Cerebral hemodynamic response induced by the Tower of Hanoi puzzle and the Wisconsin Card Sorting test.

Transcranial Doppler sonography (TCD) was applied in normal subjects to investigate the effect of prefrontal functions like the Tower of Hanoi (TOH) task and the Wisconsin Card Sorting test (WCST) on cerebral hemodynamics. In 20 healthy volunteers, left and right middle cerebral artery (MCA) and anterior cerebral artery (ACA) were insonated. The TOH task and the WCST were administered while cerebral blood flow velocity (CBFV) was registered. Each test was repeated once per artery pair. There was a visuomotor test to control the motor and visual stimulations. Three phases of CBFV time course were detected: an initial peak within 5 s, a following decrease within 25 s and a steady state beginning at 40 s. The TOH task, WCST and visuomotor tests had different mean CBFV during the initial peak (MCA: P<0.05; ACA: P<0.05) as well as for the decrease (ACA: P<0.01) and the steady state (MCA: P<0.01; ACA: P<0.01). The TOH showed an increased mean CBFV as compared with the WCST during the steady state (MCA: P<0.01; ACA: P<0.05). However, temporal modulation of mean CBFV during category shift of the WCST resulted in significantly increased values after category shift (MCA: P<0.001; ACA: P<0.01) as compared with CBFV before the category shift. These findings showed a different CBFV pattern during the TOH task and WCST than during the visuomotor test. In conclusion, TCD was able to assess CBFV in prefrontal functions, using a high resolution in time.