Perseverative errors on the Wisconsin Card Sorting Test and brain perfusion imaging in mild Alzheimer's disease

Seishi Terada, Shuhei Sato, Hajime Honda, Yuki Kishimoto, Naoya Takeda, Etsuko Oshima, Osamu Yokota, Yosuke Uchitomi

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: The Wisconsin Card Sorting Test (WCST) has long been used to investigate deficits in executive function in humans. The majority of studies investigating deficient WCST performance focused on the number of categories achieved (CA) and the number of perseverative errors of the Nelson type (PEN). However, there is insufficient evidence that these two measures reflect the same neural deficits. Methods: Twenty AD patients with high PEN scores, and 20 age- and sex-matched AD patients with low PEN scores were selected. All 40 subjects underwent brain SPECT, and the SPECT images were analyzed by Statistical Parametric Mapping. Results: No significant differences were found between high and low PEN score groups with respect to years of education, Addenbrooke's Cognitive Examination scores, and Mini-Mental State Examination scores. However, higher z scores for hypoperfusion in the bilateral rectal and orbital gyri were observed in the high PEN score group compared with the low PEN score group. Conclusions: Our results suggest that functional activity of the bilateral rectal and orbital gyri is closely related to PEN scores on a modified WCST (mWCST). The PEN score on a mWCST might be a promising index of dysfunction of the orbitofrontal area among patients with mild AD.

Original languageEnglish
Pages (from-to)1552-1559
Number of pages8
JournalInternational Psychogeriatrics
Issue number10
Publication statusPublished - Dec 2011


  • Alzheimer's disease (AD)
  • Wisconsin card sorting test (WCST)
  • cerebral blood flow (CBF)
  • perseveration
  • perseverative errors of Nelson type (PEN)

ASJC Scopus subject areas

  • Clinical Psychology
  • Gerontology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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