Cognitive persistence: Development and validation of a novel measure from the Wisconsin Card Sorting Test

Neuropsychologia. 2017 Jul 28;102:95-108. doi: 10.1016/j.neuropsychologia.2017.05.027. Epub 2017 May 25.


The Wisconsin Card Sorting Test (WCST) has long been used as a neuropsychological assessment of executive function abilities, in particular, cognitive flexibility or "set-shifting". Recent advances in scoring the task have helped to isolate specific WCST performance metrics that index set-shifting abilities and have improved our understanding of how prefrontal and parietal cortex contribute to set-shifting. We present evidence that the ability to overcome task difficulty to achieve a goal, or "cognitive persistence", is another important prefrontal function that is characterized by the WCST and that can be differentiated from efficient set-shifting. This novel measure of cognitive persistence was developed using the WCST-64 in an adult lifespan sample of 230 participants. The measure was validated using individual variation in cingulo-opercular cortex function in a sub-sample of older adults who had completed a challenging speech recognition in noise fMRI task. Specifically, older adults with higher cognitive persistence were more likely to demonstrate word recognition benefit from cingulo-opercular activity. The WCST-derived cognitive persistence measure can be used to disentangle neural processes involved in set-shifting from those involved in persistence.

Keywords: Persistence; Prefrontal cortex; Set-shifting; Speech recognition; Wisconsin Card Sorting Test.

MeSH terms

  • Acoustic Stimulation
  • Adult
  • Aged
  • Aged, 80 and over
  • Attention / physiology*
  • Cognition / physiology*
  • Executive Function / physiology*
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging
  • Male
  • Memory, Short-Term / physiology
  • Middle Aged
  • Oxygen / blood
  • Photic Stimulation
  • Prefrontal Cortex / diagnostic imaging
  • Prefrontal Cortex / physiology*
  • Recognition, Psychology
  • Reproducibility of Results
  • Visual Perception / physiology
  • Wisconsin Card Sorting Test*
  • Young Adult


  • Oxygen