The present study examined executive and overall neuropsychological functioning within a memory disorder clinic population, specifically focusing on performance on the Modified Wisconsin Card Sorting Test (M-WCST) among individuals with and without cerebrovascular disease.

A total of 268 participants were included in this study. Among them, diagnoses included 198 with Alzheimer’s disease (AD; mean age was 80.19, SD = 6.11, 65.2% female), 19 with vascular dementia (VaD; mean age was 82.74, SD = 5.91, 63.2% female), and 51 with mixed dementia (specifically AD+VaD; mean age was 82.16, SD = 5.75, 58.8% female). The average education level was 13.56 (SD = 2.37) and most individuals self-identified as being White (89.2%). This study utilized test data collected between January 2018 - August 2022. Participants were included if they were aged 65+ and if they completed a neuropsychological evaluation with the M-WCST, Trail Making Test part B (TMT-B), and the Color Word (C/W) subtest of The Stroop Test, and diagnosed with AD, VaD, or mixed dementia.

Results of a one-way multivariate analysis of variance (MANOVA) showed that M-WCST raw scores were not significantly different across diagnostic groups, F(6, 526) = 1.239, p = .285; Wilks' Λ = .972; partial η2 = .014. However, a MANOVA revealed a statistically significant difference in TMT-B performance and C/W performance among dementia diagnoses, F(4, 524) = 4.434, p = .002; Wilks' Λ = .936; partial η2 = .033. Specifically, individuals with VaD and mixed dementia both performed significantly worse on TMT-B when compared to those with AD. Additionally, individuals with mixed dementia performed significantly worse on C/W when compared to those diagnosed with AD. Lastly, correlation analysis revealed M-WCST scores were significantly correlated with performance on other executive functioning measures including TMT-B and C/W.

M-WCST scores were not significantly different among diagnostic groups. Although individuals with VaD and mixed dementia did not perform significantly worse on the M-WCST compared to those with AD as hypothesized, mean scores suggested a trend in this direction, encouraging a need for future studies with more VaD participants. Additionally, the degree of dementia progression might pose as another reason for the lack of significance observed. Future researchers should screen patients for the severity of their dementia before inclusion. Present results also suggested that TMT-B and C/W performance among the VaD group and mixed dementia group were worse in comparison to the AD group, suggesting these measures can further assist in differentiating those with and without cerebrovascular disease. Furthermore, it is of note that individuals with mixed dementia performed worse than any other diagnosis, suggesting mixed pathology involves worse cognitive impairment than either diagnosis alone. Lastly, M-WCST scores were significantly correlated with other executive functioning measures, contributing to developing the construct validity of the M-WCST as a measure of executive functioning in a memory disorder clinic population.