A review of neuropsychological differences between paranoid and nonparanoid schizophrenia patients

This review examines the literature on neuropsychological differences between paranoid and nonparanoid schizophrenia subjects. Thirty-two studies related to intellectual functioning, attention, memory, language, visual-spatial, and motor functions are discussed. Subjects with paranoid schizophrenia did not demonstrate higher intellectual functioning than those with nonparanoid schizophrenia, and both groups performed similarly on tests of verbal ability and visual-spatial functions. Several studies suggest that the paranoid subtype is associated with higher performance on tests of executive functions, attention, memory, and motor skills. However, the findings are inconsistent. Methodological issues in the literature are examined, including varying degrees of participants' chronicity and severity of illness among studies, criteria for diagnostic group membership, medication effects, reliability and validity of the neuropsychological measures, and statistical power.     

Letter and category fluency in schizophrenic patients: a meta-analysis

Patients with schizophrenia typically demonstrate impairments on semantic and letter fluency tasks but it is possible that these tests demand subtly different cognitive processing: a lexical search based on phonology or orthography or a semantic search based on organization of semantic networks by dimension or attribute. Differences in the performance between these two tasks may imply whether deficits involve difficulties in accessing or traversing connectivities in the semantic system, as opposed to those based on linguistic units. In this meta-analysis, we reviewed 13 studies (N=915) in an attempt to clarify whether schizophrenic patients are in fact differentially impaired in semantic fluency. Results from analyses indicated that schizophrenic patients are disproportionately deficient in category fluency (d=1.23 for semantic and 1.01 for letter fluency with minimal overlap of confidence intervals of weighted d's) suggesting that compromises the semantic system may be present in schizophrenia and perhaps play a role in the symptomatic anomalies exhibited in this patient population.     

Algorithmic and heuristic strategies in comprehension of complement clauses by patients with Parkinson's disease

Language ability in patients with idiopathic Parkinson's disease (PD) and normal control subjects (NC) matched on age, sex, education and socioeconomic status (SES) was investigated. The two groups of subjects were tested on eight sentence types in Greek in the form of main and complement clause with eight matrix verbs. These matrix verbs were ask (ask information), promise (commissive meaning), tell1 (order, command) and tell2 (give information) in sentences with no semantic constraints, and confess, sell, trust and scold in sentences with semantic constraints (implicit causality). The results show that language ability, despite relative preservation is significantly impaired in PD patients as compared to that of NC. More specifically, syntax with semantic constraints was the most effective independent variable to classify PD patients and NC subjects into two distinct groups according to a Logistic Regression Analysis. To restrict the algorithmic process in sentence comprehension, PD patients seem to make use of the minimal distance principle (MDP) and the "experiencer constraint" heuristic strategies. Possible similarities in language behavior between PD patients and aphasics, in general, are suggested.     

Verbal and nonverbal fluency in patients with probable Alzheimer's disease.

Verbal fluency (semantic category naming and letter fluency) and nonverbal fluency (semantic category drawing and design fluency) were measured in mildly and moderately demented patients with probable dementia of the Alzheimer type (pDAT), and related to age at onset, disease duration, and disease severity. Group and individual patient analyses revealed impairments within verbal and nonverbal modalities that were most severe on semantic category fluency tasks. Detailed assessments of errors emphasized the role of compromised semantic memory in pDAT patients' impaired fluency, regardless of the modality of response. Fluency performance was related to dementia severity but not to age of onset or disease duration. It is concluded that deficits on measures of fluency in pDAT are due in large part to semantic memory impairments and that fluency may be useful for following disease progression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal fluency deficits in patients with schizophrenia: Semantic fluency is differentially impaired as compared with phonologic fluency.

Patients with schizophrenia show deficits in phonologic (ability to name words that begin with a specific letter, e.g., F) and semantic (ability to name members of a category, e.g., "animals" fluency.) Whereas the former deficit has been presumed to reflect a dysfunction of the frontal lobe, the latter has been linked to frontal and temporoparietal brain areas. These 2 verbal fluency measures were studied in a sample of 27 schizophrenia patients and 24 normal controls who were matched on age and a putative measure of premorbid intellectual ability. A 2-min production task of switching between letters and between categories measured demand for flexibility. On switching and nonswitching tasks controls produced more words during semantic versus phonologic fluency. Conversely, schizophrenia patients produced more words for letters than for categories, suggesting dysfunction of the frontal and temporoparietal areas of the brain. Furthermore, the greater impairment of semantic fluency may be related to a breakdown of semantic information processing beyond "executive" search and retrieval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contextual insensitivity in schizophrenic language processing: Evidence from lexical ambiguity.

The authors investigated whether contextual failures in schizophrenia are due to deficits in the detection of context or the inhibition of contextually irrelevant information. Eighteen schizophrenia patients and 24 nonpsychiatric controls were tested via a cross-modal semantic priming task. Participants heard sentences containing homonyms and made lexical decisions about visual targets related to the homonyms' dominant or subordinate meanings. When sentences moderately biased subordinate meanings (e.g., the animal enclosure meaning of pen), schizophrenia patients showed priming of dominant targets (e.g., paper) and subordinate targets (e.g., pig). In contrast, controls showed priming only of subordininate targets. When contexts strongly biased subordinate meanings, both groups showed priming only of subordinate targets. The results suggest that inhibitory deficits rather than context detection deficits underlie contextual failures in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometrically matched visual-processing tasks in schizophrenia spectrum disorders.

Patients with schizophrenia show deficits in visual perception and working memory, but the relationship between these deficits has not been characterized with psychometrically matched tasks. The authors administered 2 visual discrimination and 6 recognition tasks to 43 schizophrenia spectrum patients and 22 nonpsychiatric subjects. When performing difficulty-matched tasks, spectrum subjects showed more severe impairments for motion compared with form processing. When tasks were matched on true score variance, spectrum subjects exhibited worse performance on both form and motion discrimination, and a differential deficit in motion recognition with a short display duration and long interstimulus interval. These results provide evidence of differential deficits in visual processing in schizophrenia that appear to be dependent on the temporal characteristics of the tasks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building up linguistic context in schizophrenia: Evidence from self-paced reading.

An impairment in the build-up and use of context has been proposed as a core feature of schizophrenia. The current study tested the hypothesis that schizophrenia patients show impairments in building up context within sentences because of abnormalities in combining semantic with syntactic information. Schizophrenia patients and healthy controls read and made acceptability judgments about sentences containing verbs that were semantically associated with individual preceding words but that violated either the meaning (animacy/semantic constraints) or the syntactic structure (morphosyntactic constraints) of their preceding contexts. To override these semantic associations and determine that such sentences are unacceptable, participants must integrate semantic with syntactic information. These sentences were compared with congruous and pragmatically/semantically violated sentences that imposed fewer semantic-syntactic integration demands. At sentence-final words and decisions, patients showed smaller reaction time differences than controls to animacy/semantically violated or morphosyntactically violated sentences relative to pragmatically/semantically violated or nonviolated sentences. The relative insensitivity to these violations in patients with schizophrenia may arise from impairments in combining semantic and syntactic information to build up sentence context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The double-deficit hypothesis for the developmental dyslexias.

The authors propose an alternative conceptualization of the developmental dyslexias, the double-deficit hypothesis (i.e., phonological deficits and processes underlying naming-speed deficits represent 2 separable sources of reading dysfunction). Data from cross-sectional, longitudinal, and cross-linguistic studies are reviewed supporting the presence of 2 single-deficit subtypes with more limited reading impairments and 1 double-deficit subtype with more pervasive and severe impairments. Naming-speed and phonological-awareness variables contribute uniquely to different aspects of reading according to this conception, with a model of visual letter naming illustrating both the multicomponential nature of naming speed and why naming speed should not be subsumed under phonological processes. Two hypotheses concerning relationships between naming-speed processes and reading are considered. The implications of processing speed as a second core deficit in dyslexia are described for diagnosis and intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recovery in deep dysphasia: evidence for a relation between auditory - verbal STM capacity and lexical errors in repetition

This study investigates the changes in auditory-verbal short-term memory (AVSTM) and error patterns in repetition observed in a Wernicke's aphasic, NC, over a period of about 2 years following the onset of a left middle cerebral artery aneurysm. When first tested, NC demonstrated deep dysphasia, a disorder characterized by the production of semantic errors in repetition and a severe disability in repeating nonwords. At this stage, his AVSTM span, assessed in a pointing task, was less than one item. As NC recovered somewhat, his performance on AVSTM tasks improved (span increased to two items), and his pattern of error in word repetition changed (fewer semantic errors, more formal paraphasias and neologisms). Other features of his span performance after some recovery resembled patterns associated with STM-based repetition impairments (reduced recency effects and reduced word length effects). In a series of computer simulation and empirical studies, we show that NC's repetition performance can be accounted for by varying two parameters of an interactive activation model of repetition adapted from Dell and O'Seaghdha's (1991) model of production: decay rate and temporal interval. These results provide support for the view that AVSTM performance depends on storage capacities intrinsic to the language processing system. Such a model allows deep dysphasia and STM-based repetition disorders to be seen as quantitative variants of the same underlying disturbance.     

Impairment in category fluency in ischemic vascular dementia.

The underlying mechanisms for impaired output on letter (F, A, and S) and category (e.g., animal) word list generation (WLG) tasks in subcortical ischemic vascular dementia (IVD) were investigated. Normal control (NC) and Alzheimer's disease (AD) participants were also studied. IVD and NC participants performed better on category than letter WLG tasks, whereas the opposite was observed among AD participants. IVD participants produced fewer responses than AD participants on letter WLG tasks, but there was no difference between AD and IVD participants on the "animal" WLG task. AD participants scored lower than IVD and NC participants on animal WLG indexes measuring semantic knowledge. There were few differences between IVD and NC participants. The reduced output on the animal WLG task for IVD participants is consistent with search-retrieval deficits. The reduced output of AD participants may be caused by degraded semantic knowledge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional network differences in schizophrenia: a rCBF study of semantic processing

Studies of regional cerebral blood flow in patients with schizophrenia have led to the idea that dysfunctional neurocircuitry may play a role in patients' cognitive deficits. The present PET study was designed to explore this idea by comparing the functional neural networks associated with semantic processing for patients and normal controls through structural equation modeling (path analysis). The patients showed significantly different neural interactions among frontal regions, between the frontal and temporal cortices, and between the frontal lobe and anterior cingulate than controls. These discrepancies were especially striking given there were minimal group differences in task performance. Results suggest that schizophrenia involves a neural abnormality that is evident in functional networks during cognitive performance.     

Recognition of posed and genuine facial expressions of emotion in paranoid and nonparanoid schizophrenia.

Most previous research reporting emotion-recognition deficits in schizophrenia has used posed facial expressions of emotion and chronic-schizophrenia patients. In contrast, the present research examined the ability of patients with acute paranoid and nonparanoid (disorganized) schizophrenia to recognize genuine as well as posed facial expressions of emotion. Evidence of an emotion-recognition deficit in schizophrenia was replicated, but only when posed facial expressions were used. For genuine expressions of emotion, the paranoid-schizophrenia group was more accurate than controls, nonparanoid-schizophrenia patients, and depressed patients. Future research clearly needs to consider the posed versus genuine nature of the emotional stimuli used and the type of schizophrenia patients examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retrieval from semantic memory and its implications for Alzheimer's disease.

In 3 experiments, participants generated category exemplars (e.g., kinds of fruits) while a voice key and computer recorded each response latency relative to the onset of responding. In Experiment 1, mean response latency was faster when participants generated exemplars from smaller categories, suggesting that smaller mental search sets result in faster mean latencies. In Experiment 2, a concurrent secondary task increased mean response latency, suggesting that slowed mental processing results in slower mean latencies. In Experiment 3, the mean response latency of Alzheimer's participants was faster than that of elderly controls, which is consistent with the idea that the semantic memory impairments of Alzheimer's disease patients stem primarily from a reduction in available items (as in Experiment 1) rather than retrieval slowing (as in Experiment 2). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of reading and spelling in patients with probable Alzheimer's disease.

Patients with probable Alzheimer's disease (AD) are reported to show mild, but reliable, difficulties reading aloud and spelling to dictation exception words, which have unusual or unpredictable correspondence between their spelling and pronunciation (e.g., touch). To understand the cognitive dysfunction responsible for these impairments, 21 patients and 27 age- and education-matched controls completed specially designed tests of single-word oral reading and spelling to dictation. AD patients performed slightly below controls on all tasks and showed mildly exaggerated regularity effects (i.e., the difference in response accuracy between words with regular spellings minus exception words) in reading and spelling. Qualitative analyses, however, did not demonstrate response patterns consistent with impairment in central lexical orthographic processing. The authors conclude that the mild alexia and agraphia in AD reflect semantic deficits and nonlinguistic impairments rather than a specific disturbance in lexical orthographic processing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Schizophrenics' size estimations of thematic stimuli.

Found that relationships between premorbid adjustment, schizophrenia subtype, stimulus content, and size judgments of thematic stimuli were substantially dependent on the sequences in which stimuli were presented. Ss were 36 paranoid and 36 nonparanoid schizophrenics, and a comparison sample of 36 prisoners, matched for length of institutionalization. Individual differences in schizophrenics' size estimations were not simply related to premorbid adjustment, schizophrenic subtype, or to 2 common measures of chronicity-length of illness and length of hospitalization-while proportion of time hospitalized since 1st admission, interacting with schizophrenia subtype, was correlated with size judgments. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age at onset and language disturbances in Alzheimer's disease

This study examined the effect of age at symptom onset of Alzheimer's disease (AD) on the pattern of language disturbance. We assessed 150 consecutive patients with a clinical diagnosis of mild-to-moderate AD using the Western Aphasia Battery and a 100-item picture-naming test. A multivariate linear regression analysis examined the effect of age at onset after controlling for gender, education, severity of dementia and duration of the disease. Patients with early onset performed significantly worse than did patients with late onset on the word comprehension and sequential commands subtests. On the other hand, late-onset patients performed more poorly than early-onset patients on the picture-naming test in a subgroup with mild language deficits. However, the trend disappeared in other subgroups with more degraded language function. We consider that the concomitant effects of normal aging worsened the picture-naming deficits in the late-onset patients, and the rapid decline of naming ability in the early-onset patients masked the aging effect with the progression of language deficits. The deterioration of word comprehension and the rapid decline of naming ability are the characteristics of early-onset patients. The different patterns of language deficits between early- and late-onset patients may correspond to the genetic heterogeneity of AD.     

Verbal fluency deficits in geriatric and nongeriatric chronic schizophrenic patients

This study examined age-related differences and correlates of deficits on phonological and category fluency tasks performed by schizophrenic patients. Equal numbers (n = 41) of geriatric (age > 64) and nongeriatric chronically hospitalized schizophrenic patients were examined with tests of phonological and category fluency, verbal learning and delayed recall, confrontation naming, and reading, as well as overall estimates of cognitive impairment. Both types of fluency tests were performed very poorly by both groups. Age-related differences were found to be statistically significant. In both groups, category fluency impairments were correlated with deficits in naming, while phonological fluency deficits were best predicted by memory impairments. These data suggest that category fluency impairments are part of a general profile of impaired semantic functioning, whereas phonological fluency deficits may be induced by alterations in information processing capacity.