Modified Card Sorting Test performance among community dwelling elderly Chinese people

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Date: June 2003
From: Hong Kong Journal of Psychiatry(Vol. 13, Issue 2)
Publisher: The Hong Kong College of Psychiatrists Ltd.
Document Type: Clinical report
Length: 3,917 words
Lexile Measure: 1600L

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Objective: To examine the performance of Nelson's Modified Card Sorting Test in community dwelling elderly Chinese people.

Patients and Methods: Nelson's Modified Card Sorting Test was administered to 95 healthy elderly Chinese people. Relationships between the Modified Card Sorting Test performance and demographic characteristics were evaluated.

Results: Most people (86.3%) were unable to complete 6 categories, and many of them made perseverative errors. Approximately 30% made more than 50% perseverative errors. Age, educational level, and gender significantly affected Modified Card Sorting Test performances, with education demonstrating the largest effect on performance.

Conclusion: These findings suggest that demographic factors appear to exert a significant impact on Modified Card Sorting Test performances in elderly people, so these should be taken into consideration during interpretation of clinical assessments. For the effective use of the Modified Card Sorting Test in clinical settings, further studies of specific clinical populations are required to develop normative data for elderly Chinese people.

Key words: Chinese, Demographic variables, Elderly


The Wisconsin Card Sorting Test (WCST) is commonly used in neuropsychological assessment as a measure of executive function. (1) Despite its popularity, several shortcomings of the test have been highlighted, and it may be particularly difficult for use with elderly people. Various authors have commented on its abstract stimuli, arbitrary nature, and lengthy administrative time, which may reduce the examinee's motivation to complete the test, and that many examinees become confused when performing the test. (2,3) Therefore, it has been recommended that a modified or shortened form of the WCST might be better for use as a tool in neuropsychological assessment. (2-4)

Nelson developed a considerably shorter alternative version of the test, the Modified Card Sorting Test (MCST). The MCST differs from the WCST in several ways. (3) Firstly, the 128 response cards have been reduced to 48, consisting of 2 identical packs of 24 response cards, with each card sharing only one attribute with any of the 4 stimulus cards. Lineweaver et al claimed that the change allows the examiner's feedback to provide unambiguous information to the respondent, and the participant's sorting strategy can be easily deduced. (5) Secondly, the MCST allows the participants to begin with whatever category they choose and complete the other 2 categories in a self-selected order. (5) Thirdly, instead of 10 in the original version, Nelson reduced the number of consecutive correct responses required for completing

a category to 6. Fourthly, following 6 consecutive correct sorts, the participant is informed to change the rule and is told to find a new sorting principle. Since overall cognitive performance and attention capacity declines with age, (6,7) a test with a shorter completion time, and clear and simple instructions that are easier to understand will be particularly beneficial for elderly people. The modifications in the MCST are likely to allow elderly people to perform better as they increase the flexibility and reduce the ambiguity of the test.

The MCST performance has been investigated in various neurological patient groups, for example, in the determination of executive...

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Gale Document Number: GALE|A169591477