No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Global cognitive decline in schizophrenia with remission of symptoms?
Abstract
The relation of symptoms to cognitive dysfunction in schizophrenia is still controversial. This study was aimed (i) at verifying if a homogeneous sample of 10 young treated outpatients in remission from psychotic symptoms displays a characteristic pattern of cognitive dysfunction and (ii) at testing the issue of a general cognitive impairment. The neuropsychological performance of the patients was confronted with a large control group by means of Equivalent Scores, a normative method widely used in Italy, which allows direct, reliable comparison between tests and between patients. We found that our patients, as a group, were affected by a basic activation deficit in attention and by a semantic impairment. These deficits in symptom-free patients could indicate that their brains are in some ways working differently from those of normal controls and that this pattern is not necessarily linked to psychotic symptoms: their neuropsychological impairment might reflect a basic difference in the way of processing information that is always present and is independent of general intellectual decay.
... It is generally assumed that cognitive function is often already below average in premorbid periods (Reichenberg et al., 2006;Woodberry, Giuliano, & Seidman, 2008) and decreases with manifestation of the disease (Bilder et al., 2000;Mesholam-Gately, Giuliano, Goff, Faraone, & Seidman, 2009). The respective deficits continue in patients with chronic schizophrenia, including those in whom symptoms have partially remitted (Barbarotto, Castignoli, Pasetti, & Laiacona, 2001;Heinrichs & Zakzanis, 1998). ...
Chronic schizophrenia involves neuropsychological deficits that primarily strike executive functions and episodic memory. Our study investigated these deficits throughout the lifespan in patients with chronic schizophrenia and in healthy controls. Important neuropsychological functions were tested in 94 patients and 66 healthy controls, who were assigned to three age groups. Compared with the healthy controls, patients performed significantly poorer on all tests applied. Significant age effects occurred on all tests except the digit span forward, with older subjects scoring well below the younger ones. With respect to cognitive flexibility, age effects were more pronounced in the patients. These findings underline the importance of cognitive deficits in chronic schizophrenia and indicate that diminished cognitive flexibility shows age-associated differences.
... Evidence from several avenues of research supports this hypothesis. Neuropsychological impairments emerge years before expression of psychotic symptoms (Hoff et al. 1999;Reichenbert et al. 2002), are considerably developed upon first psychiatric contact (Bilder et al. 2000;Saykin et al. 1994), persist upon remission of psychotic symptoms, and remain relatively stable over time (Barbarotto et al. 2001;Friedman et al. 2001;Martinez-Aran et al. 2002), are evident to a similar, yet mild, degree in non-psychotic siblings (Cannon et al. 1994;Goldberg et al. 1990;Goldberg et al. 1994), do not respond markedly to typical or atypical antipsychotic medication (Mishara and Goldberg 2004), and are related to functional outcome (Green 1996). ...
... The study of chronic patients with psychosis implies the presence of confounding variables in the interpretation of results, such as treatment and symptoms' effects. However, cognitive deficits are considered core manifestations of psychosis and are not related to pharmacological treatment [70,71]. Research has reported a moderate and nonspecific relationship between treatment and cognition [72][73][74]. ...
Working memory deficits are considered nuclear deficits in psychotic disorders. However, research has not found a generalized impairment in all of the components of working memory. We aimed to assess the components of the Baddeley and Hitch working memory model: the temporary systems-the phonological loop, the visuospatial sketchpad and the episodic buffer (introduced later by Baddeley)-and the central executive system, which includes four executive functions: divided attention, updating, shifting and inhibition. We assessed working memory performance in a sample of 21 patients with a psychotic disorder and 21 healthy controls. Patients also underwent a clinical assessment. Both univariate and repeated measures ANOVAs were applied to analyze performance in the working memory components between groups. Patients with a psychotic disorder underperformed compared to the controls in all of the working memory tasks, but after controlling for age and premorbid IQ, we only found a difference in performance in the N-Back task. Repeated measures ANCOVAs showed that patients also underperformed compared to the controls in the Digit span test and the TMT task. Not all of the components of working memory were impaired in the patients. Specifically, patients' performance was impaired in the tasks selected to assess the phonological loop and the shifting executive function. Patients' also showed worse performance than controls in the N-Back task, representative of the updating executive function. However, we did not find higher impairment in the patients' performance respect to controls when increasing the loading of the task.
Copyright © 2015. Published by Elsevier Inc.
... Evidence from several avenues of research supports this hypothesis. Neuropsychological impairments emerge years before expression of psychotic symptoms (Hoff et al. 1999; Reichenbert et al. 2002), are considerably developed upon first psychiatric contact (Bilder et al. 2000; Saykin et al. 1994), persist upon remission of psychotic symptoms, and remain relatively stable over time (Barbarotto et al. 2001; Friedman et al. 2001; Martinez-Aran et al. 2002), are evident to a similar, yet mild, degree in non-psychotic siblings (Cannon et al. 1994; Goldberg et al. 1990; Goldberg et al. 1994), do not respond markedly to typical or atypical antipsychotic medication (Mishara and Goldberg 2004), and are related to functional outcome (Green 1996). ...
There is substantial evidence that individuals with schizophrenia are at increased risk for violent criminal behavior and an even higher risk for committing murder, relative to the general population. Neuropsychological features of seven schizophrenic men who murdered family members were compared to neuropsychological features of seven schizophrenic men with no history of violence, criminal offenses or antisocial behavior. The two groups were matched for age, education, race, gender, handedness, and diagnosis, and had similar psychotic symptom profiles and substance abuse histories. The schizophrenic murderers demonstrated significantly worse neuropsychological impairment, involving executive dysfunction and memory dysfunction, relative to nonviolent schizophrenic men. Implications include: (1) specific neuropsychological deficits may increase the likelihood of some schizophrenic men to murder family members due to an impaired capacity to inhibit impulsive violent aggression; (2) neuropsychological status of schizophrenic defendants who commit domestic homicide should be considered by the trier-of-fact when they are tried for murder.
... Ainsi, plusieurs équipes se sont intéressées à la rémission dans la schizophrénie, mettant en évidence la persistance de troubles cognitifs lors de cette phase. ( Barbarotto et al., 2001) ont montré que les schizophrènes en rémission présentaient des troubles de l'attention et des difficultés dans les épreuves de fluence verbale sémantique et de dénomination d'objets. ( Park et al., 2002) ont également mis en évidence un déficit significatif chez 28 patients schizophrènes en rémission par rapport à des témoins sains, lors d'une épreuve de mémoire de travail utilisant des formes visuelles abstraites. ...
We have compared 15 remitted schizophrenic patient’s results to 15 patients in acute phase thanks to the Rorschach (Comprehensive system). Our aim was to detect constant cognitive impairments and troubles, which got better during a three months’ period of remission. Remitted patients showed improvement in their social life and a greater flexibility in their cognitive functions. Nevertheless numerous cognitive impairments were persistent, as mediation’s deficits, tendency to avoid stimuli and very negative self-esteem. This study emphasizes the importance to continue medical and psychological cares during remission in schizophrenia.
... Research has shown differential EEG, backward masking, attention, executive function, and verbal memory performance between positive and negative symptom schizophrenia patients (Berman et al., 1997;Collins et al., 1997;Gruzelier et al., 1993;Liu et al., 1997;Merrin and Floyd, 1996;Schuepbach et al., 2002;Slaughuis and Curran, 1999;Zakzanis, 1998). Not all investigations, however, report such unambiguous relationships between symptoms and neurocognitive function (Barbarotto et al., 2000;Nieuwenstein et al., 2001). These results indicate that symptoms of schizophrenia and neuropsychological performance may reflect a multi-dimensional disorder (Zakzanis, 1998). ...
Persons with schizophrenia and schizoaffective disorder exhibit deficits in both visual processing and neuropsychological tasks. Little is known, however, about whether these deficits are related to one another. We administered psychophysical tests of visual discrimination and recognition, and neuropsychological tests of abstract flexibility, verbal learning, visual memory, working memory and attention to 42 outpatients with stable but chronic schizophrenia or schizoaffective disorder. Multiple regression analyses were performed to determine the relationship between these measures of neuropsychological function and visual psychophysical performance. Results indicated that motion perception was associated with working memory, and that the addition of a memory component to motion perception (motion recognition) was associated with both working memory and visual memory. Visual performance was not associated with symptom severity as measured by the PANSS. These results suggest that psychophysical tests of visual processing may contribute to deficits on neuropsychological tests of visual cognition, and may also reflect cross-modal disturbances of working memory function.
... Finally, we did not measure cognition in this study. Cognitive functioning has been found to be improved in people with schizophrenia who are considered to be in full recovery Robinson, et al., 2004); however, its relationship to remission criteria is not yet clarified (Auslander and Jeste, 2004;Liberman and Kopelowicz, 2005;Emsley, et al., 2007;Barbarotto, et al., 2001;Gold et al., 2002;Smith, et al., 2002;Harvey, et al., 2007;. ...
The concepts of partial recovery and remission have become increasingly important for the evaluation of the effectiveness of schizophrenia therapeutics. The relationship of baseline symptoms and changes in symptoms to remission of psychosis was evaluated. Fifty-six outpatients with residual schizophrenia completed a double-blind trial of olanzapine versus haloperidol and were then enrolled into a one-year open-label trial of olanzapine. Out of these 56 subjects, 13 (23%) met remission criteria at the beginning of the open-label treatment and were excluded. During the one-year study, 7/43 (16%) subjects met remission criteria. These subjects had significantly lower baseline ratings for tardive dyskinesia (TD) than subjects who did not achieve remission (1.8 +/- 1.5 vs. 4.2 +/- 4.6, P = 0.03). As expected, remitted subjects had significantly greater improvements in Brief Psychiatric Rating Scale total scores, positive subscale scores and scale for the Assessment of Negative Symptoms total scores. Remitted subjects also experienced a significantly greater improvement in depressive symptoms (P = 0.001), activation (P = 0.005), and Clinical Global Impressions scores (P < 0.001), as well as greater improvements in extrapyramidal symptoms (P = 0.007) and TD (P < 0.001). These results suggest that the relationship of depressive symptoms and improved side effects to the construct of remission in schizophrenia may deserve special attention. Future studies should aim to relate remission criteria to functional outcomes, cognition, and other important symptom domains.
This article clarifies about the role of cognitive functioning in treating clients with schizophrenia. Also it touches upon the need for CBT and cognitive retraining among these population
Until recently, the dominant view was that schizophrenia patients have limited, if any, neuropsychological impairments, and those that are observed are only secondary to the florid symptoms of the disorder. This view has dramatically changed. This review integrates recent evidence demonstrating the severity and profile of neuropsychological impairments in schizophrenia. We present quantitative evaluation of the literature demonstrating that the most severe impairments are apparent in episodic memory and executive control processes, evident on a background of a generalized cognitive deficit. The neuropsychological impairments potentially represent genetic liability to the disorder, as similar, yet milder, impairments are evident in schizophrenia patients even before the onset of psychotic symptoms, as well as in the nonpsychotic relatives of schizophrenia patients. Corresponding cognitive neuroimaging literature on executive functions, episodic memory, and working memory in schizophrenia documenting abnormalities in frontal and medial temporal lobes is summarized, and current models integrating neuropsychological and neuroimaging data are discussed.
This article discusses some problems arising from the use in diagnostics of psychometric test scores previously adjusted for the influence of age and of other concomitant variables (e.g., education). Some solutions adopted by an Italian Cooperative Study on the neuropsychological aspects of aging are reported, and the limits of the statistical processing of adjusted test scores are discussed.
reviews recent theory and data on language, memory, and aging [in older adults] while attempting to avoid overlap with other recent reviews / findings in 4 broad and seemingly disparate categories are reviewed: language production, direct vs indirect tests of memory, language comprehension, and encoding under time pressure / across the 4 areas emerge 3 closely interrelated themes or hypotheses: the language-memory hypothesis, the new-vs-old connection hypothesis, and the distributed defect hypothesis / outline these hypotheses and then show how they stem from data in each of the 4 categories (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A model is proposed for integrating the neural and cognitive aspects of the positive symptoms of acute schizophrenia, using evidence from postmortem neuropathology and neurochemistry, clinical and preclinical studies of dopaminergic neurotransmission, anatomical connections between the limbic system and basal ganglia, attentional and other cognitive abnormalities underlying the positive symptoms of schizophrenia, specific animal models of some of these abnormalities, and previous attempts to model the cognitive functions of the septohippocampal system and the motor functions of the basal ganglia. Anatomically, the model emphasises the projections from the septohippocampal system, via the subiculum, and the amygdala to nucleus accumbens, and their interaction with the ascending dopaminergic projection to the accumbens. Psychologically, the model emphasises a failure in acute schizophrenia to integrate stored memories of past regularities of perceptual input with ongoing motor programs in the control of current perception. A number of recent experiments that offer support for the model are briefly described, including anatomical studies of limbic-striatal connections, studies in the rat of the effects of damage to these connections, and of the effects of amphetamine and neuroleptics, on the partial reinforcement extinction effect, latent inhibition and the Kamin blocking effect; and studies of the latter two phenomena in acute and chronic schizophrenics.
Norms are provided for verbal and visuo-spatial immediate memory span, two tasks widely used in the clinical assessment of short-term memory and its neurological disorders. Data have been collected from 1355 male and female adult subjects, with various educational backgrounds and a 20-99 years age range. Span shows a major decrement after the late sixties and is affected by educational level. Male subjects score better on the spatial task. Data collected from 1112 male and female children, 4-to-10 year-old, show that span increases with age and boys score better on the spatial test.
The use of Raven's Coloured Progressive Matrices (PM 47) in experiments with brain-damaged patients is briefly reviewed. Because norms for adults are still not available, normative data were calculated on 305 normals; corrections for age and education and centile allocation of the scores are furnished.
Equivalent Scores (ES; Capitani & Laiacona, 1988) is a 5-point scale that offers a solution to the problem of standardizing neuropsychological scores after adjustment for age and education, given that the common z-standardization is not generally applicable in these cases. ES are discussed, and their properties and limits are compared with those of z-standardization. In a battery of ES-standardized tests, the average ES (AES) for the whole battery can provide a measure of the overall cognitive level, free of the influence of age and education. We report empirical data from a battery composed of 10 ES-standardized tests, in order to discuss general properties of ES standardization. The expected mean of the AES is constant, regardless of the number or type of tests included. The standard deviation of the AES, however, is variable: it decreases in proportion to the number of tests, but increases in proportion to their intercorrelation. We provide general indications concerning the normality threshold, which are applicable to all batteries of ES-standardized tests regardless of the number and type.
Recent studies suggest that gender influences phonetically-cued fluency and some semantic memory tasks. In this study we analysed the effect of demographic variables on semantic fluency tasks. The semantic categories considered were: animals, fruits, tools and vehicles. The influence of age and education was common to all the categories considered and seems a general characteristic of the semantic fluency task. Gender had a significant effect only with fruits and tools, but a diverging role: females fared better with fruits and males with tools. We discuss whether the source of the gender effect should be located at the level of the semantic representation of each category or at the level of item recall in the short time (one minute) granted for the task.
Two-hundred and nine normal subjects underwent a study aimed at providing norms for some attention tests currently used in neuropsychological examination. Norms were calculated taking into account the demographic variables. Our battery included single visuo-manual and go/no-go reaction times, and two versions of the Stroop Colour-Word Test. For the latter test, we employed a traditional version based on card presentation and a new version based on computer-assisted presentation. We evaluated the intercorrelation of the different tests, and studied the statistical regression models in order to adjust the original scores according to age, education and gender. Normative values were calculated following the Equivalent Scores method. The pattern of intercorrelation of our battery and the regression models of the scores are discussed with reference to the literature. The newly developed computer-assisted presentation of the Stroop test offers some advantages over the traditional version, especially with patients affected by spatial disorders.
Synopsis
The aim of the study is to provide (i) a standardized procedure for a Cancellation Test of Digits, designed to assess in the visual modality selective attention deficits in patients with Alzheimer's disease, and (ii) a detailed analysis of how patients cope with it.
Age-, education-, and sex-adjusted normative scores earned by 352 healthy controls are set forth, as well as data yielded by the Digit Cancellation Test in 74 Alzheimer patients, in 26 patients with a CT-assessed frontal lobe lesion and in a group of 24 healthy subjects urged to perform the task with a shortened time-constraint. Findings include discriminant power of Alzheimer patients versus healthy controls, sensitivity to cognitive evolution of the dementing process and analysis of errors. Attention data failed to supply psychometric support for the posterior-to-anterior algorithm of progressive cortical encroachment of Alzheimer's disease suggested by PET-findings.
Emphasis is put on methodological aspects of neuropsychological research on Alzheimer patients and on the analysis of processing components of the tests employed. Results are discussed in the light of the relationships between psychometric assessments and related functions, and underlying neuronal degeneration.
The issue of progressive cognitive decline in patients with schizophrenia has been debated. We performed a cross-sectional study of patients with chronic schizophrenia, aged from 18 to 69 years, in order to address this issue. The patients included in this study passed a rigorous screen for any comorbid condition with an adverse impact on central nervous system function. We assessed intellectual deterioration with a battery of neuropsychological tests known to be sensitive to cognitive impairment in progressive dementia. No evidence of accelerated intellectual decline was found. No significant differences were found between the five age-derived cohorts (18-29, 30-39, 40-49, 50-59, and 60-69 years of age) on the Mini-Mental State Examination, Dementia Rating Scale, or other tests sensitive to dementia. While performance on the Boston Naming Test significantly declined with age, this was mainly due to age rather than duration of illness. However, it is important to note that mean performances on the majority of the tests were abnormal across all cohorts studied. These results suggest that intellectual function does not markedly decline during the adulthood of patients with schizophrenia. The course of schizophrenia is more consistent with a static encephalopathy than a dementing disorder.
We sought to determine whether neuropsychological impairment in schizophrenia is related to current age, age at onset, or duration of illness, and whether the pattern of such impairment can be distinguished from that caused by progressive dementias of Alzheimer's type. We administered a comprehensive neuropsychological test battery to a normal control group (n = 38), a group of ambulatory patients with Alzheimer's disease (n = 42), and three ambulatory schizophrenic groups: early onset-young (n = 85), early onset-old (n = 35), and late onset (n = 22). Tests were grouped and analyzed according to eight major ability areas, and published procedures were used to remove the expected effects of normal aging.
The three schizophrenic groups were found to be neuropsychologically similar to one another and different from normal controls and patients with Alzheimer's disease. There were no significant differences among the schizophrenic groups in level or pattern of neuropsychological functioning. Patients with Alzheimer's disease demonstrated less efficient learning and particularly more rapid forgetting than did the other groups.
These findings suggest that neuropsychological impairment in schizophrenia is unrelated to current age, age at onset, or duration of illness. The study further suggests that the encephalopathy associated with schizophrenia is essentially nonprogressive and produces a pattern of deficits that is different from that seen in progressive cortical dementias.
Five-hundred and three normal subjects were given a phonetically cued word-fluency task in order to investigate the controversial issue of the influence of gender and aging on this task. Subjects were requested to say in one minute all the words that occurred to them, beginning with a given letter (F, P and L). Besides the expected significance of education, we observed a female advantage, but not a significant decline in the performance with aging. However, the slope of the line expressing word fluency as a function of age was different between females and males, indicating a greater sensitivity to aging for males. We provide inner and outer tolerance limits for this test in the normal population and give a formula useful for adjusting the raw scores on the basis of gender and education. The results are discussed with reference to previous findings and some hypotheses about the origins of the female advantage in PWF.
Neurobiological foundations of human memory Handbook of memory disorders (pp. 27-50) The role of working memory in language and communication disorders
- D Tranel
- A R Damasio
Tranel, D., & Damasio, A. R. (1995). Neurobiological foundations of human memory. In A. D. Baddeley, B. A. Wilson, & F. N. Watts (Eds.), Handbook of memory disorders (pp. 27-50). New York: Wiley. Van der Linden, M., & Poncelet, M. (1998). The role of working memory in language and communication disorders. In B. Stemmer & H. A. Whitaker (Eds.), Handbook of neurolinguistics (pp. 289-300).
American Journal qfSpeech-Language Pathology
- L L Murray
- J C Stout
Murray, L. L., & Stout, J. C. (1999). American Journal qfSpeech-Language Pathology, 8, 137-146.
Human brain Junctions
- R S J Frackowiak
- K J Friston
- C D Frith
- R J Dolan
- J C Mazziotta
Frackowiak, R. S. J., Friston, K. J., Frith, C. D., Dolan, R. J., & Mazziotta, J. C. (1997). Human brain Junctions. San Diego: Academic Press.
The neuropsychology of schizophrenia.
- Gray