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Exploring Heterogeneity on the Wisconsin Card Sorting Test in Schizophrenia Spectrum Disorders: A Cluster Analytical Investigation

Published online by Cambridge University Press:  20 May 2019

Sean P. Carruthers Open the ORCID record for Sean P. Carruthers [Opens in a new window] ,
Caroline T. Gurvich ,
Denny Meyer ,
Chad Bousman ,
Ian P. Everall ,
Erica Neill ,
Christos Pantelis ,
Philip J. Sumner ,
Eric J. Tan Open the ORCID record for Eric J. Tan [Opens in a new window]  and
Elizabeth H.X. Thomas Open the ORCID record for Elizabeth H.X. Thomas [Opens in a new window]
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Sean P. Carruthers*
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria 3122, Australia
Caroline T. Gurvich
Affiliation:
Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred Hospital, Melbourne 3004, Australia
Denny Meyer
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria 3122, Australia Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Victoria 3122, Australia
Chad Bousman
Affiliation:
Cooperative Research Centre (CRC) for Mental Health, 161 Barry Street, Carlton, Victoria 3053, Australia Departments of Medical Genetics, Psychiatry, and Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada Department of Psychiatry, The University of Melbourne, Parkville, Victoria 3052, Australia
Ian P. Everall
Affiliation:
Cooperative Research Centre (CRC) for Mental Health, 161 Barry Street, Carlton, Victoria 3053, Australia Department of Psychiatry, The University of Melbourne, Parkville, Victoria 3052, Australia Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK Centre for Neural Engineering, The University of Melbourne, Carlton, VIC, Australia
Erica Neill
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria 3122, Australia Department of Psychiatry, The University of Melbourne, Parkville, Victoria 3052, Australia Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia
Christos Pantelis
Affiliation:
Cooperative Research Centre (CRC) for Mental Health, 161 Barry Street, Carlton, Victoria 3053, Australia Department of Psychiatry, The University of Melbourne, Parkville, Victoria 3052, Australia Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia Centre for Neural Engineering, The University of Melbourne, Carlton, VIC, Australia Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia
Philip J. Sumner
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria 3122, Australia
Eric J. Tan
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria 3122, Australia Department of Mental Health, St Vincent’s Hospital, Melbourne, Victoria 3065, Australia
Elizabeth H.X. Thomas
Affiliation:
Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred Hospital, Melbourne 3004, Australia
Tamsyn E. Van Rheenen
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria 3122, Australia Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia
Susan L. Rossell
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria 3122, Australia Department of Mental Health, St Vincent’s Hospital, Melbourne, Victoria 3065, Australia
Australian Schizophrenia Research Bank
Affiliation:
Schizophrenia Research Institute, 405 Liverpool Street, Darlinghurst, Sydney, NSW 2010, Australia
*
Correspondence and reprint requests to: Sean P. Carruthers, Centre for Mental Health, Level 10, ATC Building, Swinburne University of Technology, Hawthorn VIC 3122, Australia. E-mail: [email protected]
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Abstract

Objectives: The Wisconsin Card Sorting Test (WCST) is a complex measure of executive function that is frequently employed to investigate the schizophrenia spectrum. The successful completion of the task requires the interaction of multiple intact executive processes, including attention, inhibition, cognitive flexibility, and concept formation. Considerable cognitive heterogeneity exists among the schizophrenia spectrum population, with substantive evidence to support the existence of distinct cognitive phenotypes. The within-group performance heterogeneity of individuals with schizophrenia spectrum disorder (SSD) on the WCST has yet to be investigated. A data-driven cluster analysis was performed to characterise WCST performance heterogeneity. Methods: Hierarchical cluster analysis with k-means optimisation was employed to identify homogenous subgroups in a sample of 210 schizophrenia spectrum participants. Emergent clusters were then compared to each other and a group of 194 healthy controls (HC) on WCST performance and demographic/clinical variables. Results: Three clusters emerged and were validated via altered design iterations. Clusters were deemed to reflect a relatively intact patient subgroup, a moderately impaired patient subgroup, and a severely impaired patient subgroup. Conclusions: Considerable within-group heterogeneity exists on the WCST. Identification of subgroups of patients who exhibit homogenous performance on measures of executive functioning may assist in optimising cognitive interventions. Previous associations found using the WCST among schizophrenia spectrum participants should be reappraised. (JINS, 2019, 25, 750–760)

Keywords

Schizophrenia spectrum and other psychotic disordersExecutive functionCognitive subgroupCognitive flexibilityConcept formationPsychosis
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 7 , August 2019 , pp. 750 - 760
Copyright
Copyright © INS. Published by Cambridge University Press, 2019. 

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