The Wisconsin Card Sorting Test (WCST) is a popular neurocognitive task used to assess cognitive flexibility, and aspects of executive functioning more broadly, in research and clinical practice. Despite its widespread use and the development of an updated WCST manual in 1993, confusion remains in the literature about how to score the WCST, and importantly, how to interpret the outcome variables as indicators of cognitive flexibility. This critical review provides an overview of the changes in the WCST, how existing scoring methods of the task differ, the key terminology and how these relate to the assessment of cognitive flexibility, and issues with the use of the WCST across the literature. In particular, this review focuses on the confusion between the terms ‘perseverative responses’ and ‘perseverative errors’ and the inconsistent scoring of these variables. To our knowledge, this critical review is the first of its kind to focus on the inherent issues surrounding the WCST when used as an assessment of cognitive flexibility. We provide recommendations to overcome these and other issues when using the WCST in future research and clinical practice.

威斯康星卡片分类测试 (WCST) 是一项流行的神经认知任务，用于在研究和临床实践中更广泛地评估认知灵活性和执行功能的各个方面。尽管 WCST 被广泛使用并在 1993 年开发了更新的 WCST 手册，但关于如何为 WCST 评分，重要的是如何将结果变量解释为认知灵活性的指标，文献中仍然存在混淆。这篇批判性评论概述了 WCST 的变化、任务的现有评分方法有何不同、关键术语以及这些术语与认知灵活性评估的关系，以及在文献中使用 WCST 的问题。特别是，本综述重点关注术语“持续反应”和“持续错误”之间的混淆以及这些变量的不一致评分。据我们所知，当用作评估认知灵活性时，这篇批判性评论是第一次关注围绕 WCST 的固有问题。我们提供了在未来研究和临床实践中使用 WCST 时克服这些和其他问题的建议。