Adult Normative Data of the Wisconsin Card Sorting Test in Taiwan

Background: The Wisconsin Card Sorting Test (WCST) is a widely used neuropsychological test for assessing executive functions. However, the lack of culture-specific norms has often limited clinical interpretation of performance on the WCST. The aims of this study were to establish adult norms for the WCST in Taiwan, and to understand the development of performance on the WCST among age groups. Methods: A total of 475 participants (233 males, 242 females) aged from 20 to 89 years were divided into 10 age groups. All of the participants completed the WCST, and 6 indices of WCST were calculated, including percent errors (PE), percent perseverative responses (PPR), percent perseverative errors (PPE), percent non-perseverative errors (PNPE), percent conceptual-level responses (PCLR), and categories completed (CC). Results: There were several findings. First, our data showed that there was no evidence of a significant difference between manual card and computerized card presentation versions of WCST on the PE, PPR, PPE, PNPE, PCLR, and CC indices. Second, no education and gender effects on WCST performance were found. Third, although WCST indices were significantly different among age groups, no remarkable differences among the groups after 30 years of age were found. Finally, compared with Heaton's USA norms, WCST performance in Taiwanese was poorer than the USA sample in most age groups. Conclusion: The WCST is not sensitive enough to detect aging-related cognitive changes in the Taiwanese population, and there are different performances on WCST between Taiwanese and USA people. The adult norms for WCST in Taiwan will provide an important reference for future research and clinical practice. [J Chin Med Assoc 2008;71(10):517-522]