Utility of nelson’s modified card sorting test in patients with alzheimer’s disease or vascular dementia


Aim: In this study we used the Nelson’s Modified Card Sorting Test (MCST) to find the differences between Alzheimer’s disease (AD) group/Vascular dementia (VD) group and a normal control group (non-dementia and non-AD), and to identify the commonality between the MCST and dementia patients. Patients and Methods: The MCST was administered to 32 AD patients, 18 vascular dementia patients, and 38 controls. The relationship between the MCST performance and demographic characteristics was evaluated. Results: There were no statistical differences in age, sex, level of education, smoking, drinking and depression in the three groups. The MCST was classified into four groups for analysis—number of categories completed (Cat), preservative error score (PE), non-preservative error score (NPE), unique error (UE) and total error (TE). For Cat, UE and TE showed a significant difference in all three groups, whereas PE and NPE revealed no significant difference. Conclusion: These findings suggest that cognitive function appears to significantly impair MCST performances in AD and VD patients, so these should be taken into consideration during an interpretation of the clinical assessment. For the effective use of the MCST in a clinical setting, further studies of specific clinical populations are planned to develop normative data for elderly Taiwanese people.

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Chao, J. , Hao, L. , Chao, I. , Shi, M. and Chao, I. (2013) Utility of nelson’s modified card sorting test in patients with alzheimer’s disease or vascular dementia. Open Journal of Preventive Medicine, 3, 172-177. doi: 10.4236/ojpm.2013.32023.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Taiwan Review (2010) Taiwan’s aging population hits record high. Retrieved 10 October 2011. http://taiwanreview.nat.gov.tw/ct.asp?xitem=92758&ctnode=205&mp=1
[2] Su, T.W., Wu, L.L. and Lin, C.P. (2012) The prevalence of dementia and depression in Taiwanese institutionalized leprosy patients, and the effectiveness evaluation of reminiscence therapy—A longitudinal, single-blind, randomized control study. International Journal of Geriatric Psychiatry, 27, 187-196. doi:10.1002/gps.2707
[3] Liu, H.C., Lin, K.N. and Teng, E.L. (1995) Prevalence and subtypes of dementia in Taiwan: A community survey of 5297 individuals. Journal of American Geriatric Society, 43, 1-6.
[4] Chen, J.H., Lin, K.P. and Chen, Y.C. (2009) Risk factors for dementia. Journal of the Formosan Medical Association, 108, 754-764. doi:10.1016/S0929-6646(09)60402-2
[5] Chang, C.C. (2012) Prevalence and factors associated with feeding difficulty in institutionalized elderly with dementia in Taiwan. Journal of Nutrition, Health & Aging, 16, 258-261. doi:10.1007/s12603-011-0158-6
[6] Cummings, J.L. and Benson, D.F. (1992) Dementia: A clinical approach. 2nd Edition, Butterworth-Heinemann, Boston.
[7] American Psychiatric Association (1994) Diagnosis and statistical manual of mental disorders. 4th Edition, DSMIV, Washington DC.
[8] Bayles, K.A. and Kaszniak, A.W. (1987) Communication and cognition in normal aging and dementia. CollegeHill/Little, Brown and Company, Boston.
[9] Chaves, M.L., Ilha, D., Maia, A.L., Motta, E., Lehmen, R. and Oliveira, L.M. (1999) Diagnosing dementia and normal aging: Clinical relevance of brain ratios and cognitive performance in a Brazilian sample. Brazilian Journal of Medical and Biological Research, 32, 11331143. doi:10.1590/S0100-879X1999000900013
[10] Royall, D.R., Lauterbach, E.C., Cummings, J.L., Reeve, A., Rummans, T.A., Kaufer, D.I., LaFrance Jr., W.C. and Coffey, C.E. (2002) Executive control function: A review of its promise and challenges for clinical research. A report from the committee on research of the American neuropsychiatric association. The Journal of Neuropsychiatry & Clinical Neurosciences, 14, 377-405. doi:10.1176/appi.neuropsych.14.4.377
[11] Stuss, D.T. (2007) New approaches to prefrontal lobe testing. In: Miller, B.L. and Cummings, J.L., Eds., The Human Frontal Lobes: Functions and Disorders, 2nd Edition, The Guilford Press, New York, 292-305.
[12] Heaton, R.K., Chelune, G.J., Talley, J.L., Kay, G.G. and Curtiss, G. (1993) Wisconsin Card Sorting Test manual revised and expanded. Psychological Assessment Resources, Inc., Lutz.
[13] Milner, B. (1963) Effects of different brain lesions on card sorting. Archives of Neurology, 9, 100-110. doi:10.1001/archneur.1963.00460070100010
[14] Lezak, M.D. (1995) Neuropsychological assessment. 3rd Edition, Oxford University Press, New York.
[15] Anthony, M.P., Bradley, N.A., Alexander, I.T. and Karen, T.B. (1996) Utility of a Wisconsin Card Sorting Test short form in persons with Alzheimer’s and Parkinson’s disease. Journal of Clinical and Experimental Neuropsychology, 18, 892-897. doi:10.1080/01688639608408310
[16] Nelson, H.E. (1976) A modified card sorting test sensitive to frontal lobe deficits. Cortex, 12, 313-324.
[17] De Zubicaray, G. and Ashton, R. (1996) Nelson’s (1976) modified card sorting test: A review. The Clinical Neuropsychologist, 10, 245-254. doi:10.1080/13854049608406687
[18] Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198. doi:10.1016/0022-3956(75)90026-6
[19] Crum, R.M., Anthony, J.C., Bassett, S.S. and Folstein, M.F. (1993) Population-based norms for the Mini-Mental State Examination by age and educational level. The Journal of the American Medical Association, 269, 23862391. doi:10.1001/jama.1993.03500180078038
[20] Morris, J.C. (1993) The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology, 43, 24122414. doi:10.1212/WNL.43.11.2412-a
[21] Liao, Y.C., Yeh, T.L., Ko, H.C., Luo, C.M. and Lu, F.H. (1995) Geriatric depression scale-validity and reliability of the Chinese-translated version: A preliminary study. Medical Journal of Changhua Christian Hospital, 1, 1117.
[22] Hachinski, V.C. (1974) Multi-infarct dementia: A cause for mental detonation in the elderly. Lancet, 11, 207-210. doi:10.1016/S0140-6736(74)91496-2
[23] Lineweaver, T.T., Bondi, M.W., Thomas, R.G. and Salmon, D.P. (1999) A normative study of Nelson’s (1976) modified version of Wisconsin Card Sorting Test in healthy older adults. Clinical Neuropsychology, 13, 328-347. doi:10.1076/clin.13.3.328.1745
[24] Korten, A.E., Henderson, A.S., Christensen, H., Jorm, A.F., Rodgers, B., Jacomb, P. and Mackinnon, A.J. (1997) A prospective study of cognitive function in the elderly. Psychosomatic Medicine, 27, 919-930. doi:10.1017/S0033291797005217
[25] De Zubicaray, G.I., Smith, G.A., Chalk, J.B. and Semple, J. (1998) The modified card sorting test: Test-retest stability and relationships with demographic variables in a healthy older adult sample. British Journal of Clinical Psychology, 37, 457-466. doi:10.1111/j.2044-8260.1998.tb01403.x
[26] Birren, J.E. and Schaie, K.W. (2001) Handbook of the psychology of aging. Academic Press, San Diego.
[27] Milner, B. (1963) Effects of different brain lesions on card sorting. Archives of Neurology, 9, 90-100. doi:10.1001/archneur.1963.00460070100010
[28] Lezak, M.D. (1995) Neuropsychyological assessment. Oxford University Press, New York.
[29] Chen, C.W.Y., Lam, L.C.W., Wong, T.C.M. and Chiu, H.F.K. (2003) Modified card sorting test performance among community dwelling elderly Chinese people. Hong Kong Journal of Psychiatry, 13, 2-7.

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