Relationship between frontal lobe lesions and Wisconsin Card Sorting Test performance in patients with multiple sclerosis
Abstract
Conceptual reasoning deficits are common in patients with multiple sclerosis (MS) and are typically associated with focal lesions involving the frontal lobes. In this study, we predicted that MS patients with frontal white matter lesions (MS-F) would be more impaired on a standard conceptual reasoning task (Wisconsin Card Sorting Test; WCST) than patients with minimal frontal lesions (MS-NF), even if the total cerebral lesion area (TLA), measured from MRI, was equivalent across groups. We subdivided 43 definite MS patients into three groups based on MRI findings: seven in the MS-F group (mean TLA = 41.4 cm2) and seven in the MS-NF group (mean TLA = 50.0 cm2); 29 MS patients served as a low lesion burden control group (MS-C; mean TLA = 6.4 cm2). The groups did not differ with regard to demographic and illness characteristics. Although the three subgroups obtained comparable scores on a measure of global cognitive functioning (verbal intelligence), the MS-F group achieved significantly fewer categories and made more total errors on the WCST than did the MS-NF and MS-C groups. The MS-F group made significantly more perseverative responses than the MS-C group and nonsignificantly more than the MS-NF group. These results suggest that the pattern of cognitive decline in MS is a function of the location of demyelinating lesions within the cerebral hemispheric white matter. Finally, we supplement the group study results with a case report of an MS patient who was studied serially with MRI and cognitive testing.
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Set-shifting tasks are similar to the Wisconsin Card Sorting Task in that they form the gold standard for assessing executive function.
“In many ways, set-shifting tasks are similar to the Wisconsin Card Sorting Task in that they form the gold standard for assessing executive function (Drewe, 1974; Robinson et al., 1980; Arnett et al., 1994).”
From Using mice to model Alzheimer's dementia: an overview of the clinical disease and the preclinical behavioral changes in 10 mouse models (2014) · cites this paper as Arnett et al., 1994
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“The number of perseverative errors and number of categories on Nelsons version of the Wisconsin Card Sorting Test (Nelson, 1976) to assess perseveration, flexibility and ability to shift set (Glosser and Goodglass, 1990; Perrine, 1993; Arnett et al., 1994).”
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Cognitive impairment in multiple sclerosis
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“Correlations with frontal brain lesions are well documented [7, 40, 88].”
BackgroundThe impact of frontal and non-frontal brain tumor lesions on Wisconsin Card Sorting Test performance
Goldstein, B. H., Obrzut, J. E., John, C. R., Ledakis, G. E., & Armstrong, C. L. (2004) · Brain and Cognition · doi:10.1016/s0278-2626(03)00269-0 · Cited by 77 · see citing works
Depression-Executive Dysfunction Syndrome in Stroke Patients
Vataja, R., Pohjasvaara, T., Mäntylä, R., Ylikoski, R., Leskelä, M., Kalska, H., Hietanen, M., Aronen, H. J., Salonen, O., Kaste, M., et al. (2005) · American Journal of Geriatric Psychiatry · doi:10.1176/appi.ajgp.13.2.99 · Cited by 86 · see citing works
Assessment of social cognition in patients with multiple sclerosis
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Psychomotor retardation is a scar of past depressive episodes, revealed by simple cognitive tests
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“Cognitive speed might be more specifically involved, as a previous study of depression and cognition in multiple sclerosis concluded that the patients with depression were mainly characterized by slow information processing speed, whereas executive functioning was unaffected (Arnett et al., 1994).”
Iannucci, G., Minicucci, L., Rodegher, M. E., Sormani, M. P., Comi, G., & Filippi, M. (1999) · Journal of the Neurological Sciences · doi:10.1016/s0022-510x(99)00259-2 · Cited by 74 · see citing works
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Assessment of cognitive dysfunction in multiple sclerosis
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“Other consequences concern treatments: Firstly, cognitive deficit represents a marker for disease progression [2,47] with significant correlations with MRI, specially in clinically isolated syndromes [23–25] and also in multiple sclerosis patients [3,4,16,18,27,40,41, 57,60,67] and should be included in treatment deci…”
BackgroundGenova, H. M., DeLuca, J., Chiaravalloti, N. D., & Wylie, G. R. (2013) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2013.806649 · Cited by 73 · see citing works
“, lesion load and atrophy) in MS as assessed by magnetic resonance imaging (MRI; Arnett et al., 1994; Parmenter et al., 2007) Magnetic resonance spectroscopy (MRS), which measures neurometabolites as markers of neuronal integrity, has also been used to examine the relationship between executive dysfunction and neurona…”
BackgroundMethodCardiovascular autonomic dysfunction correlates with brain MRI lesion load in MS
Saari, A., Tolonen, U., Pääkkö, E. L., Suominen, K., Pyhtinen, J., Sotaniemi, K. A., & Myllylä, V. V. (2004) · Clinical Neurophysiology · doi:10.1016/j.clinph.2004.01.012 · Cited by 72 · see citing works
“In contrast to earlier reports several more recent studies (Arnett et al., 1994; Comi et al., 1993; European Study Group on interferon beta-1b in secondary progressive MS, 1998; Filippi et al., 1994, 1995) have been able to establish significant association with the MRI findings and the clinical…”
ResultOn the nature of Wisconsin Card Sorting Test performance in schizophrenia
Haut, M. W., Cahill, J., Cutlip, W. D., Stevenson, J. M., Makela, E. H., & Bloomfield, S. M. (1996) · Psychiatry Research · doi:10.1016/0165-1781(96)02940-x · Cited by 72 · see citing works
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MRI markers of destructive pathology in multiple sclerosis-related cognitive dysfunction
Rovaris, M., Comi, G., & Filippi, M. (2006) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2005.07.014 · Cited by 71 · see citing works
Multiple sclerosis⋮ the disease and its manifestations
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Prospects for the treatment of phenylketonuria by gene therapy
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Structural connectivity influences brain activation during PVSAT in Multiple Sclerosis
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“Conventional MRI parameters found to covariate with cognitive performance include disease burden indices, such as total lesion volume (Rao et al., 1989) and frontal lobe lesion volume (Arnett et al., 1994).”
BackgroundBrain mapping in multiple sclerosis: Lessons learned about the human brain
Filippi, M., Preziosa, P., & Rocca, M. A. (2017) · NeuroImage · doi:10.1016/j.neuroimage.2017.09.021 · Cited by 62 · see citing works
Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis
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“1991b), success in rehabilitation (Langdon and Thompson 1999), and social skills (Arnett et al. 1994; Benedict et al. 2001; Knight et al. 1997).”
BackgroundRegional cerebral blood flow during the wisconsin card sort test in schizotypal personality disorder
Buchsbaum, M. S., Trestman, R. L., Hazlett, E. A., et al. (1997) · Schizophrenia Research · doi:10.1016/s0920-9964(97)00081-9 · Cited by 63 · see citing works
“Neuropsychological studies of neurological patients suggest that WCST performance is particularly impaired in patients with damage in the prefrontal cortex (PFC ) (e.g., Drewe, 1974; Robinson et al., 1980; Sullivan et al., 1993; Amett et al., 1994).”
BackgroundCognitive slowing in multiple sclerosis is strongly associated with brain volume reduction
Lazeron, R. H. C., de Sonneville, L. M. J., Scheltens, P., Polman, C. H., & Barkhof, F. (2006) · Multiple Sclerosis Journal · doi:10.1177/1352458506070924 · Cited by 60 · see citing works
Cognitive and neurobehavioral features in multiple sclerosis
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Relationship between confabulation and measures of memory and executive function
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Self-citation
- Authors
- Arnett, P. A., Rao, S. M., Bernardin, L., Grafman, J., Yetkin, F. Z., & Lobeck, L.
- Affiliations
- National Institutes of Health (US)
- Venue
- Neurology
- Published
- 1994-03
- Volume
- 44
- Issue
- 3_part_1
- Pages
- 420-420
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2041731350
- Cited by
- 279
- References
- 0
- Citations by year
- 2026: 4 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 5 · 2019: 2 · 2018: 7 · 2017: 6 · 2016: 8 · 2015: 7 · 2014: 13 · 2013: 5 · 2012: 12
- FWCI
- 8.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k04ns001055-03, 5r01ns022128-07)
- National Institute of Neurological Disorders and Stroke (K04 NS01055, NINDS R01 NS22128)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- multiple sclerosis, frontal lobe lesions, Wisconsin Card Sorting Test, conceptual reasoning, perseveration, white matter lesions, lesion localization, cognitive decline, demyelinating lesions, frontal lobe
- MeSH terms
- Adult, Aged, Cognition, Female, Frontal Lobe, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Neuropsychological Tests
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