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.
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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.
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- 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.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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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.
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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.
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- 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.
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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.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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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.
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- 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.
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- 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.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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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.
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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.
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- 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.
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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.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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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.
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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.
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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.
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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.
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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.
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- 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
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Wang, X., Feng, H., Xu, X.-Z., Liu, J., & Han, X. (2024) · Aging Clinical and Experimental Research · doi:10.1007/s40520-023-02649-8 · Cited by 28
Negative symptoms, striatal dopamine and model-free reward decision-making in schizophrenia
Brandl, F., Knolle, F., Avram, M., Leucht, C., Yakushev, I., Priller, J., Leucht, S., Ziegler, S., Wunderlich, K., & Sorg, C. (2023) · Brain · doi:10.1093/brain/awac268 · Cited by 24
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“Additional assessments included the Digit Symbol Substitution Test (DSST, # correct in 1.5 minutes; Jaeger, 2018) and the Rey Auditory Verbal Learning Test (RAVLT).”
MethodInfluentialRelationships between social withdrawal and facial emotion recognition in neuropsychiatric disorders
de la Torre‐Luque, A., Viera-Campos, A., Bilderbeck, A. C., Carreras, M. T., Vivancos, J., Díaz‐Caneja, C. M., Aghajani, M., Saris, I. M. J., Raslescu, A., Malik, A., et al. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2021.110463 · Cited by 31
Marra, M. L., Villano, I., Ilardi, C. R., Carosella, M., Staiano, M., Iavarone, A., Chieffi, S., Messina, G., Polito, R., Porro, C., et al. (2022) · Brain Sciences · doi:10.3390/brainsci12060777 · Cited by 27
Williamson, M., Maruff, P. T., Schembri, A. J., Cummins, H., Bird, L., Rosenich, E., & Lim, Y. Y. (2022) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2023.2179977 · Cited by 26
“Versions of the Digit Symbol Substitution Test (DSST) are used commonly in neuropsychological research and practice (Jaeger, 2018; Lezak et al., 2012; Spreen & Strauss, 1998; Thorndike, 1919).”
BackgroundMethodCui, M., You, T., Zhao, Y., Liu, R., Guan, Y., Liu, J., Liu, X., Wang, X., & Dong, Q. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1147860 · Cited by 27
“…function by generating exemplars in the given category within 1 min (Mok et al., 2004); the Digit Symbol Substitution Test (DSST) of theWechsler Adult Intelligence Scale—Revised (WAISR), a test for associative learning by correctly matching symbols to numbers within limited time (Jaeger, 2018).”
MethodPredicting Age From Behavioral Test Performance for Screening Early Onset of Cognitive Decline
Statsenko, Y. A., Habuza, T., Charykova, I., Gorkom, K., Zaki, N., Almansoori, T. M., Baylis, G. C., Ljubisavljević, M., & Belghali, M. (2021) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.661514 · Cited by 24
“However, DSST has low specificity for determining which cognitive domain is affected (Jaeger, 2018).”
BackgroundVortioxetine improves cognition in mild cognitive impairment
Tan, S. N., & Tan, C. S. C. (2021) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000376 · Cited by 26
Flores‐Sandoval, A. A., Davila-Pérez, P., Buss, S. S., Donohoe, K. J., O’Connor, M. G., Shafi, M. M., Pascual‐Leone, Á., Benwell, C., & Fried, P. J. (2023) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2023.05.010 · Cited by 23
Davis, M. T., DellaGioia, N., Matuskey, D., Harel, B. T., Maruff, P. T., Pietrzak, R. H., & Esterlis, I. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.04.064 · Cited by 26
Hendricks, O., Andersen, T. E., Christiansen, A. A., Primdahl, J., Hauge, E., Ellingsen, T., Horsted, T. I., Bachmann, A. G., Loft, A. G., Bojesen, A. B., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028197 · Cited by 31
Stricker, N. H., Twohy, E. L., Albertson, S. M., Karstens, A. J., Kremers, W. K., Machulda, M. M., Fields, J. A., Jack, C. R., Knopman, D. S., Mielke, M. M., et al. (2022) · Alzheimer s & Dementia · doi:10.1002/alz.12895 · Cited by 25
Xu, Y., Chen, A., Chen, R., & Zheng, W. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.05.165 · Cited by 26
Šagud, M., Perković, M. N., Dvojkovic, A., Jakšić, N., Vuksan‐Ćusa, B., Živković, M., Kušević, Z., Mihaljević-Peleš, A., & Pivac, N. (2021) · Psychopharmacology · doi:10.1007/s00213-021-05790-2 · Cited by 23
“In practice, it is frequently used as an indicator of information processing speed (Jaeger 2018) A paper-and-pencil test is conducted on a sheet of paper, and the subject is instructed to match symbols to numbers, according to a certain key.”
MethodRelationship between peripheral neuropathy and cognitive performance in the elderly population
Lin, Y., Kao, T., & Chen, W. (2021) · Medicine · doi:10.1097/md.0000000000026071 · Cited by 23
“The DSST is a paper-and-pencil cognitive test presented on a single sheet of paper that requires a subject to match symbols to numbers according to a key located at the top of the page.([19]) Individuals commonly complete the test within 90 to 120s; the numbers of matched symbols represent the scores, and the maximal…”
BackgroundA rapid assay provides on-site quantification of tetrahydrocannabinol in oral fluid
Yu, H., Lee, H.-Y., Cheong, J., Woo, S. W., Oh, H.-K., Oh, H.-K., Lee, J.-H., Zheng, H., Castro, C. M., Yoo, Y., et al. (2021) · Science Translational Medicine · doi:10.1126/scitranslmed.abe2352 · Cited by 22
Giannos, P., Prokopidis, K., Church, D. D., Kirk, B., Morgan, P. T., Lochlainn, M. N., Macpherson, H., Woods, D. R., & Ispoglou, T. (2022) · The Journals of Gerontology Series A · doi:10.1093/gerona/glac162 · Cited by 24
Marra, M. L., Ilardi, C. R., Villano, I., Carosella, M., Staiano, M., Iavarone, A., Chieffi, S., Messina, G., Polito, R., Scarinci, A., et al. (2022) · Brain Sciences · doi:10.3390/brainsci12081080 · Cited by 30
Hu, L., Luo, M., Huang, H., Wu, L., Ouyang, W., Tong, J., & Le, Y. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.1037904 · Cited by 25
“, 2011); digit symbol substitution test and verbal fluency test for executive function (Jaeger, 2018; Sutin et al., 2019; Juan et al., 2022).”
BackgroundUse of either transcranial or whole‐body photobiomodulation treatments improves COVID ‐19 brain fog
Bowen, R., & Arany, P. R. (2023) · Journal of Biophotonics · doi:10.1002/jbio.202200391 · Cited by 25
Rivas-Campo, Y., Aibar‐Almazán, A., Rodríguez-López, C., Afanador-Restrepo, D. F., García-Garro, P. A., Castellote‐Caballero, Y., Achalandabaso‐Ochoa, A., & Hita‐Contreras, F. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12124049 · Cited by 24
“The number of correct symbols within the time allowed, usually 90 to 120 s, constitutes the score [26].”
BackgroundCheuk, N. K. W., Tse, W., Tsui, H. K. H., Ma, C. F., Chun, J., Chung, A. K. K., & Chan, S. K. W. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.09.027 · Cited by 27
Uchida, Y., Mise, K., Suzuki, D., Fukunaga, Y., Hakuba, N., Oishi, N., Ogawa, T., Takahashi, M., Takumi, Y., Fujimoto, S., et al. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.02.035 · Cited by 23
Li, K., Wang, K., Xu, S., Xie, X., Tang, Y., Zhang, L., & Liu, Z. (2024) · International Journal of Nanomedicine · doi:10.2147/ijn.s477482 · Cited by 23
Feng, Y., Li, Y., Tan, X. L., Liang, Y., Ma, X., Chen, Y., Lv, W., Wu, J., Kang, S., Li, M., et al. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.697349 · Cited by 22
Mack, M., Stojan, R., Bock, O. L., & Voelcker‐Rehage, C. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03201-5 · Cited by 25
Sunde, E., Mrdalj, J., Pedersen, T., Thun, E., Bjorvatn, B., Grønli, J., Harris, A., Waage, S., & Pallesen, S. (2020) · Occupational and Environmental Medicine · doi:10.1136/oemed-2019-106049 · Cited by 24
Sunde, E., Pedersen, T., Mrdalj, J., Thun, E., Grønli, J., Harris, A., Bjorvatn, B., Waage, S., Skene, D. J., & Pallesen, S. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.02172 · Cited by 24
“To minimize these learning effects participants practiced the DSST once during the enrollment session 3 days prior to the first night shift, and the symbol-digit pairs were randomized for each administration.”
BackgroundMethodInfluentialWang, Y., Mu, D., & Wang, Y. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05035-9 · Cited by 24
Trends in (not) using scales in major depression: A categorization and clinical orientation
Demyttenaere, K., & Jaspers, L. (2020) · European Psychiatry · doi:10.1192/j.eurpsy.2020.87 · Cited by 21
Jenkins, L. M., Kogan, A., Malinab, M., Ingo, C., Sedaghat, S., Bryan, R. N., Yaffe, K. S., Parrish, T. B., Nemeth, A. J., Lloyd‐Jones, D. M., et al. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2024265118 · Cited by 22
Kujawski, S., Słomko, J., Godlewska, B. R., Cudnoch‐Jędrzejewska, A., Murovska, M., Newton, J. L., Sokołowski, Ł., & Zalewski, P. (2022) · Journal of Translational Medicine · doi:10.1186/s12967-022-03460-1 · Cited by 22
Theory of Mind and social functioning among neuropsychiatric disorders: A transdiagnostic study
Braak, S., Su, T., Krudop, W. A., Pijnenburg, Y. A. L., Reus, L. M., van der Wee, N. J. A., Bilderbeck, A. C., Dawson, G. R., Rossum, I. W.-V., Campos, A. V., et al. (2022) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2022.08.005 · Cited by 25
“…importance in neuopsychiatric disorders, they are simplifications of complex omains ( de Jong-Gierveld, 1987 ; Birchwood et al., 1990 ; orcoran et al., 1995 ; Bora et al., 2006 ; Brown et al., 2014 ; inkham et al., 2016 ; Jaeger, 2018 ; Uhlmann et al., 2018 ; ddy, 2019 ; Kessels et al., 2021 ).”
BackgroundMethodInfluentialLinli, Z., Rolls, E. T., Zhao, W. D., Kang, J., Feng, J., & Guo, S. (2022) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2022.110698 · Cited by 21
“These tests of cognitive function reflect the speed with which tasks can be performed and also learning, and the ability to focus attention may be involved (Jaeger, 2018).”
BackgroundSong, G., Dong, F., Tian, C., Yang, C., Liu, M., & Wei, J. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-04661-7 · Cited by 22
Race/Ethnic Differences in Social Resources as Cognitive Risk and Protective Factors
Katz, B., Turney, I. C., Lee, J., Amini, R., Ajrouch, K. J., & Antonucci, T. C. (2020) · Research in Human Development · doi:10.1080/15427609.2020.1743809 · Cited by 23
“That being said, other research does suggest these measures draw significantly on EF capacities, and it is likely that many of the measures in the EF category draw on multiple cognitive domains, at least to a limited extent (Benjamins et al., 2019; Jaeger, 2018).”
ResultSex Differences in Subsequent Falls and Falls Risk: A Prospective Cohort Study in Older Adults
Jehu, D. A., Davis, J. C., Barha, C. K., Vesely, K., Cheung, W., Ghag, C., & Liu-Ambrose, T. Y. L. (2021) · Gerontology · doi:10.1159/000516260 · Cited by 20
Multiscale neural signatures of major depressive, anxiety, and stress-related disorders
Zhukovsky, P., Wainberg, M., Milic, M. S., Tripathy, S. J., Mulsant, B. H., Felsky, D., & Voineskos, A. N. (2022) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2204433119 · Cited by 23
Papalexi, E., Galanopoulos, A., Roukas, D., Argyropoulos, I., Michopoulos, I., Douzenis, A., Gkolia, I., Fotiadis, P., Kontis, D., & Zervas, I. M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.07.009 · Cited by 19
Wengler, K., Ashinoff, B. K., Pueraro, E., Cassidy, C., Horga, G., & Rutherford, B. R. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-00860-z · Cited by 21
RetractedSymptom subtypes and cognitive function in a clinic-based OSA cohort: a multi-centre Canadian study
Allen, A. J. H., Beaudin, A. E., Fox, N., Raneri, J. K., Skomro, R. P., Hanly, P. J., Mazzotti, D. R., Keenan, B. T., Smith, E. E., Goodfellow, S. D., et al. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.05.001 · Cited by 21
Acute aerobic exercise impairs aspects of cognitive function at high altitude
Walsh, J. J., Drouin, P. J., King, T. J., D’Urzo, K., Tschakovsky, M. E., Cheung, S. S., & Day, T. A. (2020) · Physiology & Behavior · doi:10.1016/j.physbeh.2020.112979 · Cited by 21
Liu, D., Zhou, L., Yang, M. J., McIntyre, R. S., & Cao, B. (2022) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2022.01.001 · Cited by 19
Major, L., Simonsick, E. M., Napolitano, M. A., & DiPietro, L. (2023) · The Journals of Gerontology Series A · doi:10.1093/gerona/glad020 · Cited by 20
Wei, J., Xu, H., Liese, A. D., Merchant, A. T., Wang, L., Yang, C., Lohman, M. C., Brown, M. J., Wang, T., & Friedman, D. B. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.028527 · Cited by 19
Cohen, A., Joshi, D., Bondre, A. P., Chand, P., Chaturvedi, N., Choudhary, S., Dutt, S., Khan, A., Langholm, C., Kumar, M., et al. (2024) · PLOS Digital Health · doi:10.1371/journal.pdig.0000526 · Cited by 20
Luperdi, S. C., Correa‐Ghisays, P., Vila‐Francés, J., Selva‐Vera, G., Salazar-Fraile, J., Cardoner, N., Ruíz-Veguilla, M., Livianos, L., Tabarés‐Seisdedos, R., & Balanzá‐Martínez, V. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.07.008 · Cited by 18
Usefulness of Eye Fixation Assessment for Identifying Type 2 Diabetic Subjects at Risk of Dementia
Simó‐Servat, O., Ciudin, A., Ortiz-Zúñiga, Á., Hernández, C., & Simó, R. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8010059 · Cited by 19
“Both MMSE and MOCA are time-consuming (10 min each), and DSST, which takes only 2 min, has low specificity [20,21].”
BackgroundSakal, C., Li, T., Li, J., & Li, X. (2024) · npj Aging · doi:10.1038/s41514-024-00177-x · Cited by 20
Liu-Ambrose, T. Y. L., Davis, J. C., Falck, R. S., Best, J. R., Dao, E. A., Vesely, K., Ghag, C., Rosano, C., Hsu, C. L., Dian, L., et al. (2020) · The Journals of Gerontology Series A · doi:10.1093/gerona/glaa239 · Cited by 21
Wang, X., Li, X., Xing, Y., Wang, W., Li, S., Zhang, D., Zheng, W., & Shen, X. (2021) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2021.06.002 · Cited by 19
Is Acculturation Associated with the Cognitive Performance of Older Hispanics?
Alam, R. B., Singleton, C. R., Aguiñaga, S., Chodzko-Zajko, W., Jahan, N. A., Oke, A., & Schwingel, A. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-210502 · Cited by 22
He, R., Zheng, R., Li, J., Cao, Q., Hou, T., Zhao, Z., Xu, M., Chen, Y., Lu, J., Wang, T., et al. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.769120 · Cited by 19
Gao, L., Cui, C., 袁正洲, Ge, W., Liu, Q., Li, J., Liu, N., Lei, C., & Liu, J. (2022) · The Journal of Prevention of Alzheimer s Disease · doi:10.14283/jpad.2022.39 · Cited by 18
Yamada, R., Wada, A., Stickley, A., Yokoi, Y., & Sumiyoshi, T. (2023) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyad004 · Cited by 20
Kambe, D., Hasegawa, S., Imadera, Y., Mano, Y., Matsushita, I., Konno, Y., Ogo, H., Uchimura, N., & Uchiyama, M. (2023) · Basic & Clinical Pharmacology & Toxicology · doi:10.1111/bcpt.13930 · Cited by 21
The buffering effect of attentional control on the relationship between cognitive fusion and anxiety
Thomas, K. N., & Bardeen, J. R. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103653 · Cited by 19
“Digit Symbol Substitution Test: The case for sensitivity over specificity in neuropsychological testing.”
MethodFunctional correlates of self-reported energy levels in the Health, Aging and Body Composition Study
Ehrenkranz, R. C., Rosso, A. L., Sprague, B. N., Tian, Q., Gmelin, T. A., Bohnen, N. I., Simonsick, E. M., Glynn, N. W., & Rosano, C. (2021) · Aging Clinical and Experimental Research · doi:10.1007/s40520-021-01788-0 · Cited by 18
Basu, E., Mehta, M., Zhang, C., Zhao, C., Rosenblatt, R. E., Tapper, E. B., & Parikh, N. S. (2021) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2021.120117 · Cited by 17
Petersen, N., König, H., & Hajek, A. (2022) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2022.104622 · Cited by 18
Koshikawa, Y., Nishida, K., Yamane, T., Yoshimura, M., Onohara, A., Ueda, S., Ishii, R., Kinoshita, T., & Morishima, Y. (2022) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13364 · Cited by 18
Real-World Functioning in Patients With Schizophrenia: Beyond Negative and Cognitive Symptoms
García‐Portilla, M. P., García-Álvarez, L., González-Blanco, L., Santo, F. D., Bobes-Bascarán, T., Martínez-Cao, C., García-Fernández, A., Sáiz, P. A., & Bobes, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.700747 · Cited by 18
“• VF tests: attention, memory, verbal fluency, and executive functions (28) • DSST: motor speed, attention, and visuoperceptual functions, but probably also associative learning and working memory (29) and • TMT: Part A measures psychomotor speed, attention, and spatial organization, while Part B measures attention sw…”
Long-term obesity impacts brain morphology, functional connectivity and cognition in adults
Zhang, D., Shen, C., Chen, N., Liu, C., Hu, J., Lau, K. K., Wen, Z., & Qiu, A. (2025) · Nature Mental Health · doi:10.1038/s44220-025-00396-5 · Cited by 21
Shah, C., Srinivasan, D., Erus, G., Schmitt, J. E., Agarwal, A., Cho, M. E., Lerner, A. J., Haley, W. E., Tamura, M. K., Davatzikos, C. A., et al. (2021) · Neuroradiology · doi:10.1007/s00234-020-02614-6 · Cited by 17
Cognitive and neuroimaging markers for preclinical vascular cognitive impairment
Lowry, E., Puthusseryppady, V., Johnen, A.-K., Renoult, L., & Hornberger, M. (2021) · Cerebral Circulation - Cognition and Behavior · doi:10.1016/j.cccb.2021.100029 · Cited by 20
“Indeed slower processing speeds as detected by this test may serve to identify disorders of cognition, mobility and even mood [21].”
BackgroundWefel, J. S., Ryan, C. J., Van, J., Jackson, J. C., & Morgans, A. K. (2022) · CNS Drugs · doi:10.1007/s40263-022-00913-5 · Cited by 17
Kim, H., Jung, J., & Lee, S. (2022) · Vision · doi:10.3390/vision6040068 · Cited by 18
Warsame, F., Chu, N. M., Hong, J., Mathur, A., Crews, D. C., Bayliss, G. P., Segev, D. L., & McAdams‐DeMarco, M. (2022) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfac325 · Cited by 16
Chuang, I., Chen, I.-C., Su, K.-H., Wu, Y., & Wu, C. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-03802-8 · Cited by 17
Opposing brain signatures of sleep in task-based and resting-state conditions
Abdelhack, M., Zhukovsky, P., Milic, M. S., Harita, S., Wainberg, M., Tripathy, S. J., Griffiths, J. D., Hill, S., & Felsky, D. (2023) · Nature Communications · doi:10.1038/s41467-023-43737-7 · Cited by 15
“Other psychiatric (PHQ-2) and cognitive measures (symbol digitsubstitution task) were collected from the self-reported mental health questionnaires and cognitive test results 33 conducted at the same imaging instance.”
InfluentialZamarripa, C. A., Tilton, H. E., Lin, S., Cone, E. J., Winecker, R. E., Flegel, R. R., Kuntz, D. J., Beals, M., Jacques, M. E., Clark, M., et al. (2024) · Journal of Analytical Toxicology · doi:10.1093/jat/bkae001 · Cited by 17
Xue, L., Bocharova, M., Young, A. H., & Aarsland, D. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.06.003 · Cited by 18
Theta-gamma-coupling as predictor of working memory performance in young and elderly healthy people
Abubaker, M., Qasem, W. A., Pilátová, K., Ježdík, P., & Kvašňák, E. (2024) · Molecular Brain · doi:10.1186/s13041-024-01149-8 · Cited by 19
Breton, É., Légaré, C., Overend, G., Guay, S., Monckton, D. G., Mathieu, J., Gagnon, C., Richer, L., Gallais, B., & Bouchard, L. (2020) · Epigenomics · doi:10.2217/epi-2020-0328 · Cited by 17
Myers, J. R., Glenn, J. M., Madero, E. N., Anderson, J., Mak-McCully, R. A., Gray, M., Gills, J. L., & Harrison, J. (2022) · JMIR Formative Research · doi:10.2196/34237 · Cited by 16
Is Attention-Deficit/Hyperactivity Disorder a Risk Syndrome for Parkinson’s Disease?
Baumeister, A. A. (2021) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000283 · Cited by 17
BOEDER, S. C., Gregory, J. M., Giovannetti, E. R., & Pettus, J. (2021) · Diabetes · doi:10.2337/db21-0769 · Cited by 16
Mezzaca, T. A., Dodds, L. V., Rundek, T., Hazzouri, A. Z. A., Caunca, M. R., Gomes‐Osman, J., Loewenstein, D., Schneiderman, N., & Elfassy, T. (2022) · Journal of Aging and Health · doi:10.1177/08982643221076690 · Cited by 16
Sarica, A., Pelagi, A., Aracri, F., Arcuri, F., Quattrone, A., Quattrone, A., & Initiative, A. D. N. (2024) · Brain Sciences · doi:10.3390/brainsci14030201 · Cited by 17
“Digit Symbol Substitution (DIGITSCOR) to evaluate attention, processing speed, and executive function [63].”
MethodGong, Z., Bilgel, M., An, Y., Bergeron, C. M., Bergeron, J., Zukley, L. M., Ferrucci, L., Resnick, S. M., & Bouhrara, M. (2024) · Brain Communications · doi:10.1093/braincomms/fcae412 · Cited by 17
Body roundness index and cognitive function in older adults: a nationwide perspective
Zhang, F., Ning, Z., & Wang, C. (2024) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2024.1466464 · Cited by 15
“It functions as an experimental instrument for comprehending associative learning in humans (Jaeger, 2018).”
Pelletti, G., Barone, R., Giorgetti, A., Garagnani, M., Rossi, F., Fais, P., & Pelotti, S. (2021) · Forensic Science International · doi:10.1016/j.forsciint.2021.110822 · Cited by 16
Shen, X., Yang, L., Liu, Y. Y., Jiang, L., & Huang, J. F. (2023) · Food Science & Nutrition · doi:10.1002/fsn3.3428 · Cited by 15
Garrett, D. D., Kloosterman, N. A., Epp, S. M., Chopurian, V., Kosciessa, J. Q., Waschke, L., Skowron, A., Shine, J. M., Perry, A., Salami, A., et al. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.05.05.490687 · Cited by 16
Li, F., He, R., Yue, Z., Yi, H., Lu, L., Zhang, L., Shi, J., Zheng, C. Y., Jiao, J., Peng, J., et al. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2024.11.019 · Cited by 16
Helmer, D. A., Doren, W. W. V., Litke, D. R., Tseng, C., Ho, L., Osinubi, O., & Pasinetti, G. M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17103546 · Cited by 15
“The WAIS-R Digit symbol substitution test offers a practical and effective method to monitor cognitive function over time in clinical practice but has low specificity to determine which cognitive domain has been affected [34] making it somewhat comparable to the GCFS measure calculated for this report.”
MethodHuman Cognitive and Motor Abilities in the Aging Workforce: An Information-Based Model
Digiesi, S., Cavallo, D., Lucchese, A., & Mummolo, C. (2020) · Applied Sciences · doi:10.3390/app10175958 · Cited by 17
“Different versions of DSST test can be found in [49].”
BackgroundGranot‐Hershkovitz, E., He, S., Bressler, J., Yu, B., Tarraf, W., Rebholz, C. M., Cai, J., Chan, Q. M., Garcia, T. P., Mosley, T. H., et al. (2022) · Alzheimer s & Dementia · doi:10.1002/alz.12786 · Cited by 14
Tang, X., Wang, Y., Simó, R., Stehouwer, C. D. A., & Zhou, J. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-220972 · Cited by 15
Processing speed predicts SuperAging years later
Tichá, Z., Georgi, H. S., Schmand, B. A., Heissler, R., & Kopeček, M. (2023) · BMC Psychology · doi:10.1186/s40359-023-01069-7 · Cited by 16
Skeletal muscle adiposity is a novel risk factor for poor cognition in African Caribbean women
Acevedo-Fontánez, A. I., Cvejkus, R., Zmuda, J. M., Kuipers, A. L., Barinas‐Mitchell, E., Sekikawa, A. M., Wheeler, V. W., Rosano, C., & Miljkovic, I. (2023) · Obesity · doi:10.1002/oby.23816 · Cited by 12
“However, the DSST has been proven to be a fast, reliable, validated, and sensitive test that predicts the onset of dementia [8].”
Berger, B., Kornberger, R., & Dingemanse, J. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.05.005 · Cited by 15
DCE-MRI of Brain Fluid Barriers: In Vivo Water Cycling at the Human Choroid Plexus
Anderson, V. C., Tagge, I., Doud, A., Li, X., SPRINGER, C. S. J., Quinn, J. F., Kaye, J. A., Wild, K. V., & Rooney, W. D. (2021) · Tissue Barriers · doi:10.1080/21688370.2021.1963143 · Cited by 14
Ku, L., Allen, J. J. B., & Lai, V. (2022) · Brain and Language · doi:10.1016/j.bandl.2022.105086 · Cited by 11
Sugiura, S., Nishita, Y., Uchida, Y., Shimono, M., Suzuki, H., Teranishi, M., Nakashima, T., Tange, C., Otsuka, R., Ando, F., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0258520 · Cited by 14
“The DSST is sensitive to the presence of cognitive dysfunction and changes in cognitive function across a wide range of clinical populations, including dementia, depression, schizophrenia, and sleep disorder [34].”
BackgroundZipperer, M., Churilla, J. R., Stapleton, J. N., & Richardson, M. R. (2022) · Annals of Epidemiology · doi:10.1016/j.annepidem.2022.07.003 · Cited by 11
Relationship Between Weight-Change Patterns and Cognitive Function: A Retrospective Study
Gong, H., Tang, X., Chai, Y.-H., Qiao, Y.-S., Xu, H., Patel, I., Zhang, J., Simó, R., & Zhou, J. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-220788 · Cited by 14
A Closer Look at Practice Effects in Mild Cognitive Impairment and Alzheimer’s Disease
Duff, K. M., Dixon, A. M., & Embree, L. M. (2023) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acad046 · Cited by 15
Hu, R., Gao, L., Chen, P., Wei, X., Wu, X., & Xu, H. (2023) · Journal of Neuroscience Research · doi:10.1002/jnr.25277 · Cited by 15
“Digital symbol substitution test (DSST) was used to assess motor speed, attention, and visuo-per-ceptual functions (Campitelli et al., 2023; Jaeger, 2018 ).”
Method
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
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