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Perseveration

Perseveration is the inappropriate and persistent repetition of a response, such as a word, gesture, action, or thought, that continues beyond its relevance or the cessation of the eliciting stimulus.^[1] This phenomenon is associated with disrupted executive functioning in the brain, often stemming from neurological damage or dysfunction, and it manifests across various cognitive, motor, and verbal domains.^[2] Perseveration is classified into distinct types based on clinical presentation, cognitive processes, and neuroanatomical correlates. Stuck-in-set perseveration involves the rigid maintenance of an outdated task set or category, reflecting deficits in cognitive flexibility typically linked to frontal lobe impairment.^[3] Recurrent perseveration occurs when a prior response is involuntarily repeated in response to a new stimulus, associated with abnormal facilitation of memory traces in the posterior left hemisphere.^[3] Continuous perseveration, by contrast, features the uninterrupted prolongation of a single behavior or motor act, commonly tied to basal ganglia dysfunction.^[3] The condition arises from disruptions in neural circuits governing inhibition, attention shifting, and response selection. In cases involving brain injury, the prefrontal cortex plays a central role.^[4] It is prominently observed in various neurological and psychiatric conditions, including traumatic brain injury, dementia (such as Alzheimer's disease), autism spectrum disorder, schizophrenia, and aphasia.^[5]^[6] These associations underscore perseveration's role as a marker of underlying neuropathology, impacting daily functioning.^[2]

Definition and Characteristics

Definition

Perseveration refers to the involuntary and persistent repetition of a response—such as a word, gesture, action, or thought—despite the cessation or alteration of the eliciting stimulus, often interfering with ongoing task performance or adaptive behavior.^[7] This phenomenon manifests as an inability to shift attention or response appropriately, leading to recurrent outputs that are no longer contextually relevant.^[8] The term "perseveration" was first introduced in 1895 by German neurologist Arthur Neisser during a discussion of a clinical case involving abnormal repetition, marking its entry into neuropsychological literature as a descriptor of pathological behavioral persistence.^[9] Neisser's usage highlighted the concept in relation to brain dysfunction, distinguishing it from mere habituation. Unlike transient repetitions seen in normal development, such as echolalia in young children—which typically resolves by age three and aids language acquisition—perseveration represents a maladaptive, uncontrolled persistence that disrupts communication and functioning.^[10] For example, a person might repeatedly utter the same word, like "yes," throughout a conversation even as questions or topics change, preventing meaningful dialogue.^[9] This pathological form is frequently linked to frontal lobe damage, where inhibitory control mechanisms are compromised.^[8]

Key Characteristics

Perseveration manifests primarily through inflexibility in task-switching or response adaptation, resulting in "stuck-in-set" behavior where an individual inappropriately maintains a prior mental set, category, or action despite clear signals for change. This core feature reflects an underlying executive dysfunction that impairs the ability to disengage from established patterns, leading to repetitive application of obsolete strategies in dynamic environments. Such rigidity is a hallmark of perseverative errors observed in neuropsychological assessments, distinguishing it as a failure of cognitive control rather than mere repetition.^[3]^[11] The behavior often displays a continuous or recurrent pattern, with repetitions that either extend unduly beyond the initial context or reappear in response to new but related stimuli, creating cycles of maladaptive persistence. This recurrent nature tends to intensify under stress or fatigue, as these states further compromise attentional resources and inhibitory control, thereby amplifying the propensity for prolonged or echoed responses. Research demonstrates that mental fatigue specifically elevates perseveration in tasks involving cognitive planning and set maintenance,^[12] while chronic stress correlates with heightened perseverative tendencies in set-shifting paradigms.^[13] Perseveration disrupts everyday functioning by obstructing adaptive communication and problem-solving, as the compulsion to repeat prior outputs prevents timely engagement with novel information or social cues. This interference can manifest across modalities, such as in verbal exchanges where responses loop unproductively, ultimately contributing to significant behavioral disability in affected individuals.^[11] In contrast to stereotypy—which involves rigid, non-contextual repetitions typically devoid of situational triggers and often serving sensory or self-regulatory purposes—perseveration is inherently context-bound, emerging as an erroneous prolongation or intrusion tied directly to preceding stimuli or task demands. For instance, a brief verbal example includes palilalia, the involuntary repetition of one's own words or phrases, often with decreasing volume and increasing speed. This contextual linkage underscores perseveration's association with disrupted executive processes over invariant motoric habits.^[3]

Types of Perseveration

Verbal Perseveration

Verbal perseveration refers to the inappropriate repetition or continuation of verbal responses, words, phrases, or ideas in speech and language production, often observed in neurogenic communication disorders such as aphasia. This phenomenon disrupts the ability to generate novel or contextually appropriate linguistic output, stemming from impaired response selection or inhibition mechanisms in the brain's language processing systems. Unlike voluntary repetition for emphasis, verbal perseveration is involuntary and persists despite changes in stimuli or task demands.^[11] Key subtypes of verbal perseveration include palilalia, echolalia, and semantic perseveration. Palilalia involves the unsolicited repetition of one's own previous utterances, typically with accelerating speed and diminishing volume, as seen in conditions affecting speech motor control. For instance, a speaker might repeat "go to the store, go to the store, go to the store" in a stereotypic manner shortly after initial production. Echolalia manifests as the involuntary echoing of others' words or phrases, commonly occurring immediately or delayed after hearing them, such as a patient repeating an examiner's question verbatim instead of answering it. Semantic perseveration entails the recurrent reuse of semantically related concepts or features from prior responses, rather than exact words, leading to substitutions like naming multiple animals as "dog" or "cat" in a picture-naming task due to lingering activation of animal-related semantics.^[14]^[11]^[15] A classic example of verbal perseveration is a patient who, after initially answering "yes" to a question, continues to respond "yes" to all subsequent unrelated questions, illustrating stuck-in-set perseveration where the prior response dominates despite shifting contexts. This subtype, along with recurrent forms, exemplifies how perseveration can extend beyond immediate repetition to interfere with flexible discourse.^[11] Verbal perseveration significantly impairs communication by promoting tangential speech—where responses veer off-topic due to repeated intrusions—or derailment, in which the flow of conversation fragments as new ideas fail to supplant perseverative ones. In severe cases, it results in reduced conversational coherence, making interactions effortful and inefficient for both speaker and listener. Such disruptions are particularly evident in aphasia, where perseveration exacerbates expressive and receptive language challenges.^[9]^[14] Verbal perseveration is prevalent following injury to the language-dominant hemisphere, typically the left in right-handed individuals, with studies reporting its occurrence in 50-93% of aphasia cases post-stroke or trauma. This association underscores the role of dominant-hemisphere networks in suppressing outdated verbal responses to enable adaptive language use.^[15]^[11]

Motor Perseveration

Motor perseveration refers to the involuntary and persistent repetition of physical movements or gestures, continuing beyond the appropriate context or after the task has been completed, often due to impaired inhibition of motor programs. This phenomenon is distinct from voluntary actions and arises from disruptions in executive control, leading to a "stuck-in-set" pattern where the individual fails to shift to new behaviors despite external cues or instructions.^[16]^[17] A prominent manifestation of motor perseveration is utilization behavior, first described by Lhermitte in 1983, in which patients automatically grasp and employ objects in their environment in a contextually inappropriate manner, compelled by the mere visual or tactile presence of the item. This behavior exemplifies environmental dependency, where actions are overly triggered by surrounding stimuli, bypassing internal goal-directed intentions and resulting in compulsive use of tools or objects, such as repeatedly wielding a hammer to tap surfaces long after any practical need has passed.^[18]^[19] Classic examples include a patient instructed to fold a napkin once but continuing to refold it indefinitely, or engaging in continuous hand-washing motions after the sink is turned off, demonstrating the persistence of the motor sequence without adaptive cessation. These repetitions highlight pathological inertia in motor execution, categorized in seminal work by Luria as efferent perseveration (repetition at the motor periphery due to lingering movement traces) or afferent perseveration (inability to update the action program itself).^[16]^[20] Motor perseveration differs from tics in that it lacks the premonitory urge—a subjective sensory discomfort preceding the movement that is characteristic of tic disorders—and instead involves prolonged continuation of actions tied to prior stimuli, rather than sudden, stereotyped bursts unrelated to ongoing tasks. Frontal lobe dysfunction, particularly in prefrontal and orbitofrontal regions, underlies this impairment by reducing inhibitory control over stimulus-driven responses.^[16]^[18]

Cognitive Perseveration

Cognitive perseveration refers to the persistent adherence to a particular cognitive strategy, rule, or mental set despite environmental feedback or task demands requiring a shift in approach. This form of perseveration manifests as an inability to disengage from an outdated cognitive framework, leading to repetitive errors in thinking and problem-solving. In psychological research, it is distinguished from other types by its focus on internal mental processes rather than overt behaviors.^[21] A classic example of cognitive perseveration occurs in tasks requiring set-shifting, such as the Wisconsin Card Sorting Test (WCST), where participants must adapt sorting criteria based on feedback. Perseverative errors in the WCST arise when individuals continue to sort cards by a previously reinforced dimension, like color, even after negative feedback signals a switch to a new dimension, such as shape. For instance, a participant might repeatedly place cards matching in color together despite repeated incorrect responses, fixating on the initial successful strategy. These errors quantify the degree of cognitive rigidity and are a standard measure in neuropsychological assessments of executive functions.^[22]^[23] Cognitive perseveration is closely tied to executive dysfunction, particularly impairments in set-shifting and cognitive flexibility, which are core components of prefrontal cortex-mediated control processes. This persistence disrupts adaptive problem-solving by preventing the inhibition of irrelevant strategies and the adoption of novel ones, often resulting in inefficient decision-making or stalled progress in complex tasks. In subtle manifestations, it can appear as rumination, where individuals repeatedly dwell on past failures or negative outcomes without generating new perspectives, prolonging emotional and cognitive stagnation.^[21]^[24]^[23] Assessment of cognitive perseveration typically involves standardized neuropsychological tests like the WCST to identify perseverative errors and evaluate executive function deficits.

Neurological and Psychological Mechanisms

Brain Regions and Pathways

Perseveration is primarily associated with dysfunction in the prefrontal cortex, particularly the dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC). The DLPFC, encompassing Brodmann areas 9 and 46, plays a critical role in executive functions such as rule learning, working memory, and cognitive flexibility; lesions here lead to increased perseverative errors on tasks like the Wisconsin Card Sorting Test (WCST), where individuals fail to shift strategies despite feedback.^[25] Similarly, the OFC, including areas 10, 11, 12, and 47, is involved in inhibitory control and reward-based decision-making; damage to this region results in perseveration during reversal learning, with persistent responses to previously rewarded but now unrewarded stimuli.^[25]^[26] The anterior cingulate cortex (ACC) also contributes to perseveration through its role in conflict monitoring, error detection, and signaling the need for cognitive adjustments. Dysfunction in the ACC, often observed in disorders like schizophrenia and depression, impairs the ability to detect mismatches between expected and actual outcomes, leading to persistent repetitive behaviors.^[27]^[28] The basal ganglia, through its cortico-basal ganglia-thalamo-cortical loops, contribute significantly to perseveration by facilitating habit formation and response inhibition. These loops, particularly those involving the caudate nucleus and lenticular nucleus (putamen and globus pallidus), support the selection and suppression of motor and cognitive responses; lesions in these structures are strongly linked to perseverative behaviors, as they disrupt the ability to inhibit habitual actions and adapt to changing contexts.^[29] For instance, excitotoxic lesions to the medial striatum in nonhuman primates produce perseverative impairments during reversal learning tasks, highlighting the basal ganglia's role in overriding ingrained habits.^[30] Recent research as of March 2025 has identified the median raphe nucleus (MRN), a brainstem structure, as a subcortical switchboard critical for behavioral flexibility and perseveration. Suppression of GABAergic neurons in the MRN promotes perseverative states by enhancing persistence in familiar behaviors and reducing exploratory switching, as demonstrated in mouse models of decision-making tasks.^[31] Disruptions in connectivity, especially along frontostriatal pathways, further underlie perseveration by impairing communication between the prefrontal cortex and basal ganglia. The medial prefrontal cortex (mPFC) to nucleus accumbens (NAc) pathway, a key frontostriatal circuit, promotes behavioral flexibility; optogenetic activation of this pathway reduces perseverative errors by enhancing the inhibition of maladaptive responses.^[32] Additionally, white matter tracts such as the superior longitudinal fasciculus, which connects frontal regions to parietal and temporal lobes, support executive control; alterations in its integrity are associated with perseverative tendencies in conditions involving frontoparietal network dysfunction, though direct causal links require further lesion mapping.^[33] These pathways often intersect with dopaminergic modulation in the basal ganglia, where dysregulation can exacerbate inhibition failures.^[34] Evidence from lesion studies reinforces these anatomical associations. Frontal lobe strokes damaging the DLPFC or OFC commonly result in perseverative deficits, as seen in patients exhibiting persistent task repetition post-vascular injury.^[25] Traumatic brain injury (TBI) involving frontal regions similarly induces perseveration, with neuroimaging confirming involvement of frontostriatal circuits and basal ganglia in the resulting executive impairments.^[29] Such findings from both human and animal models underscore the vulnerability of these structures to perseverative syndromes.

Underlying Processes

Perseveration often arises from deficits in executive functions, particularly failures in response inhibition and cognitive flexibility, which impair the ability to suppress irrelevant responses or shift mental sets. Response inhibition involves the suppression of prepotent or habitual actions, and its disruption leads to the repetitive execution of previously appropriate but now maladaptive behaviors. Cognitive flexibility, the capacity to adapt to changing environmental demands, is similarly compromised, resulting in "stuck-in-set" perseveration where individuals rigidly adhere to an outdated strategy despite feedback indicating a need for change.^[35]^[36] Neurotransmitter imbalances, especially excess dopamine in mesolimbic pathways, contribute to perseverative pursuit by enhancing the salience of rewarded or habitual actions at the expense of inhibitory control. Hyperdopaminergic states in these pathways, which project from the ventral tegmental area to the nucleus accumbens, amplify motivational drive toward previously reinforced behaviors, leading to persistent repetition even when outcomes diminish. Dopamine agonists, by mimicking this excess, have been shown to increase perseverative errors in instrumental tasks, underscoring the role of dopaminergic dysregulation in sustaining maladaptive response patterns.^[37]^[38] Computational models elucidate these processes through frameworks like the race model of response selection, where perseveration emerges from a lag in inhibition signals relative to activating ones. In Gordon Logan's stop-signal paradigm, response execution is modeled as a race between a "go" process (driving the response) and a "stop" process (inhibiting it); delays in the stop process allow the go response to complete, resulting in perseverative failures to withhold actions. This model predicts that weakened inhibitory mechanisms prolong the time needed to interrupt ongoing responses, aligning with observed perseveration in tasks requiring rapid set-shifting.^[39] Genetic factors, such as the COMT Val158Met polymorphism, influence perseveration by modulating prefrontal dopamine regulation, which in turn affects executive control. The Val allele increases catechol-O-methyltransferase (COMT) enzyme activity, accelerating dopamine breakdown in the prefrontal cortex and reducing dopaminergic signaling, which impairs performance on tasks measuring perseverative tendencies like the Wisconsin Card Sorting Test. Individuals homozygous for the Val allele exhibit more perseverative errors compared to Met carriers, highlighting how this genetic variant contributes to vulnerability in cognitive flexibility.^[40]^[41]

Associated Conditions

Neurodevelopmental Disorders

Perseveration manifests prominently in neurodevelopmental disorders, which originate during early brain development and persist into later life. These conditions, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), often involve difficulties in cognitive flexibility and response inhibition, leading to repetitive thoughts, behaviors, or speech patterns. Such perseverative tendencies typically emerge in childhood, coinciding with delays in frontal lobe maturation, particularly in the prefrontal cortex, which is crucial for executive functions like shifting attention and adapting to new contexts.^[42]^[43] In autism spectrum disorder, perseveration is a core feature reflected in restricted interests and repetitive behaviors, where individuals intensely focus on specific topics or activities to the exclusion of others. This can include repetitive questioning, such as repeatedly asking the same question despite receiving answers, or fixating on particular objects or routines, which interferes with social interactions and adaptive functioning. Verbal perseveration, in particular, is common, often linked to challenges in pragmatic language use and cognitive set-shifting. These traits are diagnostic hallmarks and contribute to the disorder's characteristic rigidity.^[43]^[44]^[45] In attention-deficit/hyperactivity disorder, perseveration often appears as off-task behaviors or hyperfocus on irrelevant stimuli, where individuals struggle to disengage from unhelpful activities despite cues to shift attention. For instance, a child with ADHD might persistently engage in a distracting action, like fiddling with an object during a lesson, or become overly absorbed in a single task to the detriment of broader responsibilities. This form of perseveration stems from similar early developmental disruptions in frontal-subcortical circuits, exacerbating inattention and impulsivity symptoms. Unlike in ASD, where perseveration aligns with restricted interests, in ADHD it more frequently disrupts task completion and environmental adaptation.^[46]

Psychiatric Disorders

In schizophrenia, perseveration often manifests as repetitive thought patterns, including perseverative delusions where patients fixate on specific delusional themes that resist modification despite contradictory evidence, and thought blocking interspersed with recurrent ideas.^[47] This form of cognitive perseveration is linked to an underlying neurocognitive deficit that impairs the ability to shift mental sets, leading to persistent repetition of verbal responses or ideas during clinical interviews and cognitive tasks.^[47] Comparative studies indicate that individuals with schizophrenia exhibit significantly higher levels of perseverative errors on executive function tests, such as the Wisconsin Card Sorting Test, compared to healthy controls.^[48] In obsessive-compulsive disorder (OCD), perseveration is prominently observed in compulsive rituals, which represent a form of motor perseveration characterized by repetitive behaviors that persist even after the reinforcing stimulus is removed, demonstrating resistance to extinction.^[49] For instance, patients may repeatedly perform checking or washing actions due to an inability to disengage from initial response rules, particularly under conditions of uncertainty or punishment, as evidenced by increased perseverative errors in probabilistic reversal learning tasks.^[49] These behaviors correlate with OCD symptom severity, and serotonergic medications like SSRIs can mitigate perseverative tendencies by enhancing cognitive flexibility in stable environments.^[49] Perseveration in bipolar disorder is evident during manic episodes as repetitive thinking, often encompassing rumination-like repetition of goal-directed or grandiose ideas.^[50]^[51] Epidemiological studies reveal higher rates of perseveration among individuals with positive symptoms of psychosis, such as hallucinations and delusions, where it covaries with symptom severity and is more prevalent in schizophrenia spectrum disorders than in non-psychotic conditions.^[47] This association underscores perseveration as a marker of disorganized thought processes in psychotic states.^[52]

Neurodegenerative Diseases

In Alzheimer's disease, semantic perseveration manifests prominently during naming tasks, where patients repeatedly produce the same semantically related errors due to underlying episodic and semantic memory deficits. For instance, individuals may consistently misname objects within a category, such as labeling various animals as "dog," reflecting a breakdown in semantic processing networks in the temporal lobes. This type of perseveration increases with disease severity and is linked to hippocampal atrophy, as evidenced in studies using confrontation naming tests.^[53]^[54] In Parkinson's disease, motor perseveration arises from disruptions in the basal ganglia circuits, leading to repetitive movements amid bradykinesia and rigidity, such as prolonged grasping or tapping sequences that patients struggle to terminate. This is often observed in tasks requiring sequential motor generation, where patients exhibit higher perseveration correlating with dopamine depletion in the substantia nigra. Unlike voluntary repetition, these behaviors stem from impaired inhibitory control in the supplementary motor area, exacerbating functional impairments in daily activities like dressing or writing.^[55]^[56] Perseveration in these neurodegenerative conditions progressively worsens with advancing disease stages, paralleling the spread of Lewy body pathology from the brainstem to cortical areas, which disrupts executive functions and motor inhibition. In Parkinson's disease and dementia with Lewy bodies, perseveration is associated with alpha-synuclein aggregates in the locus coeruleus and frontal lobes, as confirmed in autopsy-confirmed cases. This progression underscores the role of Lewy body dissemination in amplifying perseverative tendencies beyond initial motor symptoms.^[57]^[58] Case studies of frontotemporal dementia illustrate environmental perseveration, characterized by compulsive interactions with surrounding objects, akin to utilization behavior, where patients repeatedly manipulate items like utensils or tools without purpose due to orbitofrontal disinhibition. These behaviors highlight the disorder's impact on contextual response inhibition, distinguishing them from semantic or motor forms in other dementias.^[59]^[60]

Assessment and Management

Diagnostic Methods

Diagnosing perseveration involves a multifaceted approach that combines behavioral observation, standardized neuropsychological assessments, neuroimaging techniques, and clinical interviews to identify and quantify persistent, inappropriate repetition of responses or actions across cognitive, motor, and verbal domains. These methods aim to distinguish perseveration from other executive function deficits or motor impairments, ensuring accurate identification in clinical populations such as those with frontal lobe damage or neurodevelopmental disorders. Early detection relies on sensitive tools that measure set-shifting abilities and response inhibition, with validation against normative data to account for age, education, and cultural factors.^[61] Neuropsychological tests are cornerstone tools for evaluating cognitive perseveration, particularly through tasks that probe executive functions like flexibility and rule-shifting. The Wisconsin Card Sorting Test (WCST) is widely used to assess perseverative errors, where participants fail to adapt to changing sorting criteria despite feedback, reflecting frontal lobe dysfunction. In this test, individuals sort cards based on color, shape, or number, and perseveration is quantified by the number of trials where previous rules are rigidly repeated, with meta-analyses confirming its sensitivity to cognitive inflexibility in various neurological conditions. Similarly, the Tower of London test evaluates planning and set-shifting by requiring participants to move disks to match target configurations in a minimal number of moves, where perseverative tendencies manifest as repeated suboptimal sequences, correlating with deficits in prefrontal-mediated executive control. These tests provide quantifiable scores, such as perseverative error rates on the WCST relative to normative data, to benchmark severity.^[62]^[63]^[64]^[65] Observation scales facilitate the direct assessment of motor and verbal perseveration in naturalistic or semi-structured settings, capturing repetitive behaviors that may not emerge in formal testing. For motor forms, tasks like line cancellation or drawing exercises quantify perseverative marks or strokes, where individuals redundantly target the same elements, as seen in neglect syndromes with ipsilesional bias. Verbal perseveration is often evaluated during fluency tasks, such as semantic verbal fluency (e.g., naming animals), by counting recurrent responses that violate category rules, with elevated rates indicating impaired inhibition. Although no single universal "Perseverative Behavior Scale" dominates, composite observational protocols, including Rorschach-based scoring for response repetition and clinical rating of speech patterns, provide reliable metrics for both domains. These scales emphasize qualitative descriptors alongside counts to contextualize the behavior's impact on daily functioning.^[66]^[54]^[67] Neuroimaging, particularly functional magnetic resonance imaging (fMRI), aids in corroborating behavioral findings by revealing underlying neural correlates of perseveration during task-switching paradigms. Studies using fMRI during WCST or analogous set-shifting tasks demonstrate frontal hypoactivation, especially in the dorsolateral prefrontal cortex (DLPFC) and inferior frontal gyrus, in individuals exhibiting perseverative errors, with reduced blood-oxygen-level-dependent (BOLD) signals correlating with error rates compared to controls. This hypoactivation reflects impaired recruitment of frontoparietal networks essential for cognitive flexibility, providing objective evidence beyond behavioral measures. Such imaging is typically reserved for research or complex cases due to its cost and requires integration with clinical data for diagnostic utility.^[68]^[69]^[70] Differential diagnosis employs structured clinical interviews to rule out confounds like apraxia, which can mimic motor perseveration through execution errors rather than repetition. Interviews, such as those using the Frontal Behavioral Inventory, probe for discriminatory features: perseveration involves rigid recurrence of prior actions (e.g., repeating a gesture indefinitely), whereas apraxia features groping or ideomotor deficits without persistence. By systematically querying onset, context, and associated symptoms—via tools like the Apraxia of Speech Rating Scale for verbal domains—clinicians distinguish these, with perseveration often linked to frontal disinhibition rather than parietal motor planning issues. This process ensures perseveration is not misattributed, guiding targeted interventions.^[71]^[72]

Treatment Approaches

Treatment approaches for perseveration aim to address its underlying mechanisms and manifestations across cognitive, behavioral, and motor domains, often tailored to the associated condition. Pharmacological interventions, particularly antipsychotics, target dopamine dysregulation implicated in perseverative symptoms in psychiatric contexts. For instance, risperidone has demonstrated efficacy in reducing repetitive behaviors and irritability in individuals with autism spectrum disorder by modulating dopaminergic pathways, leading to decreased perseveration in daily activities.^[73] In schizophrenia, risperidone similarly enhances executive function, including reduced perseverative responses on cognitive tasks, through its antagonism of dopamine D2 receptors.^[74] These medications are typically initiated at low doses to minimize side effects such as weight gain and sedation, with monitoring for long-term efficacy. Behavioral therapies focus on interrupting and redirecting perseverative patterns, particularly in neurodevelopmental and obsessive-compulsive contexts. Cognitive behavioral therapy (CBT) incorporating exposure and response prevention (ERP) effectively diminishes OCD-related perseveration by gradually exposing individuals to triggers while preventing compulsive repetitions, fostering habituation and inhibitory learning.^[75] For autism, response interruption and redirection (RIR) techniques interrupt repetitive behaviors and guide toward alternative responses, reducing perseverative scripting or actions that interfere with learning and social engagement.^[76] These interventions emphasize positive reinforcement and functional communication training to promote flexibility, with evidence showing sustained reductions in perseverative frequency after consistent application. Neurorehabilitation strategies address motor perseveration following brain injury, such as stroke or traumatic brain injury, where repetitive incorrect movements persist due to disrupted motor planning. Constraint-induced movement therapy (CIMT) constrains the unaffected limb to force intensive use of the impaired one, promoting neuroplasticity and overcoming learned non-use patterns that contribute to perseverative motor responses.^[77] In post-stroke recovery, CIMT improves upper extremity function and reduces reliance on habitual, perseverative gestures by emphasizing task-specific practice, with studies indicating lasting gains in motor control.^[78] Emerging interventions like transcranial magnetic stimulation (TMS) offer non-invasive modulation of prefrontal circuits to alleviate perseveration. Repetitive TMS (rTMS) applied to the dorsolateral prefrontal cortex reduces perseverative errors on executive function tests, such as the Wisconsin Card Sorting Test, in conditions like treatment-resistant depression. High-frequency rTMS protocols enhance cognitive flexibility by increasing cortical excitability in hypoactive prefrontal areas, with preliminary trials showing decreased perseverative thinking and improved response inhibition; emerging evidence suggests similar benefits in Parkinson's disease with cognitive inflexibility.^[79] These approaches are often combined with behavioral strategies for synergistic effects, though larger randomized trials are needed to establish optimal parameters.

References

[1]
Perseveration - APA Dictionary of Psychology
Apr 19, 2018 · in neuropsychology, the inappropriate repetition of behavior that is often associated with damage to the frontal lobe of the brain.
[2]
Perseveration. Part I: a review - PubMed - NIH
Perseveration refers to the inappropriate continuation or repetition of a response or activity. It is associated with a variety of neurological disorders.Missing: definition psychology
[3]
Varieties of perseveration - PubMed
We propose a new taxonomy for perseveration consisting of three categories which are distinctive at the levels of clinical features, process, and neuroanatomy.
[4]
https://www.flintrehab.com/perseveration-after-brain-injury/
[5]
Perseveration (Repetition) | Fact sheet - Synapse
Perseveration is repetitive and continuous behaviour, speech or thought that occurs due to changes in cognitive skills such as memory, attention, and mental ...Missing: neuroscience | Show results with:neuroscience
[6]
Number perseveration in healthy subjects: Does prolonged stimulus ...
Perseveration is defined as the uncontrollable repetition of a particular response or as the inability to interrupt a task in progress and shift from one ...
[7]
Frontal Lobe Syndrome - StatPearls - NCBI Bookshelf - NIH
Frontal lobe syndrome is a broad term used to describe the damage of higher functioning processes of the brain such as motivation, planning, social behavior, ...
[8]
Full article: A review of classical accounts of verbal perseveration ...
Dec 2, 2010 · As noted earlier, the term “perseveration” was first coined by Neisser in 1894 in a discussion of a case presented by Heilbronner at the 65th ...
[9]
Echolalia - StatPearls - NCBI Bookshelf - NIH
Echolalia is a normal part of speech and language development. It improves over the first two years of life. Pathological echolalia persists beyond the age of ...
[10]
Perseveration in behavioral neurology - PubMed - NIH
Stuck-in-set perseveration was associated with dopamine system dysfunction, and continuous perseveration with right hemisphere damage. We propose a theory ...Missing: conditions | Show results with:conditions
[11]
Effects of chronic stress on cognitive function – From neurobiology to ...
For example, in healthy young adults, early life stress correlates with increased perseveration ... Early life stress stress also correlated with decreased ...
[12]
Perseveration and other repetitive verbal behaviors - PubMed
This article will review types of perseveration from a neurolinguistic perspective. During the course of the article, continuous, stuck-in-set, ...
[13]
[PDF] Challenging Symptoms - JBLearning
Stark (2011a) defines perseveration as “a phenomenon whereby the subject unintentionally produces or “gets stuck” on an information unit, i.e., a particular ...Missing: Carl | Show results with:Carl
[14]
[PDF] Two Kinds of Motor Perseveration in Massive Injury of the Frontal ...
In this paper we will describe two cases of massive injury to the frontal lobes. The first is a particularly clear example of "efferent" perseveration, in which ...
[15]
Motor perseverations: a function of the side and the site of ... - PubMed
Motor perseverations are commonly thought to be a sign of frontal lobe lesions, although they may also occur following lesions outside the frontal lobes.
[16]
'Utilization behaviour' and its relation to lesions of the frontal lobes
A new type of behaviour, termed 'utilization behaviour', was observed among patients affected with left or right unilateral, or bilateral, frontal lesions.Missing: original paper
[17]
Utilization Behavior: What Is Known and What Has to Be Known? - NIH
The lesions reported originally by Lhermitte in his landmark paper [1] were very heterogeneous, ranging from “anterior right cortical-subcortical frontal lobe” ...
[18]
Utilization behavior - PMC - NIH
Utilisation Behaviour (UB) denotes the appropriate usage of an object by a patient, however at an inappropriate situation.
[19]
Tic disorders and the premonitory urge - PMC - NIH
Premonitory urge was not correlated with tic severity in the entire sample. In youths older than 10, as opposed to youths younger than 10, premonitory urge did ...Missing: perseveration | Show results with:perseveration
[20]
Habits, Goals, and Behavioral Signs of Cognitive Perseveration on ...
PE refer to those behavioral errors on Wisconsin card-sorting tasks that are committed when cognitive rules are maintained even though recently received ...
[21]
https://pmc.ncbi.nlm.nih.gov/articles/PMC10296075/
[22]
https://doi.org/10.3390/brainsci13060919
[23]
A Review of Perseverative Cognition, the Default Stress Response ...
Perseverative cognition is defined as “the repeated or chronic activation of the cognitive representation of one or more psychological stressors” (Brosschot et ...
[24]
Insights into Human Behavior from Lesions to the Prefrontal Cortex
Notably, PFC patients make random errors in addition to perseverative errors that may result from transient lapses of attention (Barcelo and Knight, 2002).
[25]
Dysfunction of orbitofrontal and dorsolateral prefrontal cortices in ...
Oct 8, 2013 · Patients with DLPFC damage also show more perseverative errors in the WCST than controls [20], and DLPFC activation measured by PET [21] and ...
[26]
Neuropsychological and neuroanatomical correlates of ...
Aug 1, 2006 · Secondly, even if the frontal lobe may not be structurally involved in motor perseveration, it might still be functionally involved in the ...
[27]
Lesions of the Medial Striatum in Monkeys Produce Perseverative ...
Oct 22, 2008 · The present study compared the effects of excitotoxic lesions of the medial striatum (MS), amygdala, and OFC in the marmoset monkey on performance of the ...
[28]
Frontostriatal regulation of brain circuits contributes to flexible ... - NIH
Feb 14, 2025 · The current study demonstrated that activation of the mPFC-NAc pathway enhanced behavioral flexibility by reducing perseverative errors and ...
[29]
The superior longitudinal fasciculus and its functional triple-network ...
Individual differences in brain structure that might perseverate dysfunctional connectivity of brain networks associated with brooding are less clear, however.
[30]
Shifting and stopping: fronto-striatal substrates, neurochemical ...
The neurochemical modulation of fronto-striatal circuitry in parallel with effects on task performance has been investigated using specific neuropharmacological ...
[31]
Varieties of perseveration - ScienceDirect.com
Stuck-in-set perseveration, the inappripriate maintenance of a current category or framework, involves an underlying process deficit in executive functioning ...
[32]
Executive Dysfunction - PMC - PubMed Central - NIH
Executive functions can be split into four distinct components: working memory, inhibition, set shifting, and fluency.
[33]
Dopamine agonists increase perseverative instrumental responses ...
Dopamine (DA) deafferentation of the dorsolateral striatum has been shown to prevent habit development, leaving instrumental behavior under action–outcome ...Missing: imbalances | Show results with:imbalances
[34]
A neuronal mechanism underlying decision-making deficits during ...
Feb 21, 2018 · Hyperdopaminergic states in mental disorders are associated with disruptive deficits in decision making. However, the precise contribution ...Missing: imbalances | Show results with:imbalances
[35]
Models of Response Inhibition in the Stop-Signal and Stop-Change ...
The stop-signal paradigm is very useful for the study of response inhibition. Stop-signal performance is typically described as a race between a go process.
[36]
Effect of COMT Val108/158 Met genotype on frontal lobe function ...
The COMT Val allele, because it increases prefrontal dopamine catabolism, impairs prefrontal cognition and physiology, and by this mechanism slightly increases ...
[37]
A Functional Polymorphism in the COMT Gene and Performance on ...
The COMT gene contains a functional polymorphism, Val158Met, that exerts a fourfold effect on enzyme activity. The current study investigated whether prefrontal ...
[38]
Prefrontal damage in childhood and changes in the development of ...
We present a case of a 40-year-old man who suffered a frontal lobe lesion at the age of nine years and developed impulsivity, disinhibition and inappropriate ...
[39]
Autism spectrum disorder: MedlinePlus Genetics
Oct 21, 2021 · Affected individuals often dwell on or repeatedly express particular thoughts; this trait is called perseveration.
[40]
Association between anger rumination and autism symptom severity ...
Many individuals with autism spectrum disorder (ASD) have a tendency to focus intently and excessively on one thing, a trait known as perseveration (Liss et al.
[41]
Perseveration in the Connected Speech of Boys with Fragile X ... - NIH
Topic perseveration was coded when a child repeated a topic, theme, or idea two or more times in an excessive manner. Repetitions of this type did not need to ...
[42]
Perseveration by NK1R-/- ('knockout') mice is blunted by doses ... - NIH
Apr 19, 2016 · These mice express all abnormalities seen in ADHD (locomotor hyperactivity, impulsive behaviour, inattentiveness and perseveration), whereas ...
[43]
Hyperfocus: the forgotten frontier of attention - PMC - PubMed Central
'Hyperfocus' is a phenomenon that reflects one's complete absorption in a task, to a point where a person appears to completely ignore or 'tune out' everything ...
[44]
Perseveration in schizophrenia - PubMed
Comparative studies have demonstrated higher than normal levels of perseverative responding among schizophrenia patients on capacity-demanding tasks, including ...
[45]
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[46]
Perseveration and Shifting in Obsessive-Compulsive Disorder as a ...
Both perseveration and increased shifting can be observed in OCD, depending on test conditions including the predictability of reinforcement. Perseveration was ...
[47]
https://pubmed.ncbi.nlm.nih.gov/9050113/
[48]
Rumination in bipolar disorder: evidence for an unquiet mind - PMC
Patients with bipolar disorder may experience an exacerbation in executive dysfunction when manic or depressed, which may lead to a tendency to ruminate because ...
[49]
Perseveration and over-switching in schizophrenia - ScienceDirect
Perseveration and switching have been suggested to support the accepted distinction between positive and negative schizophrenia. Over-switching seemed to be ...
[50]
Verbal perseveration in individuals with Alzheimer's disease - PubMed
The study investigated the frequency of verbal perseveration in individuals with AD in relation to task type, mental status, and performance on attention and ...
[51]
Recurrent Perseverations on Semantic Verbal Fluency Tasks as an ...
In particular, perseveration errors were found to be associated with multiple neurological disorders including mild and moderate Alzheimer's disease dementia ( ...
[52]
Motor perseveration is an early sign of Parkinson's disease
Motor perseveration is an early sign of Parkinson's disease. D. Stoffers, MA, H.W. Berendse, MD, PhD, J.B. Deijen, PhD, and E.C. Wolters, MD, PhDAuthors Info ...
[53]
Perseverative motor behaviour in Parkinson's disease - PubMed
... Parkinson's disease using the Breidt Perseveration Test Device (PTD). In this experiment subjects are instructed to press one of nine buttons arranged ...
[54]
Cognitive Profiles of Autopsy-Confirmed Lewy Body Variant vs Pure ...
02). Planned post hoc comparisons revealed that patients with LBV scored significantly lower than patients with AD on the Initiation/Perseveration subscale ( ...
[55]
Motor perseveration is an early sign of Parkinson's disease - PubMed
Perseveration in the generation of random motor behavior was examined ... Motor perseveration is an early sign of Parkinson's disease. Neurology. 2001 ...
[56]
Perseverations and non-verbal confabulations on the Rey-Osterrieth ...
Dec 2, 2011 · We describe the case of a patient with late onset fronto-temporal dementia (FTD), who presented with typical personality changes, ...
[57]
Frontotemporal Dementia (FTD) - Neurologic Disorders
Patients may pick up and manipulate random objects for no reason (called utilization behavior). Verbal output is reduced; echolalia, perseveration ( ...
[58]
The Reliability of the Wisconsin Card Sorting Test in Clinical Practice
The Wisconsin Card Sorting Test (WCST) represents the gold standard for the neuropsychological assessment of executive function.
[59]
Wisconsin Card Sorting Test - an overview | ScienceDirect Topics
The Wisconsin Card Sorting Test (WCST) is defined as a cognitive assessment designed to measure the flexibility of human thought, where participants sort ...Introduction to the Wisconsin... · Neurocognitive Functions...
[60]
Considerations for using the Wisconsin Card Sorting Test to assess ...
Mar 22, 2021 · The Wisconsin Card Sorting Test (WCST) is a popular neurocognitive task used to assess cognitive flexibility, and aspects of executive functioning more broadly.
[61]
The most frequently used tests for assessing executive functions in ...
There are numerous neuropsychological tests for assessing executive functions in aging, which vary according to the different domains assessed.
[62]
Regulatory Match Effects on a Modified Wisconsin Card Sort Task
Tests of executive function such as the Tower of London test (Shallice, 1982) ... perseverative responses, provides an estimate of cognitive set shifting ability.
[63]
Motor perseverative behavior on a line cancellation task | Neurology
The current findings indicate that perseveration during target cancellation most frequently follows anterior brain (basal ganglia and frontal lobe) lesions or ...
[64]
A multimethod approach to assessing perseverations in ...
We assessed perseverations in schizophrenia patients (N = 71) using the Wisconsin Card Sorting Test (WCST) and a new Rorschach perseveration scale which yields ...
[65]
Cognitive Inflexibility and Frontal-Cortical Activation in Pediatric ...
In neuroimaging studies, compared with healthy boys, boys with OCD showed less inferior frontal cortex activation during task switching as well as less caudate ...
[66]
Performance and brain activity during the Wisconsin Card Sorting ...
May 21, 2019 · This study provides exploratory analyses to address this gap by measuring brain activity with functional magnetic resonance imaging (fMRI)
[67]
Neural correlates of set-shifting: decomposing executive functions in ...
As one of the prominent mental subcomponents, set-shifting was found to be related to a frontoparietal activation pattern involving the inferior frontal gyrus.<|separator|>
[68]
The Frontal Behavioral Inventory in the differential diagnosis of ...
Perseveration and verbal apraxia were important discriminatory items for FLD and PPA, respectively. The FBI is a standardized behavioral inventory useful to ...
[69]
Reliability and Validity of the Comprehensive Limb and Oral Apraxia ...
Oct 31, 2019 · Unlike apraxia of speech, oral motor apraxia means impairment of non-speech vocal tract gestures [9]. Several assessments have been developed ...Loat Development Process · 1) Limb Apraxia Test (56) · 2) Oral Apraxia Test (16)<|separator|>
[70]
Risperidone For Autism: Symptoms, Side Effects & More
Aug 3, 2023 · Risperidone can be an effective medication for managing symptoms of autism, particularly irritability, aggression, and repetitive behaviors.
[71]
Cognitive Improvement After Treatment With Second-Generation ...
Numerous recent clinical trials have suggested that second-generation antipsychotic medications significantly enhance cognition in schizophrenia.
[72]
(PDF) Family Cognitive-Behavioral Treatment for a Child With ...
Aug 10, 2025 · The aim of this naturalistic study was to evaluate the effectiveness of a novel adolescent autism-adapted CBT manual for OCD in a specialist ...Missing: interruption | Show results with:interruption<|separator|>
[73]
Evidence-Based Behavioral Interventions for Repetitive Behaviors in ...
Evidence-based treatments have been developed and used to treat repetitive behavior in disorders other than autism such as OCD, Tic Disorders, and Impulse ...
[74]
Constraint-Induced Movement Therapy after Stroke - PMC
Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for treating ...Missing: perseveration | Show results with:perseveration
[75]
Constraint-induced movement therapy for recovery of upper-limb ...
These preliminary results suggest that CI therapy may be effective for improving UL motor function following chronic TBI.Missing: perseveration | Show results with:perseveration
[76]
Effects of Repetitive Transcranial Magnetic Stimulation on Cognitive ...
Some authors have demonstrated that patients with depression in an active rTMS group improved significantly on a test of cognitive flexibility, conceptual ...