No, It Is Not Possible to Be Schizophrenic Yet Neuropsychologically Normal.

Cognitive impairment is well documented in schizophrenia, though some reports have been interpreted to suggest that it is possible to have schizophrenia without neuropsychological impairment. The authors tested this by comparing the neuropsychological profiles of closely matched patients with schizophrenia and healthy comparison participants. Sixty-four patients with schizophrenia and 64 healthy comparison cases, matched to within 3 Full-Scale IQ points, were tested using the Wechsler Adult Intelligence Scale (3rd ed.; D. Wechsler, 1997b) and the Wechsler Memory Scale (3rd ed.; D. Wechsler, 1997c). Neuropsychological profiles for these groups were markedly different, with the group of patients with schizophrenia exhibiting performance deficits in memory and speeded visual processing but superior verbal comprehension and perceptual organization relative to the group of healthy comparison participants matched on Full-Scale IQ. Thus, scoring in the normal range does not preclude neuropsychological abnormality in schizophrenia, confirming that neuropsychological impairment is a core feature of the illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crystallized verbal skills in schizophrenia: Relationship to neurocognition, symptoms, and functional status.

Objective: To study the relationship of superior (i.e., ≥ 90th percentile), average (11th?89th percentile) or extremely low (i.e., ≤ 10th percentile) crystallized verbal skills to neurocognitive profiles, symptoms and everyday life function in schizophrenia. Method: Crystallized verbal skill was derived from Vocabulary subtest scores from the Wechsler Adult Intelligence Scale (WAIS). Out of a sample of 165 stable outpatients with schizophrenia we identified 25 participants with superior crystallized verbal skill, 104 participants with average verbal skill, and 36 participants with extremely low crystallized verbal skill. Each participant was administered measures of attention, working memory, verbal learning and memory, problem-solving and processing speed, as well as symptom and performance-based adaptive life skill assessments. Results: The magnitude of neuropsychological impairment across the three groups was different, after adjusting for group differences in education and duration of illness. Working memory, and verbal learning and memory skills were different across all three groups, while processing speed differentiated the extremely low verbal skill group from the other two groups and problem-solving differentiated the very low verbal skill group from the superior verbal skill group. There were no group differences in sustained attention. Capacity measures of everyday life skills were different across each of the three groups. Conclusion: Crystallized verbal skill in schizophrenia is related to the magnitude of impairment in neurocognitive function and performance-based skills in everyday life function. Patterns of neuropsychological impairment were similar across different levels of crystallized verbal skill. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Imagining the future: Degraded representations of future rewards and events in schizophrenia.

Over the course of life, most people work toward temporally distant rewards such as university degrees or work-related promotions. In contrast, many people with schizophrenia show deficits in behavior oriented toward long-term rewards, although they function adequately when rewards are more immediately present. Moreover, when asked about possible future events, individuals with schizophrenia show foreshortened future time perspectives relative to healthy individuals. Here, we take the view that these deficits are related and can be explained by cognitive deficits. We compared the performance of participants with schizophrenia (n = 39) and healthy participants (n = 25) on tasks measuring reward discounting and future event representations. Consistent with previous research, we found that relative to healthy participants, those with schizophrenia discounted the value of future rewards more steeply. Furthermore, when asked about future events, their responses were biased toward events in the near future, relative to healthy participants' responses. Although discounting and future representations were unrelated in healthy participants, we found significant correlations across the tasks among participants with schizophrenia, as well as correlations with cognitive variables and symptoms. Further analysis showed that statistically controlling working memory eliminated group differences in task performance. Together these results suggest that the motivational deficits characteristic of schizophrenia relate to cognitive deficits affecting the ability to represent and/or evaluate distant outcomes, a finding with important implications for promoting recovery from schizophrenia. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Age-related practice effects across longitudinal neuropsychological assessments in older people with schizophrenia.

Objective: The relationship between aging and practice effects on longitudinal neuropsychological assessments was investigated in middle-aged and older people with schizophrenia and healthy controls. Method: Older people with schizophrenia (n = 107; M age = 56.1) and age-comparable nonpsychiatric controls (n = 107; M age = 57.7) were scheduled to receive annual assessments on a comprehensive battery of neuropsychological tests for an average of 2.5 years (range 11 months to 4 years). Mixed-model analyses were used to separately examine the effects of practice and age on test performance. Results: Number of prior assessments (practice) was associated with significant performance improvement across assessments, whereas older age was associated with significant decline in performance. The groups did not differ significantly in extent of age-related cognitive decline, but a three-way interaction among group, age, and practice was found, such that greater age-related decline in practice effects were found for older people with schizophrenia relative to nonpsychiatric participants. Conclusions: This study did not find any evidence of neurodegenerative age-related decline in neuropsychological abilities in middle-aged and older people with schizophrenia, but older age was associated with diminished ability to benefit from repeated exposure to cognitive tasks in people with schizophrenia. Cognitive impairment in schizophrenia may combine with cognitive decline associated with normal aging to reduce practice effects in older patients. These findings have important implications for the design of studies examining the longitudinal trajectory of cognitive functioning across the life span of people with schizophrenia, as well as clinical trials that attempt to demonstrate cognitive enhancement in these individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Impairments and Disordered Speech in Schizophrenia: Thought Disorder, Disorganization, and Communication Failure Perspectives.

This article posits that basic cognitive impairments in schizophrenia are more highly related to speech disorder measured as communication failures than speech disorder measured as thought disorder or disorganization. The author tested 47 schizophrenia patients and 36 control participants for sustained attention, sequencing, and conceptual sequencing ability. Their speech was also rated for communication failures, thought disorder, and conceptual disorganization. Attention and sequencing impairments, examined hierarchically, explained a substantial 38% of the variance in the communication measure of speech disorder but little of the variance in formal thought disorder or conceptual disorganization. The author concludes that (a) impairments in attention and sequencing abilities contribute substantially to schizophrenic communication failures, and (b) it is important to consider lower level cognitive "3rd variables" when examining higher level cognitive associates of speech disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive skill learning and schizophrenia: Implications for cognitive remediation.

The ability to acquire a motor and cognitive skill was investigated in 26 patients with schizophrenia and 26 normal participants using repeated testing on the Tower of Toronto puzzle. Seven patients with defective performance were retested using additional trials and immediate feedback designed to facilitate problem solving. A component analysis of performance was used based on J. R. Anderson's (1987) model of cognitive skill learning. Patients exhibited a performance deficit on both motor and cognitive skills. However, their acquisition rate was similar to that of normal participants on most parameters, indicating that skill learning suffered little or no impairment. Performance deficit was accounted for by poor problem-solving ability, explicit memory, and general intellectual capacities. It was remediable in some, but not all, patients. Remediation failure was also related to severe defects of cognitive functions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Easier tasks can have higher processing loads: Task difficulty and cognitive resource limitations in schizophrenia.

A differential deficit on the more difficult of 2 cognitive tasks has been found in numerous studies of schizophrenia. Resource limitations, rather than impairments in particular cognitive abilities, can explain these findings. Researchers often match tasks for difficulty level (healthy participant performance) to rule out resource limitations. This assumes processing resource load can be estimated from task difficulty, which is not always the case. A direct measure of resource allocation is needed. In this study, pupillary responses were recorded to index resource allocation (greater dilation indicates greater allocation) during performance of the digit span distractibility task in participants with schizophrenia (n = 35) and nonpsychiatric participants (n = 35). Nonpsychiatric participants recalled significantly more digits in the distraction, relative to the neutral, condition but also showed significantly greater pupil dilation in the distraction condition. The psychometrically "easier" condition, therefore, had a higher processing load. Participants with schizophrenia showed greater impairment relative to nonpsychiatric participants in the distraction condition. This finding cannot be attributed to a deficit in distractibility, however, because poorer performance was found in the higher-load condition, so resource limitations cannot be ruled out. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognitive basis of impaired empathy in schizophrenia.

Patients with schizophrenia show impaired emotional and social behavior, such as lack of theory of mind and misinterpretation of social situations. However, there is a paucity of work focusing on the empathic abilities of these patients. The present study was designed to examine the degree of impairment in cognitive and affective empathy in schizophrenia and to evaluate the contribution of executive prefrontal functions to empathy in these patients. To explore the neurocognitive processes that underlie the empathic ability in schizophrenic patients, the relationship between empathy scores and the performance on a cognitive flexibility task that assesses dorsolateral and orbitofrontal functioning (set shifting and reversal, respectively) was examined in 26 patients with schizophrenia and 31 healthy control subjects. Results indicated that patients with schizophrenia were significantly impaired in both cognitive and affective empathy compared with healthy control subjects. The degree of impaired empathy related to the severity of negative symptoms. In addition, patients showed impaired performance on measures of both shifting and reversal. However, while cognitive empathy was particularly related to measurements of orbitofrontal (rather than dorsolateral) functioning, affective empathy was related to measures of social functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines for surgical procedures after liver transplantation

The ability to acquire a motor and cognitive skill was investigated in 26 patients with schizophrenia and 26 normal participants using repeated testing on the Tower of Toronto puzzle. Seven patients with defective performance were retested using additional trials and immediate feedback designed to facilitate problem solving. A component analysis of performance was used based on J. R. Anderson's (1987) model of cognitive skill learning. Patients exhibited a performance deficit on both motor and cognitive skills. However, their acquisition rate was similar to that of normal participants on most parameters, indicating that skill learning suffered little or no impairment. Performance deficit was accounted for by poor problem-solving ability, explicit memory, and general intellectual capacities. It was remediable in some, but not all, patients. Remediation failure was also related to severe defects of cognitive functions.     

Cognitive deficits and psychiatric rehabilitation outcomes in schizophrenia

Many patients with schizophrenia are characterized by cognitive deficits that limit their ability to benefit from psychiatric rehabilitation interventions. While this suggests that cognitive rehabilitation is important, more needs to be known about which cognitive deficits interfere with which aspects of outcome and functioning before effective interventions are developed. We report data on cognitive predictors of three types of outcome: acquisition and performance of skills in a skills training group; aspects of daily ward functioning; and ability to be discharged from a state hospital. Our data indicate that poorer outcomes in each of these areas are associated with different, but somewhat overlapping, profiles of cognitive deficits. These data are relevant for designing both ward-based and individualized interventions. Integrating traditional psychiatric rehabilitation approaches with targeted cognitive interventions is necessary to maximize the impact of psychiatric rehabilitation services on individuals with chronic schizophrenia.     

Heterogeneity of auditory verbal working memory in schizophrenia.

The heterogeneity of schizophrenia remains an obstacle for understanding its pathophysiology. Studies using a tone discrimination screening test to classify patients have found evidence for 2 subgroups having either a specific deficit in verbal working memory (WM) or deficits in both verbal and nonverbal memory. This study aimed to (a) replicate in larger samples differences between these subgroups in auditory verbal WM; (b) evaluate their performance on tests of explicit memory and sustained attention; (c) determine the relation of verbal WM deficits to auditory hallucinations and other symptoms; and (d) examine medication effects. The verbal WM and tone discrimination performance did not differ between medicated (n = 45) and unmedicated (n = 38) patients. Patients with schizophrenia who passed the tone screening test (discriminators; n = 60) were compared with those who did not (nondiscriminators; n = 23) and healthy controls (n = 47). The discriminator subgroup showed poorer verbal WM than did controls and a deficit in verbal but not visual memory on the Wechsler Memory Scale–Revised (Wechsler, 1987), whereas the nondiscriminator subgroup showed overall poorer performance on both verbal and nonverbal tests and a marked deficit in sustained attention. Verbal WM deficits in discriminators were correlated with auditory hallucinations but not with negative symptoms. The results are consistent with a verbal memory deficit in a subgroup of schizophrenia having intact auditory perception, which may stem from dysfunction of language-related cortical regions, and a more generalized cognitive deficit in a subgroup having auditory perceptual and attentional dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-associated losses of brain volume predict longitudinal cognitive declines over 8 to 20 years.

Absolute differences in global brain volume predict differences in cognitive ability among healthy older adults. However, absolute differences confound lifelong differences in brain size with amounts of age-related shrinkage. Measurements of cerebrospinal fluid (CSF) volume were made to estimate age-related shrinkage in 93 healthy volunteers aged 63 to 86 years. Their current levels of brain shrinkage predicted their amounts of decline over the previous 8 to 20 years on repeated assessments during a longitudinal study on the Cattell "Culture Fair" Intelligence Test, on two tests of information processing speed, and marginally on the Wechsler Adult Intelligence Scale (D. Wechsler, 1981), but not on three memory tests. Loss of brain volume is an effective marker both for current cognitive status and for amounts and rates of previous age-related cognitive losses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term stability and intercorrelations of cognitive abilities in older persons.

This project studied the intercorrelations and long-term stabilities of standard Wechsler Adult Intelligence Scale—Revised (WAIS—R), Wechsler Memory Scale—Revised (WMS—R), and Auditory–Verbal Learning Test (AVLT) summary indexes. It also reports similar data on the recently published Mayo Cognitive Factor Scales (MCFS), which are derivative indexes for the combined administrations of these 3 tests. These analyses challenge 2 assumptions that most psychologists make when interpreting adult cognitive tests: (a) that for cognitively normal people, performance in one cognitive domain correlates well with and predicts functioning in other cognitive domains, and (b) that in the absence of pathology, cognition is stable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Context-processing deficits in schizophrenia: Converging evidence from three theoretically motivated cognitive tasks.

To test the hypothesis that the ability to actively represent and maintain context information is a central function of working memory and that a disturbance in this function contributes to cognitive deficits in schizophrenia, the authors modified 3 tasks—the AX version of the Continuous Performance Test Stroop, and a lexical disambiguation task—and administered them to patients with schizophrenia as well as to depressed and healthy controls. The results suggest an accentuation of deficits in patients with schizophrenia in context-sensitive conditions and cross-task correlations of performance in these conditions. However, the results do not definitively eliminate the possibility of a generalized deficit. The significance of these findings is discussed with regard to the specificity of deficits in schizophrenia and the hypothesis concerning the neural and cognitive mechanisms that underlie these deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification of Tone Duration, Line Length, and Letter Position: An Experimental Approach to Timing and Working Memory Deficits in Schizophrenia.

Patients with schizophrenia display numerous cognitive deficits, including problems in working memory, time estimation, and absolute identification of stimuli. Research in these fields has traditionally been conducted independently. We examined these cognitive processes using tasks that are structurally similar and that yield rich error data. Relative to healthy control participants (n = 20), patients with schizophrenia (n = 20) were impaired on a duration identification task and a probed-recall memory task but not on a line-length identification task. These findings do not support the notion of a global impairment in absolute identification in schizophrenia. However, the authors suggest that some aspect of temporal information processing is indeed disturbed in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working Memory Impairments in Schizophrenia: A Meta-Analysis.

Working memory (WM) deficit is a cardinal cognitive symptom of schizophrenia, but the differences among the tasks and measures used to assess WM make it difficult to compare across studies. The authors conducted a meta-analytic review to address 3 major questions: (a) Do patients with schizophrenia show WM deficits across diverse methodology; (b) Is WM deficit supramodal; and (c) Does the WM deficit worsen with longer delays? The results indicate that significant WM deficit was present in schizophrenia patients in all modalities examined. Increasing delay beyond 1 s did not influence the performance difference between schizophrenia patients and healthy control participants in WM. These results suggest that WM deficit in schizophrenia is modality independent and that encoding and/or early part of maintenance may be problematic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A day at the races: A study of IQ, expertise, and cognitive complexity.

30 middle-aged and older men who were avid racetrack patrons were studied and tested over a 3-yr period. 14 were classified as experts and the remaining as nonexperts based on their ability to predict posttime odds on the basis of factual information about horses. The important background characteristics of experts and nonexperts were equivalent. IQ was measured by the Wechsler Adult Intelligence Scale (WAIS). Cognitive complexity was measured by the extent to which Ss used a sophisticated multiplicative model to handicap races, as opposed to a simpler additive model. Ss were asked to handicap 10 actual races and 50 experimenter-contrived races. Analyses revealed that expert handicapping was a cognitively sophisticated enterprise, with experts using a mental model that contained multiple interaction effects and nonlinearity. The findings suggest that (a) IQ is unrelated to skilled performance at the racetrack and (b) IQ is unrelated to real-world forms of cognitive complexity that would appear to conform to some of those that scientists regard as the hallmarks of intelligent behavior. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The paradox of normal neuropsychological function in schizophrenia.

Mounting evidence suggests that compromised neurocognitive function is a core feature of schizophrenia. However, some studies have found neuropsychologically normal schizophrenia patients. To address this apparent contradiction, we blindly rated individual neuropsychological profiles of 75 schizophrenia patients and 91 control participants on the basis of methods developed by L. J. Seidman, S. V. Faraone, W. S. Kremen, J. R. Pepple, M. J. Lyons, and M. T. Tsuang (1993). Almost one-quarter of the patients were classified as neuropsychologically within normal limits (WNL). Despite significantly worse neuropsychological performance, WNL patients had higher estimated premorbid ability than did controls. Compared to a subset of controls matched on overall neuropsychological function, WNL patients had higher estimated premorbid ability and current IQs. Our results favor the view that even neuropsychologically normal schizophrenia patients have compromised cognitive function relative to their presumed expected or premorbid level of intellectual ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intrinsic motivation in schizophrenia: Relationships to cognitive function, depression, anxiety, and personality.

The goal of the current project was to assess subjective reports of intrinsic motivation and their relationship to cognitive function, mood, and personality in schizophrenia. The authors used the Motivational Trait Questionnaire to examine 3 components of intrinsic motivation (personal mastery, competitive excellence, motivation related to anxiety). They also examined fluid intelligence, context processing, and working memory, as well as self-reports of mood and personal traits related to motivation. Participants were 66 individuals with schizophrenia or schizoaffective disorder and 44 healthy controls. Self-reports of personal mastery and competitive excellence did not differ between controls and individuals with schizophrenia, though patients did report significantly higher motivation related to anxiety. Among controls, but not patients, self-reports of intrinsic motivation were strongly related to cognitive performance. In contrast, both controls and patients showed similar strong relationships between self-reports of intrinsic motivation and related measures of mood and personality. These results are not consistent with the hypothesis that motivational deficits in schizophrenia reflect impairments in intrinsic motivation. However, they do suggest that the normal relationship between self-reports of intrinsic motivation and cognitive function is disrupted in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Norms for change in episodic memory as a prerequisite for the diagnosis of mild cognitive impairment (MCI).

The new diagnostic criteria for mild cognitive impairment (MCI) from the International Working Group on Mild Cognitive Impairment (Winblad et al., 2004, p. 243) list “evidence of decline over time in objective cognitive tasks” as one diagnostic sign, implying the repeated neuropsychological testing. This study aimed to compare different assessment methods of longitudinal change based on the performances of 366 cognitively healthy participants (237 men, 129 women) examined with a German version of the California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) at baseline and 2 years later. Age, education, gender, and baseline performance were taken into account. Results revealed marked practice effects after 2 years. Normal ranges for change that controls for practice effects and regression to the mean proved to be superior to other reliable change indexes. This new method allows for more valid interpretation of change in neuropsychological functioning and thus diagnosis of MCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)