and executive functions.29”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Sensitivity and Sensitivity to Change of the DSST
What the sources say
- Not checked yetcites [29] Amaresha AC Danivas V Shivakumar V Clinical correlates of parametric digit-symbol substitution test in schizophrenia. Asian J Psychiatr. 2014; 10: 45– 50. 25042951 PMC4156309 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“now the DSST is among the most commonly used tests in clinical neuropsychology.”
§ Digit Symbol Substitution Test > Abstract > Purpose/Background
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“Since then, the DSST was found to be the single most sensitive test, among WAIS subtests, to determine the presence of brain damage and discriminate between patient groups (including healthy comparison groups).26”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Sensitivity and Sensitivity to Change of the DSST
What the sources say
- Not checked yetcites [26] Russell EW WAIS factor analysis with brain-damaged subjects using criterion measures. J Consult Clin Psychol. 1972; 39: 133– 139. 5045269
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Working memory, another executive function, is likely required to hold in mind the task rules and for the continual updating of required symbol-digit pairs.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, if pairings are rapidly learned following the first few trials, performance speed will improve because the subject will not need to refer to the key to check the accuracy of each pairing.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSST is a valid and sensitive measure of cognitive dysfunction impacted by many domains.”
§ Digit Symbol Substitution Test > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Performance on the DSST correlates with real-world functional outcomes (eg, the ability to accomplish everyday tasks) and recovery from functional disability in a range of psychiatric conditions including schizophrenia and major depressive disorder.”
§ Digit Symbol Substitution Test > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSST measures a range of cognitive operations.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The authors showed that both elderly and young subjects improved not only within each day but also between days.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not checked yetcites [22] Beres CA Baron A Improved digit symbol substitution by older women as a result of extended practice. J Gerontol. 1981; 36: 591– 597. 7264244 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Good performance on the DSST requires intact motor speed, attention, and visuoperceptual functions, including scanning and the ability to write or draw (ie, basic manual dexterity).”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“and described (quoting Kinsbourne) DSST responses as “the end product of the integration of visual perceptual, oculomotor, fine manual motor, and mental functions.””
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not matchedcites [19] Darby D Walsh K Neuropsychology. 5th ed Melbourne: Churchill Livingstone; 2005.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“For example, Glosser et al27 noted the sensitivity of the DSST in alcoholic Korsakoff patients, patients with right hemisphere damage, and patients with chronic alcoholism.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Sensitivity and Sensitivity to Change of the DSST
What the sources say
- Not checked yetcites [27] Glosser G Butters N Kaplan E Visuoperceptual processes in brain damaged patients on the digit symbol substitution test. Int J Neurosci. 1977; 7: 59– 66. 893004 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The decision to consciously engage in this learning strategy to improve performance speed calls for the executive functions of planning and strategizing.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Performance might also be affected by associative learning.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Darby and Walsh19 emphasized that performance on the DSST is the final common pathway for expression of quite diverse types of impairment”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > What Does the DSST Measure?
What the sources say
- Not matchedcites [19] Darby D Walsh K Neuropsychology. 5th ed Melbourne: Churchill Livingstone; 2005.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSST is perhaps the most commonly used test in all of neuropsychology, owing to several inherent properties: brevity, reliability, and the minimal impact of language, culture, and education on test performance.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Tucker et al39 also measured the effect of sleep deprivation on DSST performance and yielded similar results.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Sensitivity and Sensitivity to Change of the DSST
What the sources say
- Not checked yetcites [39] Tucker AM Whitney P Belenky G Effects of sleep deprivation on dissociated components of executive functioning. Sleep. 2010; 33: 47– 57. 20120620 PMC2802247 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the validity and reliability of the paper DSST depend on the test being administered in the manner it was validated.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The 8-hour group showed some improvement over the first few days (possibly a learning effect), whereas the 4-hour group differed from the 8-hour group by more than 12 points by the end of the first week and continued to decline over the second week.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Sensitivity and Sensitivity to Change of the DSST
What the sources say
- Not checked yetcites [37] Van Dongen HP Maislin G Mullington JM The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003; 26: 117– 126. 12683469 source
- Not checked yetcites [38] Banks S Dinges DF Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. 2007; 3: 519– 528. 17803017 PMC1978335 source
plaincorrelationaln = 35- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSST is sensitive to both the presence of cognitive dysfunction and change in cognitive function, across a wide range of clinical populations.”
§ Digit Symbol Substitution Test > CONCLUDING COMMENTS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Performance on the DSST correlates with real-world functional outcomes (eg, the ability to accomplish everyday tasks) and recovery from functional disability.”
§ Digit Symbol Substitution Test > CONCLUDING COMMENTS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, where the objective of testing is not diagnosis, but rather to identify impairment regardless of its nature and origin or to detect change within a patient, a brief and simple test such as the DSST may offer important benefits to clinical practice.”
§ Digit Symbol Substitution Test > CONCLUDING COMMENTS
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As discussed previously, the DSST's sensitivity to change is one of its main strengths.”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Clinical Meaningfulness in Patients With MDD
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The utility of the DSST for monitoring patients in the clinic derives from several properties, many of which are shared by other neuropsychological tests, including its brevity, its sensitivity to change, and minimal impact from education and culture.”
§ Digit Symbol Substitution Test > CONCLUDING COMMENTS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Cognition is important for functioning and quality of life.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the context of clinical decision making in a physician's office, this simple cognitive test can, in combination with a psychiatric clinical evaluation, be useful at the level of the individual patient for medication choice and dosing.”
§ Digit Symbol Substitution Test > CONCLUDING COMMENTS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- The authors state this as an assumption: Cognition is important for functioning and quality of life.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSST offers high sensitivity to detect impairment, but low specificity to determine exactly which cognitive domain has suffered the impairment.”
§ Digit Symbol Substitution Test > CONCLUDING COMMENTS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Further, there is growing awareness of the prevalence of cognitive symptoms and their impact on life functioning in MDD patients, leading to an increase in the recognition of such symptoms as clinically important targets for therapeutic improvement.47”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY > Clinical Meaningfulness in Patients With MDD
What the sources say
- Not checked yetcites [47] Mattingly G Anderson RH Mattingly SG The impact of cognitive challenges in major depression: the role of the primary care physician. Postgrad Med. 2016; 128: 665– 671. 27500820 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
In clinical practice, the DSST is administered in the manner in which it was validated.
“the validity and reliability of the paper DSST depend on the test being administered in the manner it was validated.”
The authors state this as an assumption.
Cognition is important for functioning and quality of life.
“Although the importance of cognition for functioning and quality of life may be regarded as self-evident”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Enhanced processing speed has been correlated with improved ability to perform day-to-day tasks and a lower risk of future cognitive/mobility/mood disorders [32].”
From Health Benefits of Video Games in Adolescents and Young Adults (2026) · cites this paper as [32]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY
“The original WAIS, developed in 1955, has 90 stimulus items (number of blanks into which the symbols are copied)”
§ Digit Symbol Substitution Test > DESCRIPTION AND HISTORY
“all of which were among the 67 stimulus items in its predecessor, the WBIS.”
Citations
Cites
Van Dongen, H. P. A., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003) · Sleep · doi:10.1093/sleep/26.2.117 · Cited by 3,173
(1995) · Cited by 2,809
Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998) · Journal of Clinical and Experimental Neuropsychology · doi:10.1076/jcen.20.3.310.823 · Cited by 2,519
Snyder, H. R. (2013) · Psychological Bulletin · doi:10.1037/a0028727 · Cited by 1,667
Behavioral and Physiological Consequences of Sleep Restriction
Banks, S., & Dinges, D. F. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26918 · Cited by 1,505
Robbins, T. W., James, M., Owen, A. M., Sahakian, B. J., McInnes, L., & Rabbitt, P. (1994) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000106735 · Cited by 1,078
The Measurement of Adult Intelligence.
Wechsler, D. (1940) · Archives of Neurology And Psychiatry · doi:10.1001/archneurpsyc.1940.02280030188021 · Cited by 980
Benedict, R. H. B., DeLuca, J., Phillips, G. A., LaRocca, N. G., Hudson, L. D., & Rudick, R. A. (2017) · Multiple Sclerosis Journal · doi:10.1177/1352458517690821 · Cited by 846
A meta-analysis of cognitive deficits in first-episode Major Depressive Disorder
Lee, R. S. C., Hermens, D. F., Porter, M. A., & Redoblado-Hodge, M. A. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.10.023 · Cited by 737
SAHAKIAN, B. J., MORRIS, R. G., EVENDEN, J. L., HEALD, A., LEVY, R., PHILPOT, M., & ROBBINS, T. W. (1988) · Brain · doi:10.1093/brain/111.3.695 · Cited by 666
Cited by
Sorted by citations
Falck, R. S., Davis, J. C., Best, J. R., Crockett, R. A., & Liu-Ambrose, T. (2019) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2019.03.007 · Cited by 437
Dong, X. Z., Li, S., Sun, J., Li, Y., & Zhang, D. (2020) · Nutrients · doi:10.3390/nu12030840 · Cited by 217
Herring, W. J., Ceesay, P., Snyder, E., Bliwise, D., Budd, K., Hutzelmann, J., Stevens, J., Lines, C., & Michelson, D. (2020) · Alzheimer's & Dementia · doi:10.1002/alz.12035 · Cited by 185
Goodwin, G. M., Aaronson, S. T., Alvarez, O., Atli, M., Bennett, J. C., Croal, M., DeBattista, C., Dunlop, B. W., Feifel, D., Hellerstein, D. J., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.01.108 · Cited by 191
Adolescent cannabis use, cognition, brain health and educational outcomes: A review of the evidence
Lorenzetti, V., Hoch, E., & Hall, W. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2020.03.012 · Cited by 166
Liu, X., Morris, M. C., Dhana, K., Ventrelle, J., Johnson, K., Bishop, L. M., Hollings, C. S., Boulin, A., Laranjo, N., Stubbs, B. J., et al. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106270 · Cited by 146
“For executive function: (Trails B) [42] and the NIH toolbox flanker test [43] will be used, and for perceptual speed: (Trails A) [42], the Digit Symbol Substitution Test [44], and the NIH toolbox pattern comparison test [45] will be used.”
MethodCognitive impairment and neurocognitive profiles in major depression: A clinical perspective
Hammar, Å., Ronold, E. H., & Rekkedal, G. Å. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.764374 · Cited by 132
“In addition, Jaeger (87), in a review of the digit symbol substitution test, i.e., a measure of processing speed, cites research that finds consistent impairments in processing speed and effect sizes that increase in elderly MDD populations.”
BackgroundInfluentialSpindle, T. R., Cone, E. J., Goffi, E., Weerts, E. M., Mitchell, J. M., Winecker, R. E., Bigelow, G. E., Flegel, R. R., & Vandrey, R. G. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.107937 · Cited by 128
“, 2017), the DSST has been shown to be a valid and reliable predictor of general cognitive impairment caused by brain injury and a variety of psychiatric conditions (Jaeger, 2018).”
BackgroundAssociation of Thyroid Dysfunction With Cognitive Function
van Vliet, N. A., van Heemst, D., Almeida, O. P., Åsvold, B. O., Aubert, C. E., Bae, J. B., Barnes, L., Bauer, D. C., Blauw, G. J., Brayne, C., et al. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.5078 · Cited by 129
Zhang, J., Chen, J., Ding, B., Yongping, L., Liu, K., Wang, L., Le, Y., Liao, Q., Shi, J., Huang, J., et al. (2021) · European Journal of Cancer · doi:10.1016/j.ejca.2021.11.006 · Cited by 132
Hutten, N. R. P. W., Mason, N. L., Dolder, P. C., Theunissen, E. L., Holze, F., Liechti, M. E., Feilding, A., Ramaekers, J. G., & Kuypers, K. P. C. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2020.10.002 · Cited by 123
“This task measures a variety of processes ike motor speed, attention, working memory, and visual processng ( Jaeger, 2018 ).”
BackgroundTang, H., Zhang, X., Luo, N., Huang, J., & Zhu, Y. (2023) · The Journals of Gerontology Series A · doi:10.1093/gerona/glad175 · Cited by 121
Passiflora incarnata in Neuropsychiatric Disorders—A Systematic Review
Janda, K., Wojtkowska, K., Jakubczyk, K., Antoniewicz, J., & Skonieczna‐Żydecka, K. (2020) · Nutrients · doi:10.3390/nu12123894 · Cited by 129
Spindle, T. R., Martin, E. L., Grabenauer, M., Woodward, T., Milburn, M. A., & Vandrey, R. G. (2021) · Journal of Psychopharmacology · doi:10.1177/02698811211021583 · Cited by 98
Curtin, A., Ayaz, H., Tang, Y., Sun, J., Wang, J., & Tong, S. (2019) · NeuroImage · doi:10.1016/j.neuroimage.2019.05.020 · Cited by 102
You, Y., Li, J., Zhang, Y., Li, X., Li, X., & Ma, X. (2024) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.14783 · Cited by 102
Yoon, S., Jeong, S., Jung, E., Kim, K. S., Jeon, I., Lee, Y., Cho, J., Oh, W. Y., & Chung, J. (2021) · Scientific Reports · doi:10.1038/s41598-021-98689-z · Cited by 80
Chu, N. M., Hong, J., Harasemiw, O., Chen, X., Fowler, K. J., Dasgupta, I., Bohm, C. J., Segev, D. L., McAdams‐DeMarco, M., & the Global Renal Exercise Network (2021) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfab338 · Cited by 94
Rivan, N. F. M., Shahar, S., Rajab, N. F., Singh, D. K. A., Din, N. C., Mahadzir, H., Sakian, N. I. M., Ishak, W. S., Rahman, M. H. A., Mohammed, Z., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17051547 · Cited by 86
“The digit symbol task has been shown to be a sensitive method for detecting the decrements in cognitive function, specifically in the processing speed among older people with DM and depression [60,61].”
MethodAssociations between Metal Exposures and Cognitive Function in American Older Adults
Sasaki, N., & Carpenter, D. O. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19042327 · Cited by 83
Bavato, F., Cathomas, F., Klaus, F., Guetter, K., Barro, C., Maceski, A. M., Seifritz, E., Kühle, J., Kaiser, S., & Quednow, B. B. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.05.072 · Cited by 76
“DSST is an unspecific but sensitive marker of cognitive functioning and is widely used as monitoring tool in MDD (Jaeger, 2018).”
MethodZolpidem and Gender: Are Women Really At Risk?
Greenblatt, D. J., Harmatz, J. S., & Roth, T. G. (2019) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001026 · Cited by 75
Dong, X. Z., Li, S., Chen, J., Li, Y., Wu, Y., & Zhang, D. (2020) · Nutrition Journal · doi:10.1186/s12937-020-00547-7 · Cited by 84
Cognitive Function in a Sleep Clinic Cohort of Patients with Obstructive Sleep Apnea
Beaudin, A. E., Raneri, J. K., Ayas, N., Skomro, R. P., Fox, N., Allen, A. J. M. H., Bowen, M. W., Nocon, A., Lynch, E. J., Wang, M., et al. (2020) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202004-313oc · Cited by 81
Liloia, D., Brasso, C., Cauda, F., Mancuso, L., Nani, A., Manuello, J., Costa, T., Duca, S., & Rocca, P. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.01.010 · Cited by 71
“These data-driven associations accord well with the findings of Liao et al. (2015), who found positive correlations between the GM volume of the L-Ins and performance at the Digit Symbol Substitution Test (DSST; Jaeger, 2018) in a large cohort of patients with SZ.”
Rouch, I., Edjolo, A., Laurent, B., Pongan, É., Dartigues, J., & Amieva, H. (2020) · Pain · doi:10.1097/j.pain.0000000000002047 · Cited by 76
“0001 None 179 (26) 142 (31) 37 (16) Mild 303 (44) 200 (44) 103 (44) Moderate 177 (26) 98 (21) 79 (34) Severe 31 (4) 13 (3) 12 (5) Depressive symptomatology 72 (10) 34 (7) 38 (16) 0.”
Association of peripheral blood DNA methylation level with Alzheimer’s disease progression
Li, Q. S., Vasanthakumar, A., Davis, J. W., Idler, K. B., Nho, K. T., Waring, J. F., Saykin, A. J., & Initiative, A. D. N. (2021) · Clinical Epigenetics · doi:10.1186/s13148-021-01179-2 · Cited by 66
In Vivo Availability of Cannabinoid 1 Receptor Levels in Patients With First-Episode Psychosis
Borgan, F., Laurikainen, H., Veronese, M., Marques, T. R., Haaparanta‐Solin, M., Solin, O. H., Dahoun, T., Rogdaki, M., Salokangas, R. K. R., Karukivi, M., et al. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.1427 · Cited by 73
Subtypes of physical frailty and their long‐term outcomes: a longitudinal cohort study
Huang, S., Tange, C., Otsuka, R., Nishita, Y., Peng, L., Hsiao, F., Tomida, M., Shimokata, H., Arai, H., & Chen, L. (2020) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12577 · Cited by 68
“that the DSST score is associated with memory and social recognition, especially in executive function and working memory.(21)”
BackgroundBalbim, G. M., Falck, R. S., Barha, C. K., Starkey, S. Y., Bullock, A., Davis, J. C., & Liu-Ambrose, T. Y. L. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-104955 · Cited by 76
Treviño, M., Zhu, X., Lu, Y. Y., Scheuer, L., Passell, E. J., Huang, G. C., Germine, L. T., & Horowitz, T. S. (2021) · Cognitive Research Principles and Implications · doi:10.1186/s41235-021-00313-1 · Cited by 63
“However, the downside is that it is very difficult to pin down which cognitive faculties are affected (Jaeger, 2018).”
BackgroundHolm, H., Bachus, E., Jujić, A., Nilsson, E. D., Wadström, B. N., Molvin, J., Minthon, L., Fedorowski, A., Nägga, K., & Magnusson, M. (2020) · ESC Heart Failure · doi:10.1002/ehf2.12909 · Cited by 66
“screening to evaluate attention, visual scanning, motor speed, and associative learning.(18) Subjects are required to repeatedly pair nine specific symbols to a specific number from 1–9.”
BackgroundWei, J., Hou, R., Xie, L., Chandrasekar, E. K., Lu, H., Wang, T., Li, C., & Xu, H. (2020) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2020.09.013 · Cited by 63
Colwell, M., Tagomori, H., Chapman, S., Gillespie, A. L., Cowen, P. J., Harmer, C. J., & Murphy, S. E. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02249-6 · Cited by 68
Malpetti, M., Jones, P. S., Tsvetanov, K. A., Rittman, T., Swieten, J. C. V., Borroni, B., Sánchez‐Valle, R., Moreno, F., Laforce, R. J., Graff, C., et al. (2020) · Alzheimer s & Dementia · doi:10.1002/alz.12252 · Cited by 58
Peeri, N. C., Egan, K. M., Chai, W., & Tao, M. (2020) · European Journal of Nutrition · doi:10.1007/s00394-020-02267-4 · Cited by 58
Walsh, J. J., Caldwell, H. G., Neudorf, H., Ainslie, P. N., & Little, J. P. (2021) · The Journal of Physiology · doi:10.1113/jp281988 · Cited by 57
“Increased QVA would support cognitive processes facilitated by the posterior cortex and cerebellum, including visual search efficiency, visual processing and aspects of psychomotor speed required for DSST performance (Usui et al. 2009; Jaeger, 2018).”
BackgroundMethodCognitive enhancement of healthy older adults using hyperbaric oxygen: a randomized controlled trial
Amir, H., Daniel-Kotovsky, M., Gil, S., Boussi-Gross, R., Catalogna, M., Kobi, D., Yafit, H., Ramzia, A. H., Sasson, E., Gregory, F., et al. (2020) · Aging · doi:10.18632/aging.103571 · Cited by 58
Cathomas, F., Guetter, K., Seifritz, E., Klaus, F., & Kaiser, S. (2021) · Scientific Reports · doi:10.1038/s41598-021-89335-9 · Cited by 55
Gouraud, C., Bottemanne, H., Lahlou‐Laforêt, K., Blanchard, A., Günther, S., Batti, S. E., Auclin, É., Limosin, F., Hulot, J., Lebeaux, D., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.725861 · Cited by 61
Wei, J., Wang, L., Kulshreshtha, A., & Xu, H. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.121.022959 · Cited by 54
Spindle, T. R., Kuwabara, H., Eversole, A., Nandi, A., Vandrey, R. G., Antoine, D. G., Umbricht, A., Guarda, Á. S., Wong, D. F., & Weerts, E. M. (2021) · Addiction Biology · doi:10.1111/adb.13061 · Cited by 49
Wu, Y., Lei, S., Li, D., Li, Z., Zhang, Y. N., & Guo, Y. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02632-x · Cited by 50
Protein Intake and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis
Coelho‐Júnior, H. J., Calvani, R., Landi, F., Picca, A., & Marzetti, E. (2021) · Nutrition and Metabolic Insights · doi:10.1177/11786388211022373 · Cited by 61
Royer, M. F., Guerithault, N., Braden, B. B., Laska, M. N., & Bruening, M. M. (2021) · International Journal of Translational Medicine · doi:10.3390/ijtm1030015 · Cited by 55
Wang, G., Si, T., Li, L., Fang, Y., Wang, C., Wang, L., Tan, K. H. X., Ettrup, A., Eriksen, H. F., Luo, S., et al. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s195505 · Cited by 53
Chakraborty, A., Hegde, S., Praharaj, S. K., Prabhu, K., Patole, C., Shetty, A. K., Mayya, S. S., Acharya, R. V., Hande, M., Prabhu, M. M., et al. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.798652 · Cited by 52
Li, Q., Zhao, Y., Hu, Y., Liu, Y., Wang, Y., Zhang, Q., Long, F., Chen, Y., Wang, Y., Li, H., et al. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2024.105255 · Cited by 50
Frailty is associated with worse cognitive functioning in older adults
Li, C.-M., Ge, S., Yin, Y., Tian, C., Mei, Y., & Han, P. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1108902 · Cited by 37
“The number of correct matches was the person’s score (28), which ranged from 0 to 133 (29).”
BackgroundVortioxetine for the treatment of post-COVID-19 condition: a randomized controlled trial
McIntyre, R. S., Phan, L., Kwan, A. T. H., Mansur, R. B., Rosenblat, J. D., Guo, Z., Le, G. H., Lui, L. M. W., Teopiz, K. M., Ceban, F., et al. (2023) · Brain · doi:10.1093/brain/awad377 · Cited by 47
Lighting up living spaces to improve mood and cognitive performance in older adults
Shishegar, N., & Boubekri, M. (2022) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2022.101845 · Cited by 47
Zhang, Y., Lai, S., Wu, W., Wang, Y., Zhao, H., He, J., Zhu, Y., Chen, G., Qi, Z., Chen, P., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.132 · Cited by 42
Zheng, Y., Habes, M., Gonzales, M. M., Pomponio, R., Nasrallah, I. M., Khan, S. S., Vaughan, D. E., Davatzikos, C. A., Seshadri, S. S., Launer, L. J., et al. (2022) · Aging · doi:10.18632/aging.203918 · Cited by 42
Xue, D., Li, P. W. C., Yu, D. S. F., & Lin, R. S. Y. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104592 · Cited by 48
Wu, J., He, Y., Liang, S., Liu, Z., Huang, J., Liu, W., Tao, J., Chen, L., Chan, C. C. H., & Lee, T. M. C. (2023) · Alzheimer s Research & Therapy · doi:10.1186/s13195-023-01292-9 · Cited by 44
Huang, I.-C., Chang, T.-S., Chen, C., & Sung, J.-Y. (2022) · International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyac054 · Cited by 41
“Multiple cognitive domains, such as executive function, working memory, attention, and motor speed, are assessed in the DSST (Jaeger, 2018).”
MethodMemory markers in the continuum of the Alzheimer’s clinical syndrome
Parra, M. A., Calia, C., Pattan, V., & Sala, S. D. (2022) · Alzheimer s Research & Therapy · doi:10.1186/s13195-022-01082-9 · Cited by 39
Iranpour, S., Saadati, H. M., Koohi, F., & Sabour, S. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.09.003 · Cited by 42
Vijverberg, E. G. B., Axelsen, T., Bihlet, A. R., Henriksen, K., Weber, F., Fuchs, K., Harrison, J., Kühn‐Wache, K., Alexandersen, P., Prins, N. D., et al. (2021) · Alzheimer s Research & Therapy · doi:10.1186/s13195-021-00882-9 · Cited by 45
Enlarged perivascular space burden associations with arterial stiffness and cognition
Bown, C. W., Khan, O. A., Liu, D., Remedios, S. W., Pechman, K. R., Terry, J. G., Nair, S., Davis, L. T., Landman, B. A., Gifford, K. A., et al. (2022) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2022.10.014 · Cited by 38
Liddle, P. F. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719870515 · Cited by 42
Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample
Владимировна, Л. Н., Filatova, E. G., Osipova, D. V., & Danilov, A. B. (2020) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x20190159 · Cited by 40
The neuropsychological profile of professional action video game players
Benoit, J. J., Roudaia, E., Johnson, T. E., Love, T., & Faubert, J. (2020) · PeerJ · doi:10.7717/peerj.10211 · Cited by 50
“Thus, in addition to speed of processing, good performance in the Coding task requires attention, motor speed, visuo-perceptual abilities, and dexterity to write the appropriate symbols (Jaeger, 2018).”
BackgroundGhodrati, N., Haghighi, A. H., Kakhak, S. A. H., Abbasian, S., & Goldfield, G. S. (2022) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2022.11.005 · Cited by 41
Jia, W., Wang, H., Li, C., Shi, J., Yong, F., & Jia, H. (2024) · Journal of Translational Medicine · doi:10.1186/s12967-024-04969-3 · Cited by 39
Revisiting the Role of Worries in Explaining the Link Between Test Anxiety and Test Performance
Schillinger, F. L., Mosbacher, J. A., Brunner, C., Vogel, S., & Grabner, R. H. (2021) · Educational Psychology Review · doi:10.1007/s10648-021-09601-0 · Cited by 54
“Whereas the DSST is thought to assess the functioning of domain-general associative learning (for a review, see Jaeger 2018), the arithmetic test used by Donati et al. (2019) taps into domain-specific abilities, such as applying arithmetic procedures.”
BackgroundTaking a break: Exploring the restorative benefits of short breaks and vacations
Packer, J. (2020) · Annals of Tourism Research Empirical Insights · doi:10.1016/j.annale.2020.100006 · Cited by 41
Cognitive effects of vortioxetine in older adults: a systematic review
Bishop, M. M., Fixen, D. R., Linnebur, S. A., & Pearson, S. M. (2021) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253211026796 · Cited by 39
Kaczorowska, M., Plechawska–Wójcik, M., & Tokovarov, M. (2021) · Brain Sciences · doi:10.3390/brainsci11020210 · Cited by 37
Dietary creatine and cognitive function in U.S. adults aged 60 years and over
Ostojić, S. M., Korovljev, D., & Štajer, V. (2021) · Aging Clinical and Experimental Research · doi:10.1007/s40520-021-01857-4 · Cited by 37
Assessment of the Acute Effects of 2C‐B vs. Psilocybin on Subjective Experience, Mood, and Cognition
Mallaroni, P., Mason, N. L., Reckweg, J. T., Paci, R., Ritscher, S., Toennes, S. W., Theunissen, E. L., Kuypers, K. P. C., & Ramaekers, J. G. (2023) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.2958 · Cited by 42
Verhagen, S. J. W., Daniëls, N. E. M., Bartels, S. L., Tans, S., Borkelmans, K. W. H., de Vugt, M. E., & Delespaul, P. (2019) · PLoS ONE · doi:10.1371/journal.pone.0226409 · Cited by 44
“The choice for a DSST-based task was deliberate because it proved sensitive to detect cognitive complaints and changes in cognitive functioning in clinical samples[33, 34].”
BackgroundBa, D. M., Gao, X., Al‐Shaar, L., Muscat, J. E., Chinchilli, V. M., Ssentongo, P., Beelman, R. B., & Richie, J. P. (2022) · British Journal Of Nutrition · doi:10.1017/s0007114521005195 · Cited by 36
Association Between Grip Strength and Cognitive Function in US Older Adults of NHANES 2011–2014
Yang, J., Deng, Y., He, Y., Li, B., Wang, Z., Liao, J., Cai, X., Zhou, L., Tan, W., & Rong, S. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-215454 · Cited by 37
Longitudinal assessment of physical activity and cognitive outcomes among women at midlife
Greendale, G. A., Han, W., Huang, M., Upchurch, D. M., Karvonen-Gutierrez, C., Avis, N. E., & Karlamangla, A. S. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.3227 · Cited by 37
Association of vitamin B2 intake with cognitive performance in older adults: a cross-sectional study
Zhou, L. (2023) · Journal of Translational Medicine · doi:10.1186/s12967-023-04749-5 · Cited by 35
Deckers, K., Zwan, M. D., Soons, L. M., Waterink, L., Beers, S., van Houdt, S., Stiensma, B., Kwant, J. Z., Wimmers, S. C. P. M., Heutz, R. A. M., et al. (2024) · Alzheimer s Research & Therapy · doi:10.1186/s13195-024-01495-8 · Cited by 35
Vascular endothelial‐cadherin as a marker of endothelial injury in preclinical Alzheimer disease
Tarawneh, R. M., Kasper, R. S., Sanford, J., Phuah, C., Hassenstab, J. J., & Cruchaga, C. (2022) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.51685 · Cited by 29
Balance and cognitive decline in older adults in the cardiovascular health study
Meunier, C. C., Smit, E., Fitzpatrick, A. L., & Odden, M. C. (2021) · Age and Ageing · doi:10.1093/ageing/afab038 · Cited by 36
“DSST is a well-known valid and reliable measure that tests psychomotor performance that requires matching symbols and numbers with scores ranging from 0 to 90 [17,24,25].”
BackgroundAlmby, K. E., Lundqvist, M., Abrahamsson, N., Kvernby, S., Fahlström, M., Pereira, M. J., Gingnell, M., Karlsson, F. A., Fanni, G., Sundbom, M., et al. (2021) · Diabetes · doi:10.2337/db20-1172 · Cited by 36
Dong, X. Z., Jiang, H. F., Li, S., & Zhang, D. (2021) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.712237 · Cited by 36
“…they have been used in large-scale screening and epidemiological studies to examine the associations between cognitive performance and many of the medical conditions and risk factors measured in NHANES examination (Fillenbaum et al., 2008; Gao et al., 2009; Clark et al., 2009; Jaeger, 2018).”
MethodMüller, K., Poppele, I., Ottiger, M., Zwingmann, K., Berger, I., Thomas, A., Wastlhuber, A., Ortwein, F., Schultz, A.-L., Weghofer, A., et al. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021468 · Cited by 31
“Afterward, the number of correct digit-symbol matches executed in 90 s was recorded [72].”
BackgroundLiu, X., Dhana, K., Furtado, J. D., Agarwal, P., Aggarwal, N. T., Tangney, C., Laranjo, N., Carey, V. J., Barnes, L. L., & Sacks, F. M. (2021) · Journal of Nutritional Science · doi:10.1017/jns.2021.56 · Cited by 34
McIntyre, R. S., Rosenblat, J. D., Rodrigues, N. B., Lipsitz, O., Chen-Li, D. C. J., Lee, J. G., Nasri, F., Subramaniapillai, M., Kratiuk, K., Wang, A., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113993 · Cited by 33
Daderwal, M. C., Sreeraj, V. S., Suhas, S., Rao, N. P., & Venkatasubramanian, G. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114731 · Cited by 30
The bidirectional associations between sarcopenia-related traits and cognitive performance
Lu, C., Liu, W., Cang, X., Sun, X., Wang, X., Wang, C., & Xu, F. (2024) · Scientific Reports · doi:10.1038/s41598-024-58416-w · Cited by 34
Booranasuksakul, U., Macdonald, I. A., Stephan, B. C. M., & Siervo, M. (2024) · Journal of the American Nutrition Association · doi:10.1080/27697061.2024.2333310 · Cited by 32
Acclimatization to Hearing Aids by Older Adults
Wright, D., & Gagné, J. (2020) · Ear and Hearing · doi:10.1097/aud.0000000000000913 · Cited by 31
“Additionally, while the DSST is a sensitive measure of the presence of cognitive dysfunction, it is not a specific measure of the speed of processing (Jaeger 2018).”
BackgroundPlasma MCP-1 and changes on cognitive function in community-dwelling older adults
Sánchez‐Sánchez, J. L., Giudici, K. V., Guyonnet, S., Delrieu, J., Li, Y., Bateman, R. J., Parini, A., Vellas, B. J., Barreto, P. D. S., for the MAPT/DSA Group, et al. (2022) · Alzheimer s Research & Therapy · doi:10.1186/s13195-021-00940-2 · Cited by 25
Qi, X., Ng, T. K. S., & Wu, B. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106023 · Cited by 34
Tsatali, M. S., Poptsi, E., Μoraitou, D., Agogiatou, C., Bakoglidou, E., Gialaouzidis, M., Papasozomenou, C., Soumpourou, A., & Tsolaki, M. (2021) · Brain Sciences · doi:10.3390/brainsci11070881 · Cited by 30
Hearing Loss, Hearing Aids, and Cognition
Grenier, B., Berr, C., Goldberg, M., Jouven, X., Zins, M., Empana, J. P., & Lisan, Q. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.36723 · Cited by 31
Handing, E. P., Leng, X., Kritchevsky, S. B., et al. (2020) · Innovation in Aging · doi:10.1093/geroni/igaa050 · Cited by 29
Chern, A., Irace, A. L., Sharma, R. K., Zhang, Y., Chen, Q., & Golub, J. S. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.789515 · Cited by 29
“It assesses working memory, motor speed, attention, and visuo-perceptual functions [scanning and ability to write/draw (i.e., basic manual dexterity); Wechler, 1981; Jaeger, 2018].”
BackgroundDeng, L., Simin, Y., Zilong, Z., Li, Y., Shi, Q., & Birong, D. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2023.1053390 · Cited by 24
“The Digit Symbol Substitution Test (DSST) measured performance on speed tests (Jaeger, 2018).”
MethodZeng, H., Tan, Y., Wang, L., Xiang, M., Zhou, Z., Chen, J.-A., Wang, J., Zhang, R., Tian, Y., Luo, J., et al. (2021) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2021.111990 · Cited by 28
Chien, Y.-J., Chien, Y.-C., Liu, C.-T., Wu, H.-C., Chang, C., & Wu, M. (2019) · Brain Sciences · doi:10.3390/brainsci9110291 · Cited by 27
“Studies have shown that DSST not only relates to the severity of TBI, but also correlates well with the patient’s functional outcome [38,39].”
BackgroundSunde, E., Pedersen, T., Mrdalj, J., Thun, E., Grønli, J., Harris, A., Bjorvatn, B., Waage, S., Skene, D. J., & Pallesen, S. (2020) · Clocks & Sleep · doi:10.3390/clockssleep2040037 · Cited by 29
“The DSST is sensitive to changes in cognitive function, and able to detect sleep deprivation effects [50].”
BackgroundMethodInfluentialHeffernan, K. S., Stoner, L. R., Meyer, M. L., & Loprinzi, P. D. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-220042 · Cited by 26
Llana, T., Méndez, M., Zorzo, C., Fidalgo, C., Juan, M. ‐., & Méndez-López, M. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.1082811 · Cited by 32
“Performance on DSST requires several cognitive functions, including planning, working memory, motor speed, attention, and visuoperceptual functions (Jaeger, 2018).”
BackgroundMethodInfluential
Metadata
- Authors
- Jaeger, J.
- Affiliations
- Albert Einstein College of Medicine (US)
- Corresponding author
- Jaeger, Judith
- ORCID
- Jaeger, Judith
- Venue
- Journal of Clinical Psychopharmacology
- Published
- 2018-10
- Volume
- 38
- Issue
- 5
- Pages
- 513-519
- ISSN
- 0271-0749 (ISSN-L)
- 1533-712X
- PMC
- PMC6291255
- OpenAlex
- W2888254436
- Semantic Scholar
- 03a57054a4cacf4a26d3972a3d9d226a7a3b0249
- Cited by
- 836
- References
- 51
- Citations by year
- 2026: 103 · 2025: 169 · 2024: 175 · 2023: 119 · 2022: 100 · 2021: 100 · 2020: 52 · 2019: 17
- FWCI
- 5.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Clinical Psychopharmacology (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- Digit Symbol Substitution Test, cognitive impairment, neuropsychological assessment, major depressive disorder, schizophrenia, treatment monitoring, functional disability, sensitivity to change, associative learning, clinical decision-making
- MeSH terms
- Association Learning, Major Depressive Disorder, Humans, Neuropsychological Tests, Reproducibility of Results, Cognitive Dysfunction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
