Neuropsychological and Behavioral Measures of Attention Assess Different Constructs in Children With Traumatic Brain Injury

Assessment of Executive Function in Patients with Traumatic Brain Injury with the Wisconsin Card-Sorting Test

This review aimed at providing a brief and comprehensive summary of recent research regarding the use of the Wisconsin Card-Sorting Test (WCST) to assess executive function in patients with traumatic brain injury (TBI). A bibliographical search, performed in PubMed, Web of Science, Scopus, Cochrane Library, and PsycInfo, targeted publications from 2010 to 2020, in English or Spanish. Information regarding the studies’ designs, sample features and use of the WCST scores was recorded. An initial search eliciting 387 citations was reduced to 47 relevant papers. The highest proportion of publications came from the United States of America (34.0%) and included adult patients (95.7%). Observational designs were the most frequent (85.1%), the highest proportion being cross-sectional or case series studies. The average time after the occurrence of the TBI ranged from 4 to 62 years in single case studies, and from 6 weeks up to 23.5 years in the studies with more than one patient. Four studies compared groups of patients with TBI according to the severity (mild, moderate and/or severe), and in two cases, the studies compared TBI patients with healthy controls. Randomized control trials were seven in total. The noncomputerized WCST version including 128 cards was the most frequently used (78.7%). Characterization of the clinical profile of participants was the most frequent purpose (34.0%). The WCST is a common measure of executive function in patients with TBI. Although shorter and/or computerized versions are available, the original WCST with 128 cards is still used most often. The WCST is a useful tool for research and clinical purposes, yet a common practice is to report only one or a few of the possible scores, which prevents further valid comparisons across studies. Results might be useful to professionals in the clinical and research fields to guide them in assessment planning and proper interpretation of the WCST scores.

Intellectual functioning and multi-dimensional attentional processes in long-term survivors of a central nervous system related pediatric malignancy

AIMS

Central nervous system (CNS) malignancies and/or their treatment in pediatric cancer survivors are known to be associated with deficits in neuropsychological functions. We report findings from a nation-wide study of childhood cancer survivors to investigate intelligence and attention/concentration from a multi-dimensional perspective in a diverse sample from this population.

MAIN METHODS

Four hundred forty-four pediatric cancer survivors between 6 and 17 years of age, who had suffered CNS involvement associated with their malignancy, were evaluated. All patients completed a measure of general intelligence. Attention was measured by a continuous performance test (CPT) and by parental report using a standardized psychological inventory.

KEY FINDINGS

Social economic status (SES) was a significant predictor of intellectual functioning and scores on independent measures of attention. After controlling for SES, cranial radiation therapy (CRT) was strongly predictive of impairments in intellectual functioning. Patients who had completed a transplant procedure did not have significant impairments in intellectual functioning when compared to other participants. CPT performance was most clearly influenced by a younger age at diagnosis and the presence of a supratentorial brain tumor. Reaction time was lower in patients who had received CRT. Gender did not correlate with CPT performance, but caregiver reports of deficits in attentional functioning were more prevalent in girls compared to boys.

SIGNIFICANCE

These findings are important given the large, representative sample and multi-dimensional assessment of attentional functioning. The presence of a very strong SES effect on all dependent variables must be addressed in studies of this nature.