Effect of Aging on Executive Functions in Healthy Indian Adults: A Wisconsin Card Sorting Test-based Analysis

Abstract Background: Age-related decline in executive functioning (EF) is often explained by the frontal aging model, which proposes heightened vulnerability of the prefrontal cortex to age-related neurobiological changes. While this phenomenon is well-documented globally, normative evidence from healthy Indian populations remains limited. Aim: The aim of this study was to examine age-associated differences in EF among healthy Indian adults across three age groups: 40–55 years, 55–70 years, and 70–85 years. Materials and Methods: A cross-sectional comparative design was employed. One hundred and fifty healthy adults were stratified into three age groups ( n = 50 per group). Executive function was assessed using the manual Wisconsin Card Sorting Test (WCST). Data were collected and analyzed using a one-way analysis of variance to compare performance across 11 specific WCST indices, followed by Tukey’s honestly significant difference post hoc comparisons. Effect sizes (η 2 ) were calculated. Results: Significant age-related differences were found in all 11 WCST variables. Large effect sizes were found for total errors (η 2 = 0.58), nonperseverative errors (η 2 = 0.52), categories completed (η 2 = 0.52), and conceptual-level responses (η 2 = 0.46). The 70–85 group demonstrated significantly poorer performance relative to younger groups, whereas differences between the 40–55 and 55–70 groups were generally nonsignificant. Conclusion: EF declines significantly after 70 years of age, particularly in cognitive flexibility, rule acquisition, and error monitoring. These findings provide important normative reference data for the healthy Indian population and emphasize the need for age-adjusted executive function benchmarks in geriatric assessment.