title: Use of the WCST and the WCST-64 in the assessment of traumatic brain injury.
abstract: The Wisconsin Card Sorting Test (WCST) has been found to be valid in characterizing cognitive dysfunction in a variety of neurological disorders including traumatic brain injury (TBI). However, the test has been criticized as being too lengthy and frustrating for severely impaired patients. As a result, shortened versions of the WCST have been proposed. The utility of one of these shortened versions, the Wisconsin Card Sorting Test-64 (WCST-64), was examined in 106 persons with TBI. Findings showed strong associations between scores derived from the two tests. WCST scores were predicted from WCST-64 scores with sufficient accuracy for research purposes with adjusted R-squared values ranging from .74 to .87. Using the standard cutpoint of < 40T to indicate impairment or normal performance for perseverative responses from each of the two tests, 91 (86%) of 106 subjects received the same classification showing substantial agreement (Kappa statistic 0.71; 95% CI 0.58-0.84). The WCST and the WCST-64 also performed comparably in predicting functional status at discharge from inpatient rehabilitation using the first score from a principal components analysis as a summary measure (both significant with p = .0002). These findings support theuse of the WCST-64 in early evaluations of persons with moderate and severe TBI.
authors.affiliation: Neuropsychology Department, Methodist Rehabilitation Center, Jackson, MS 39216, USA. marks@mmrcrehab.org
authors.forename: Mark
authors.initials: M
authors.lastname: Sherer
authors.forename: Todd G
authors.initials: TG
authors.lastname: Nick
authors.forename: Scott R
authors.initials: SR
authors.lastname: Millis
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Novack
mesh_terms: D001288:Attention; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology*; D003071:Cognition; D003210:Concept Formation; D005163:Factor Analysis, Statistical; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity