Motivational, cultural, and socioeconomic factors on the Wisconsin card sorting test

The Wisconsin Card Sorting Test (WCST) has been widely used in the neuropsychological assessment of adult patient groups. In most cases, poor performance on the WCST correlates with frontal lobe pathology. Some evidence suggests that performance on this test may also be affected by certain demographic characteristics and the subject's motivation. The purpose of this study was to examine the impact of motivation (monetary feedback vs. verbal feedback), culture (County Roscommon, Ireland vs. New England), and socioeconomic status (SES; high vs. low) on WCST performance. The results indicated that motivation did not improve the performance of subjects who received monetary feedback for correct responses on the WCST. Cultural background affected performance. The Roscommon subjects performed more poorly than the American subjects on the WCST measures. The impact of socioeconomic status was less robust. In the New England sample, subjects in the low socioeconomic group performed more poorly on the WCST than subjects in the high socioeconomic group. In the Roscommon sample, subjects in the low socioeconomic group achieved fewer categories than the high SES group although there were no significant differences on the other WCST measures. Although the WCST has demonstrated its sensitivity to frontal lobe dysfunction in a variety of well-controlled investigations, these results indicate that one should use caution when interpreting WCST scores across cultures and socioeconomic groups for whom normative data does not exist.