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Abstract
For over four decades the Wisconsin Card Sorting Test (WCST) has been one of the most
distinctive tests of prefrontal function. Clinical research and recent brain imaging
have brought into question the validity and specificity of this test as a marker of
frontal dysfunction. Clinical studies with neurological patients have confirmed that,
in its traditional form, the WCST fails to discriminate between frontal and non-frontal
lesions. In addition, functional brain imaging studies show rapid and widespread activation
across frontal and non-frontal brain regions during WCST performance. These studies
suggest that the concept of an anatomically pure test of prefrontal function is not
only empirically unattainable, but also theoretically inaccurate. The aim of the present
review is to examine the causes of these criticisms and to resolve them by incorporating
new methodological and conceptual advances in order to improve the construct validity
of WCST scores and their relationship to prefrontal executive functions. We conclude
that these objectives can be achieved by drawing on theory-guided experimental design,
and on precise spatial and temporal sampling of brain activity, and then exemplify
this using an integrative model of prefrontal function [i.e., Miller, E. K. (2000).
The prefrontal cortex and cognitive control. Nature Reviews Neuroscience, 1, 59-65.]
combined with the formal information theoretical approach to cognitive control [Koechlin,
E., & Summerfield, C. (2007). An information theoretical approach to prefrontal executive
function. Trends in Cognitive Sciences, 11, 229-235.].