Interactive effect of apolipoprotein e genotype and age on hippocampal activation during memory processing in healthy adults

CONTEXT

Although the apolipoprotein E (APOE) ϵ4 allele is a major genetic risk factor for late-onset Alzheimer disease, its effect on hippocampal function during episodic memory is controversial because studies have yielded mixed results. The age of the studied cohorts may contribute to this apparent inconsistency: activation for ϵ4 carriers tends to be increased in studies of older adults but decreased in some studies of younger adults. Consistent with differential age effects, research in transgenic mice suggests that the ϵ4 allele may particularly affect the aging process.

OBJECTIVE

To define the interactions of age and this allelic variation on brain activation during episodic memory across adult life in healthy individuals.

DESIGN

Functional magnetic resonance imaging (fMRI) using an episodic memory paradigm to test for differences in neuroactivation across APOE genotypes and age groups.

SETTING

A federal research institute.

PARTICIPANTS

Healthy white volunteers (APOE ϵ3 homozygotes and ϵ2 and ϵ4 heterozygotes) completed the fMRI task (133 volunteers aged 19-77 years).

MAIN OUTCOME MEASURE

Memory-related regional blood oxygenation level-dependent (BOLD) activation.

RESULTS

Genotype affected the pattern of change in hippocampal BOLD activation across the adult lifespan: older age was associated with decreased activation in ϵ2 carriers and, to a lesser extent, in ϵ3 homozygotes, but this pattern was not observed in ϵ4 carriers. Among young participants, ϵ4 carriers had less hippocampal activation compared with ϵ3 homozygotes despite similar task performance.

CONCLUSIONS

The findings support the hypothesis that aging and APOE allele status have interacting effects on the neural substrate of episodic memory and lend clarification to disparities in the literature. The stepwise decrease in activation with age found among genotype groups resembles the order of susceptibility to Alzheimer disease, suggesting a compensatory neurobiological mechanism in older asymptomatic ϵ4 carriers.

The neuromagnetic dynamics of time perception

Examining real-time cortical dynamics is crucial for understanding time perception. Using magnetoencephalography we studied auditory duration discrimination of short (<.5 s) versus long tones (>.5 s) versus a pitch control. Time-frequency analysis of event-related fields showed widespread beta-band (13–30 Hz) desynchronization during all tone presentations. Synthetic aperture magnetometry indicated automatic primarily sensorimotor responses in short and pitch conditions, with activation specific to timing in bilateral inferior frontal gyrus. In the long condition, a right lateralized network was active, including lateral prefrontal cortices, inferior frontal gyrus, supramarginal gyrus and secondary auditory areas. Activation in this network peaked just after attention to tone duration was no longer necessary, suggesting a role in sustaining representation of the interval. These data expand our understanding of time perception by revealing its complex cortical spatiotemporal signature.

Metaphor interpretation and use: a window into semantics in schizophrenia

The nature of putative semantic anomalies in schizophrenia is controversial. Metaphor interpretation and use provide a useful methodology with which to probe semantics since metaphors are critical in reasoning processes and in how conceptual knowledge is organized. The first study examined free speech for figurative language. The second study explored whether emotional versus non-emotional metaphorical language interpretation elicits differences in the tendencies to produce idiosyncratic (bizarre) or literal interpretations or use of other metaphors to describe the meaning of a metaphor. The third study examined the interpretation of time metaphors. We expected the time perspective in ambiguous sentences to be differentially influenced by previously presented unambiguous sentences of a specific perspective, either events moving relative to a stationary observer (moving-time) or an observer moving relative to a stationary event (moving-ego). First, we found that patients used a similar amount of figurative language as control participants. Second, we did not find any difference between the groups in terms of idiosyncratic interpretations, although patients did interpret more metaphors literally and controls utilized more figurative language. Third, we did not find evidence of a difference between the groups in terms of time perspectives influencing ambiguous target sentences differentially. As operationalized here, the interpretation and use of metaphors is similar in patients with schizophrenia to that of healthy control participants. To the extent that metaphors recruit semantic processes this area of cognition is generally intact in schizophrenia.

Cognitive factor structure and invariance in people with schizophrenia, their unaffected siblings, and controls

INTRODUCTION

Separable, but positively correlated, factors emerge from analyses of cognitive test data in schizophrenia and control samples (eg, verbal memory and processing speed) and these factors guide data reduction. Additionally, data support a hierarchical model of cognitive performance, in which these correlations reflect the influence of a higher-order factor, referred to as "g." We tested these findings in large, carefully screened samples of people with schizophrenia (n = 496), their unaffected siblings (n = 504), and controls (n = 823). Furthermore, we tested the hypothesis that cognitive performance in schizophrenia is more generalized across domains than among siblings and controls.

METHOD

A combination of exploratory and confirmatory factor analyses (EFA and CFA) and multiple groups CFA (MCFA) was used.

RESULTS

EFA yielded factors for verbal memory, visual memory, processing speed, working memory span, nback performance, and card sorting. The solution was consistent across groups, in terms of the factor assignments of individual cognitive variables and the magnitude of loadings. Method variance may have contributed to the card sorting, visual memory, and nback factors. CFA indicated that the hierarchical model, incorporating a "g" factor, was a good fit for data from all groups. MCFA suggested that this hierarchical structure was fully invariant for controls and siblings. While the variable/factor loadings for the schizophrenia group also were invariant with comparison groups, factor/"g" loadings were higher in schizophrenia, as were correlations among factor-based composite scores.

CONCLUSIONS

Cognitive variables sort into domains consistently in schizophrenia, unaffected siblings, and controls. However, performance in schizophrenia is more generalized and less domain specific.

Detecting order-disorder transitions in discourse: implications for schizophrenia

Several psychiatric and neurological conditions affect the semantic organization and content of a patient's speech. Specifically, the discourse of patients with schizophrenia is frequently characterized as lacking coherence. The evaluation of disturbances in discourse is often used in diagnosis and in assessing treatment efficacy, and is an important factor in prognosis. Measuring these deviations, such as "loss of meaning" and incoherence, is difficult and requires substantial human effort. Computational procedures can be employed to characterize the nature of the anomalies in discourse. We present a set of new tools derived from network theory and information science that may assist in empirical and clinical studies of communication patterns in patients, and provide the foundation for future automatic procedures. First we review information science and complex network approaches to measuring semantic coherence, and then we introduce a representation of discourse that allows for the computation of measures of disorganization. Finally we apply these tools to speech transcriptions from patients and a healthy participant, illustrating the implications and potential of this novel framework.

Meaningful confusions and confusing meanings in communication in schizophrenia

Unconventional discourse in schizophrenia has been speculated to be attributable to the mixing up of symbols and signs. We illustrate how a series of scientific images, cartoons, and prose are used by a patient to weave disparate-and objectively unrelated-concepts. The resulting prose is incoherent science.

Data-driven methodology illustrating mechanisms underlying word list recall: applications to clinical research

OBJECTIVE

Word list learning tasks such as the California Verbal Learning Test (CVLT; Delis, Kramer, Kaplan, & Ober, 1987) are widely used to investigate recall strategies. Participants who recall the most words generally employ semantic techniques, whereas those with poor recall (e.g., patients with schizophrenia) rely on serial techniques. However, these conclusions are based on formulas that assume that categories reflect semantic associations, bind strategy to overall performance, and neglect strategy changes over 5 trials. Therefore, we derived novel measures-independent of recall performance-to compute strategies across trials and identify whether diagnosis predicts recall strategy.

METHOD

Participants were included on the basis of performance on the CVLT (i.e., total words recalled over 5 trials). The 50 highest and 50 lowest performers among healthy volunteers (n = 100) and patients with schizophrenia (n = 100) were selected. Novel measures of recall and transition probability were calculated and analyzed by permutation tests.

RESULTS

Recall patterns and strategies of patients resembled those of controls with similar performance levels: Regardless of diagnosis, low performers were more likely to recall the first 2 and last 4 items from the list; high performers increased engagement of semantically based transitions across the 5 trials, whereas low performers did not.

CONCLUSIONS

Cognitive strategy must be considered independent of overall performance before attributing poor performance to degraded learning processes. Our results demonstrate the importance of departing from global scoring techniques, especially when working with clinical populations such as patients with schizophrenia for whom episodic memory deficits are a hallmark feature.

COMT Val158Met polymorphism, cognitive stability and cognitive flexibility: an experimental examination

Background

Dopamine in prefrontal cortex (PFC) modulates core cognitive processes, notably working memory and executive control. Dopamine regulating genes and polymorphisms affecting PFC - including Catechol-O-Methyltransferase (COMT) Val158Met - are crucial to understanding the molecular genetics of cognitive function and dysfunction. A mechanistic account of the COMT Val158Met effect associates the Met allele with increased tonic dopamine transmission underlying maintenance of relevant information, and the Val allele with increased phasic dopamine transmission underlying the flexibility of updating new information. Thus, consistent with some earlier work, we predicted that Val carriers would display poorer performance when the maintenance component was taxed, while Met carriers would be less efficient when rapid updating was required.

Methods

Using a Stroop task that manipulated level of required cognitive stability and flexibility, we examined reaction time performance of patients with schizophrenia (n = 67) and healthy controls (n = 186) genotyped for the Val/Met variation.

Results

In both groups we found a Met advantage for tasks requiring cognitive stability, but no COMT effect when a moderate level of cognitive flexibility was required, or when a conflict cost measure was calculated.

Conclusions

Our results do not support a simple stability/flexibility model of dopamine COMT Val/Met effects and suggest a somewhat different conceptualization and experimental operationalization of these cognitive components.

Handedness, heritability, neurocognition and brain asymmetry in schizophrenia

Higher rates of non-right-handedness (i.e. left- and mixed-handedness) have been reported in schizophrenia and have been a centrepiece for theories of anomalous lateralization in this disorder. We investigated whether non-right-handedness is (i) more prevalent in patients as compared with unaffected siblings and healthy unrelated control participants; (ii) familial; (iii) associated with disproportionately poorer neurocognition; and (iv) associated with grey matter volume asymmetries. We examined 1445 participants (375 patients with schizophrenia, 502 unaffected siblings and 568 unrelated controls) using the Edinburgh Handedness Inventory, a battery of neuropsychological tasks and structural magnetic resonance imaging data. Patients displayed a leftward shift in Edinburgh Handedness Inventory laterality quotient scores as compared with both their unaffected siblings and unrelated controls, but this finding disappeared when sex was added to the model. Moreover, there was no evidence of increased familial risk for non-right-handedness. Non-right-handedness was not associated with disproportionate neurocognitive disadvantage or with grey matter volume asymmetries in the frontal pole, lateral occipital pole or temporal pole. Non-right-handedness was associated with a significant reduction in left asymmetry in the superior temporal gyrus in both patients and controls. Our data neither provide strong support for 'atypical' handedness as a schizophrenia risk-associated heritable phenotype nor that it is associated with poorer neurocognition or anomalous cerebral asymmetries.

Cognitive differences between men and women: a comparison of patients with schizophrenia and healthy volunteers

Gender modulates cognition such that women display advantages in certain domains while men excel in others tasks. Similar patterns have been seen in patients with schizophrenia. We derived six cognitive factor domain scores from a cognitive battery and examined gender-based cognitive differences in patients with schizophrenia and controls. There were strikingly different effects of gender in patients as compared to controls. The large sample size and broad range of tests in our study add important findings to the neuropsychological literature of schizophrenia, which serve to reinforce some aspects of past research on gender differences in cognition, while questioning others.

Where have all the women gone?: participant gender in epidemiological and non-epidemiological research of schizophrenia

Though archival literature states that schizophrenia occurs equally in males and in females, recent epidemiological studies report higher incidence of schizophrenia in men than in women. Moreover, there is longstanding evidence that women may be under-represented in non-epidemiological research literature. Our first goal was to quantify gender ratios in non-epidemiological research published in 2006. Secondly, we sought to investigate which factors contribute to high numbers of men in research studies. Our final goal was to compare gender ratios in non-epidemiological schizophrenia research to reported incidence rates. In a recent meta-analysis of incidence, there were 1.4 males for each female with schizophrenia. In non-epidemiological studies of the schizophrenia patients, there was an average of 1.94 men for every woman. Although the degree to which men outnumbered women varied according to study type and region of study, research studies included more men than women across all investigated variables. Either the incidence rates are higher for men than has previously been reported or women are less visible in research settings than in the greater community. Importantly, the discrepancy between gender ratios in epidemiological and non-epidemiological research is consistent. However, specific, identifiable factors are present when male participants are greatest, suggesting that many research environments yield a higher number of men. Thus much of our understanding of the illness and its treatment is based on research conducted disproportionately with men.

An automated method to analyze language use in patients with schizophrenia and their first-degree relatives

Communication disturbances are prevalent in schizophrenia, and since it is a heritable illness these are likely present - albeit in a muted form - in the relatives of patients. Given the time-consuming, and often subjective nature of discourse analysis, these deviances are frequently not assayed in large scale studies. Recent work in computational linguistics and statistical-based semantic analysis has shown the potential and power of automated analysis of communication. We present an automated and objective approach to modeling discourse that detects very subtle deviations between probands, their first-degree relatives and unrelated healthy controls. Although these findings should be regarded as preliminary due to the limitations of the data at our disposal, we present a brief analysis of the models that best differentiate these groups in order to illustrate the utility of the method for future explorations of how language components are differentially affected by familial and illness related issues.

Random texts do not exhibit the real Zipf's law-like rank distribution

Background

Zipf's law states that the relationship between the frequency of a word in a text and its rank (the most frequent word has rank , the 2nd most frequent word has rank ,…) is approximately linear when plotted on a double logarithmic scale. It has been argued that the law is not a relevant or useful property of language because simple random texts - constructed by concatenating random characters including blanks behaving as word delimiters - exhibit a Zipf's law-like word rank distribution.

Methodology/Principal Findings

In this article, we examine the flaws of such putative good fits of random texts. We demonstrate - by means of three different statistical tests - that ranks derived from random texts and ranks derived from real texts are statistically inconsistent with the parameters employed to argue for such a good fit, even when the parameters are inferred from the target real text. Our findings are valid for both the simplest random texts composed of equally likely characters as well as more elaborate and realistic versions where character probabilities are borrowed from a real text.

Conclusions/Significance

The good fit of random texts to real Zipf's law-like rank distributions has not yet been established. Therefore, we suggest that Zipf's law might in fact be a fundamental law in natural languages.

Perception of self and other in psychosis: a method for analyzing the structure of the phenomenology

Although the phenomenology accompanying psychoses is fascinating, hitherto empirical examinations have been qualitative and thus limited in their clinical conclusions regarding the actual underlying cognitive mechanisms responsible for the formation and maintenance of the delusion, which is often distressing to the patient. We investigated the internal cognitive structure (i.e., connections) of some delusions pertaining to self and others in a patient with psychosis who was very fluent and thus able to provide a lucid account of his phenomenological experiences. To this end we employed a clustering method (HICLAS disjunctive model) in conjunction with standard neuropsychological tests. A well-fitting, but parsimonious solution revealed the absence of unique feature sets associated with certain persons, findings that provide a compelling case underlying the confusion in certain instances between real and delusional people. We illustrate the methodology in one patient and suggest that it is sensitive enough to explore the structure of delusions, which in conjunction with standard neuropsychological and clinical assessments promises to be useful in uncovering the mechanisms underlying delusions in psychosis.

Introduction: genes, cognition and neuropsychiatry

Numerous genes modulate dopamine and consequently prefrontal cortical function. Some of these genes - notably catechol-O-methyltransferase - have been shown to impact a variety of core cognitive processes that are dependent upon the prefrontal cortex. This demonstration that a single functional polymorphism can contribute so dramatically to individual differences heralds a new era for neuropsychiatry. Although enormous detail remains to be discovered about these various genes that regulate neurotransmitters, how they interact and how they affect brain systems, there is much excitement and promise regarding new neuropsychopharmacological possibilities. However, this new research program is magnitudes more complex than any enterprise embarked on hitherto and requires the development, validation and deployment of novel behavioural and neurophysiological phenotypes in order to unravel the pathologies within neural functional systems. This research foundation is essential if these genetic breakthroughs are to be translated to successful clinical agents.

Genes, cognition and brain through a COMT lens

Various genes are known to modulate the delicate balance of dopamine in prefrontal cortex and influence cortical information processing. Catechol-O-methyltransferase (COMT) on chromosome 22q11 is the most widely studied of these genes. Val158Met, a common, functional variant in the coding sequence that increases or decreases the enzymatic activity of the gene has been shown to impact the efficiency of prefrontally-mediated cognition, specifically executive functioning, working memory, fluid intelligence and attentional control. We review the rapidly evolving literature exploring the association between COMT genotype and cognitive performance, and illustrate how this polymorphism has served a pivotal role in characterizing various interacting dimensions of complexity in the relationship between genes and cognition. We review how Val158Met has been used to help develop and validate behavioral and neurophysiological phenotypes, as a critical tool in dissecting overlapping neural functional systems and exploring interactions within and between genes, and in exploring how gene effects on cognition are modulated by environmental, demographic and developmental factors. Despite the impressive range of findings, the COMT story is also a bracing reminder of how much work remains to translate this knowledge into practical clinical applications.

Exaggerations in consultations between psychiatrists and patients suffering from psychotic disorders

We present and discuss instances of exaggeration in consultations between psychiatrists and patients suffering from psychotic disorders. Drawing on a corpus of 15 consultations as well as on instances of exaggeration from non-clinical talk, we discuss how the use of exaggerations in psychiatric interactions differs from the use of exaggerations in everyday conversations. In some interactions involving patients suffering from psychotic disorders, the exaggerations are handled differently from everyday conversations--especially in terms of how the interactants respond to the exaggerations. When an excessive exaggeration is used in an everyday conversation, the interactant typically responds by signalling an understanding of the prior utterance as hyperbolic, for instance by laughing. In contrast, a strategy often chosen by the psychiatrists is to not confirm or challenge the factual content of the exaggeration, but rather to avoid alignment and to change the topic. This strategy appears to be selected when the exaggeration is more exact and less typically hyperbolic in design. While the strategies used to respond to exaggerations in everyday conversations suggest that the interactants understand these exaggerations as figures of speech, the psychiatrists' responses suggest that they think the patients actually believe in the content of the exaggerations.

Context binding in schizophrenia: effects of clinical symptomatology and item content

Impairments in source monitoring have been widely reported in schizophrenia, with patients typically misattributing self-generated items to external sources. Some studies have reported that patients with more severe positive symptoms (notably hallucinations) exhibit a greater impairment on these tasks, although findings are not uniformly positive. The emotional content of the items to be remembered also may affect subsequent retrieval, with some studies suggesting a greater misattribution bias for affectively-laden material. Recently, it has been proposed that schizophrenic patients have a fundamental deficit in binding different contextual elements together in memory. The effect of clinical symptomatology and item content on source monitoring and context binding has yet to be examined in a single study. Twenty-one patients with schizophrenia and 21 healthy control subjects completed a task wherein memory for affective and neutral word pairs was assessed in conjunction with memory for both source and temporal information. Schizophrenic patients performed more poorly than controls overall, and tended to exhibit a more fractionated retrieval of word pairs across all levels of affective valence. Current intellectual level and overall verbal memory performance were significantly correlated with context binding performance for positive and neutral word pairs. Clinical symptomatology was unrelated to source monitoring performance. The results of this pilot study provide tentative support for the notion that schizophrenia is associated with an impairment in combining contextual cues together to form a coherent memory of an event, irrespective of the affective valence of the material. Clinical symptomatology bore no significant relationship to source memory performance.

Amygdala activation in affective priming: a magnetoencephalogram study

We employed magnetoencephalography (MEG) to examine amygdala activity during a linguistic affective priming task. The experimental design included positive and negative word pairs. Using synthetic aperture magnetometry in the analysis of MEG data, we identified a left amygdala power increase in the theta frequency range during priming involving negative words. We found that the amygdala displayed a time-dependent intensification in responsiveness to negative stimuli, specifically between 150 and 400 ms after target presentation. This study provides evidence for theta power changes in the amygdala and demonstrates that the analysis of brain oscillations provides a powerful tool to explore mechanisms implicated in emotional processing.

Quantifying incoherence in speech: an automated methodology and novel application to schizophrenia

Incoherent discourse, with a disjointed flow of ideas, is a cardinal symptom in several psychiatric and neurological conditions. However, measuring incoherence has often been complex and subjective. We sought to validate an objective, intrinsically reliable, computational approach to quantifying speech incoherence. Patients with schizophrenia and healthy control volunteers were administered a variety of language tasks. The speech generated was transcribed and the coherence computed using Latent Semantic Analysis (LSA). The discourse was also analyzed with a standard clinical measure of thought disorder. In word association and generation tasks LSA derived coherence scores were sensitive to differences between patients and controls, and correlated with clinical measures of thought disorder. In speech samples LSA could be used to localize where in sentence production incoherence occurs, predict levels of incoherence as well as whether discourse "belonged" to a patient or control. In conclusion, LSA can be used to assay disordered language production so as to both complement human clinical ratings as well as experimentally parse this incoherence in a theory-driven manner.

Dissociating the effects of Sternberg working memory demands in prefrontal cortex

Earlier neuroimaging studies of working memory (WM) have demonstrated that dorsolateral prefrontal cortex (DLPFC) activity increases as maintenance and load demand increases. However, few studies have carefully disambiguated these two WM processes at the behavioral and physiological levels. The objective of the present functional resonance imaging (fMRI) study was to map within prefrontal cortex locales that are selectively load sensitive, delay sensitive, or both. We studied 18 right-handed normal subjects with fMRI at 3 Tesla during a block design version of the Sternberg task. WM load was manipulated by varying the memory set size (3, 5, or 8 letters). The effect of memory maintenance was examined by employing two time delays (1 s and 6 s) between the letter set and probe stimuli. The DLPFC was strongly activated in load manipulation, whereas activation as a function of delay was restricted to the left premotor regions and Broca's areas. Moreover, regions of prefrontal cortex on the right (BA 46) were found to be exclusively affected by load. These results suggest the possibility that top-down modulation of attention or cognitive control at encoding and/or decisionmaking may be mediated by these areas.

Differentiating allocation of resources and conflict detection within attentional control processing

Increasing demands for conflict detection and for allocation of attentional resources increase the need for attentional control. While prior evidence suggests that different cortical regions are preferentially engaged by these two attentional processes, the effect of increasing demand for conflict detection and/or allocation of attentional resources has been relatively unexplored. We designed a novel task (the 'variable attentional control'--VAC--task) that varies the demand for attentional control by increasing conflict detection and allocation of attentional resources within the same stimuli. We studied 34 subjects who underwent event-related functional magnetic resonance imaging while performing the VAC task. Increasing demand for attentional control, as reflected by longer reaction time and reduced accuracy, was associated with greater activation in the dorsolateral prefrontal cortex, parietal cortex and dorsal cingulate. Furthermore, an increase in conflict detection was associated with greater dorsal cingulate activity, whereas an increase in demand for allocation of attentional resources implied greater activation in the dorsolateral prefrontal and parietal cortices. In essence, in addition to allowing the exploration of the overall effects of increasing demand for attentional control, our novel task also allowed parsing of the neural components of attentional control into those related to allocation of attentional resources and those related to conflict detection.

Effect of catechol-O-methyltransferase val158met genotype on attentional control

The cingulate cortex is richly innervated by dopaminergic projections and plays a critical role in attentional control (AC). Evidence indicates that dopamine enhances the neurophysiological signal-to-noise ratio and that dopaminergic tone in the frontal cortex is critically dependent on catechol-O-methyltransferase (COMT). A functional polymorphism (val158met) in the COMT gene accounts for some of the individual variability in executive function mediated by the dorsolateral prefrontal cortex. We explored the effect of this genetic polymorphism on cingulate engagement during a novel AC task. We found that the COMT val158met polymorphism also affects the function of the cingulate during AC. Individuals homozygous for the high-activity valine ("val") allele show greater activity and poorer performance than val/methionine ("met") heterozygotes, who in turn show greater activity and poorer performance than individuals homozygous for the low-activity met allele, and these effects are most evident at the highest demand for AC. These results indicate that met allele load and presumably enhanced dopaminergic tone improve the "efficiency" of local circuit processing within the cingulate cortex and thereby its function during AC.

Cognitive control and semantics in schizophrenia: an integrated approach

OBJECTIVE

The authors tested whether decisions about incongruencies in the representation and processing of semantic knowledge, thought to be related to cognitive control, are selectively impaired in schizophrenia.

METHOD

Twenty-four patients with schizophrenia and 24 healthy comparison subjects determined the relative size of paired stimuli as they are in the real world. Stimuli were words or images. Real-world "distance" (size difference between stimuli) was manipulated within pairs, as was "congruency" between real-world and presentation size.

RESULTS

Although patients were slower overall, both groups exhibited similar effects of "distance" and "congruency"; the task was easier when the real-world size difference between stimuli was greater and when stimuli were congruent in presentation and real-world size.

CONCLUSIONS

Some aspects of the representation of semantic knowledge are preserved in schizophrenia, and patients use this information to control cognition in the same manner as healthy individuals.

Reduced Parahippocampal Connectivity Produces Schizophrenia-like Memory Deficits in Simulated Neural Circuits With Reduced Parahippocampal Connectivity

CONTEXT

Episodic memory impairments are well characterized in schizophrenia, but their neural origin is unclear.

OBJECTIVE

To determine whether the episodic memory impairments in schizophrenia may originate from reduced parahippocampal connectivity.

DESIGN

Experimental in silico model.

SETTING

Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.

INTERVENTIONS

A new, in silico medial temporal lobe model that simulates normal performance on a variety of episodic memory tasks was devised. The effects of reducing parahippocampal connectivity in the model (from perirhinal and parahippocampal cortex to entorhinal cortex and from entorhinal cortex to hippocampus) were evaluated and compared with findings in schizophrenic patients. Alternative in silico neuropathologies, increased noise and loss of hippocampal neurons, were also evaluated.

RESULTS

In the model, parahippocampal processing subserves integration of different cortical inputs to the hippocampus and feature extraction during recall. Reduced connectivity in this area resulted in a pattern of deficits that closely mimicked the impairments in schizophrenia, including a mild recognition impairment and a more severe impairment in free recall. Furthermore, the schizophrenic model was not differentially sensitive to interference, also consistent with behavioral data. Notably, neither increased noise levels nor a reduction of hippocampal nodes in the model reproduced this characteristic memory profile.

CONCLUSIONS

Taken together, these findings highlight the importance of parahippocampal neuropathology in schizophrenia, demonstrating that reduced connectivity in this region may underlie episodic memory problems associated with the disorder.

Levels of processing effects on recognition memory in patients with schizophrenia

This study sought to characterize the performance of patients with schizophrenia, as compared with healthy participants, on a memory task that required encoding of items to different depths. Participants included 21 individuals with schizophrenia and 26 healthy controls. During the encoding phase of the study, participants processed successively presented words in two ways: perceptually (by making a decision as to whether the letter "a" was present in the word) or semantically (by making a living/nonliving decision for each word). During the recognition phase of the study, participants were presented with a list of words containing items that had been presented during the encoding phase (during either the letter decision task or the semantic decision task), as well as items that had not been seen before (foils). Though patients with schizophrenia performed more poorly overall on the recognition task, recognition was facilitated by semantic encoding to an equivalent degree in both groups. In other words, while significant main effects were present for group and encoding, no groupxencoding condition was present. This result is consistent with previous findings of a lack of qualitative differences in performance on learning and memory tasks between patients with schizophrenia and healthy controls. It also suggests that strategies that place constraints on the encoding processes used by patients may help improve the efficiency with which they learn and remember information.

Category Content and Structure in Schizophrenia: An Evaluation Using the Instantiation Principle

In numerous studies, researchers have suggested anomalies in semantics in patients with schizophrenia. In this study, the authors addressed whether one such anomaly might reflect a difference in knowledge content or in the structure or organization of this information. Using a category member production task and a typicality rating task, the authors assessed knowledge content and found that patients' and control participants' knowledge about categories of foods and animals was very similar. In terms of structure, their findings from a mathematical model of category judgment (the instantiation model; E. Heit & L. W. Barsalou, 1996) revealed a similar category structure in patients and control participants. In conclusion, the authors suggest that the content and organization of categories in patients with schizophrenia is similar to that in healthy control participants.

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.

Lack of false recognition in schizophrenia: a consequence of poor memory?

The tendency to falsely recognize items as ones previously presented is increased in patients with frontal lesions and in older participants, whereas patients with medial temporal lobe damage may display such poor memory that they are not especially susceptible to false recognition. Since patients with schizophrenia are often compared to these groups neurocognitively, we explored the extent to which they are more susceptible to false memory. Participants were presented with word lists along a semantic theme, such as "bread". After list presentation, recognition tasks were administered which contained both the studied words as well as unstudied words. Some of the unstudied words were related to the theme of the previously studied words, but never actually presented (e.g. semantic "lures"). In a separate test, free recall of these lists of words was assessed. Interestingly, it was control participants who made more errors at recall, and were especially susceptible to intrusions of the semantic lures. Patients with schizophrenia did not make more false recognition errors in general, and surprisingly they made disproportionately fewer false recognition errors to semantic lures specifically. We conclude that despite poor memory, patients with schizophrenia are not especially susceptible to interference from previous tasks and are not particularly prone to false recollections.

Scaling and clustering in the study of semantic disruptions in patients with schizophrenia: a re-evaluation

Some recent studies of semantics in schizophrenia have employed multidimensional scaling and clustering techniques to analyse verbal fluency and triadic comparison data. The conclusions have been: (i) patients generate fewer words in fluency tasks and display more variable similarity groupings of words in triadic tasks, and (ii) this is due to deficits in semantics. We analysed data from both tasks. On the verbal fluency task, patients produced significantly fewer responses than controls. The results also showed little patient-specific inter-individual consistency. Similarly, for triadic comparison data, we did not find much patient-specific inter-individual consistency. When correlating patients' results at different measurement times with means of controls, the data of individual patients (at either of the two measurement times) were not predicted better from their data at the other measurement time than from controls. This latter finding suggests little patient-specific intra-individual consistency and, thus, pleads against idiosyncratic semantic deficits. Our findings do not refute the hypothesis that schizophrenia is associated with semantic disruptions. However, our results demonstrate that because of severe statistical restrictions and requirements associated with some scaling and clustering techniques, these methods may not be as useful in this enterprise as previously thought.

Duration judgements in patients with schizophrenia

BACKGROUND

The ability to encode time cues underlies many cognitive processes. In the light of schizophrenic patients' compromised cognitive abilities in a variety of domains, it is noteworthy that there are numerous reports of these patients displaying impaired timing abilities. However, the timing intervals that patients have been evaluated on in prior studies vary considerably in magnitude (e.g. 1 s, 1 min, 1 h etc.).

METHOD

In order to obviate differences in abilities in chronometric counting and place minimal demands on cognitive processing, we chose tasks that involve making judgements about brief durations of time (< 1 s).

RESULTS

On a temporal generalization task, patients were less accurate than controls at recognizing a standard duration. The performance of patients was also significantly different from controls on a temporal bisection task, in which participants categorized durations as short or long. Although time estimation may be closely intertwined with working memory, patients' working memory as measured by the digit span task did not correlate significantly with their performance on the duration judgement tasks. Moreover, lowered intelligence scores could not completely account for the findings.

CONCLUSIONS

We take these results to suggest that patients with schizophrenia are less accurate at estimating brief time periods. These deficits may reflect dysfunction of biopsychological timing processes.

Habitual prospective memory in schizophrenia

BACKGROUND

Prospective memory (PM), the act of remembering that something has to be done in the future without any explicit prompting to recall, provides a useful framework with which to examine problems in internal-source monitoring. This is because it requires distinguishing between two internally-generated processes, namely the intention to perform an action versus actual performance of the action. In habitual tasks, such as taking medicine every few hours, the same PM task is performed regularly and thus it is essential that the individual is able to distinguish thoughts (i.e., thinking about taking the medicine) from actions (i.e., actually taking the medicine).

METHODS

We assessed habitual PM in patients with schizophrenia by employing a laboratory analogue of a habitual PM task in which, concurrently with maneuvering a ball around an obstacle course (ongoing activity), participants were to turn over a counter once during each trial (PM task). After each trial, participants were asked whether they had remembered to turn the counter over.

RESULTS

Patients with schizophrenia made a disproportionate number of errors compared to controls of reporting that a PM response had been made (i.e., the counter turned over) after an omission error (i.e., the counter was not turned over). There was no group difference in terms of reporting that an omission error occurred (i.e., forgetting to turn over the counter) when in fact a PM response had been made.

CONCLUSION

Patients with schizophrenia displayed a specific deficit distinguishing between two internally-generated sources, attributable to either poor source monitoring or temporal discrimination.

Autobiographical memory in schizophrenia: an examination of the distribution of memories

Patients with schizophrenia display numerous memory impairments. Examination of autobiographical memory distribution across the life span can constrain theories of how schizophrenia affects memory. Previously, schizophrenic patients were shown to produce fewer memories from early adulthood than from childhood or the recent past (A. Feinstein, T. E. Goldberg, B. Nowlin, & D. R. Weinberger, 1998), this temporal paucity corresponding with illness onset. The current study examined this issue further using a different (noncued) method. Age-matched schizophrenic patients (n = 21) and controls (n = 21) were to freely generate 50 episodes, after which they dated these memories. Patients generated fewer memories than did controls, especially from the recent decade. When the overall lower production of memories was controlled for, the groups displayed equivalent recency effects. It was concluded that patients' paucity of memories generated from the recent decade reflects encoding or acquisition problems, which may be associated with the illness period.

Probed recall for serial order deficits in short-term memory in schizophrenic patients

BACKGROUND

Patients with schizophrenia frequently display problems in tasks demanding working memory. In a previous study, we examined short-term memory (STM) for serial order by having participants recall lists of letters from the first item to the last item in the order in which they were presented, and we examined the types of errors made (e.g., omissions, intrusions and movements; [Neuropsychology 15 (2001) 128]). We found that the disproportionate errors schizophrenic patients made were omissions at the end of six-item lists, a finding we suggested might reflect patients' longer output times, which adds to information maintenance demands. If this is the case, we predicted that the group difference in the terminal positions could be eliminated through the use of a probed recall paradigm.

METHOD

In the current study, 26 schizophrenic patients and 33 control participants were tested on a probed recall task that was similar to our previous serial recall task except that instead of recalling the whole sequence of letters, participants were probed as to which letter appeared in a specific position in the sequence.

RESULTS

We found that when participants were probed for later positions, recall was equivalent in the groups (i.e., recency), but disproportionately worse in patients for earlier positions.

CONCLUSIONS

We suggest that schizophrenic patients' limited STM span for serial order is not attributable to a selective deficit in memory for serial order. Rather, we propose that it may be explicable in terms of impaired information maintenance and thus this becomes evident in conditions involving longer sequences of stimuli.

An examination of the suppression of overlearned responses in schizophrenia

INTRODUCTION

Individuals often experience interference from overlearned responses. This phenomenon is reported to be increased in patients with schizophrenia.

METHODS

In order to determine the generality of such interference in these patients, the frequency of repetitive responses in simple tasks was manipulated. It was hypothesised that patients' performance would be disproportionately impaired when a strong response tendency needed to be overridden. This was expected to be the case especially where task rules had to be maintained for a period of time in order to respond appropriately.

RESULTS

A spatial analogue of the Stroop test, with a response bias to a side of space, produced stronger expectancy in patients than in controls. A similar manipulation of expectancy in a variant of the Continuous Performance Test, in which subjects were to respond to sequentially presented pairs of letters, did not result in a difference between patients and controls in terms of inhibiting inappropriate responses. In this test, patients' deficits were associated with the delay period between stimulus and target.

CONCLUSIONS

The cognitive impairment in patients with schizophrenia is not simply a general deficit in the suppression of overlearned responses, rather, the susceptibility to interference appears more task specific.

The phonological similarity effect in short-term memory serial recall in schizophrenia

Lists of phonologically similar items are more often recalled in the wrong order than phonologically dissimilar items. At recall, patients with schizophrenia were neither especially susceptible to confusing phonologically similar items nor to making disproportionate movement (i.e. order) errors with phonologically similar lists of items. We conclude that patients with schizophrenia employ recall strategies for phonologically similar items in short-term memory that are equivalent to those of healthy controls.

Semantic clustering in verbal fluency: schizophrenic patients versus control participants

BACKGROUND

Schizophrenic patients generate fewer words than healthy controls during verbal fluency tasks. The structure of output may explain why patients generate fewer exemplars.

METHODS

Twenty-four healthy controls and 24 patients with schizophrenia participated in six, 3 min semantic fluency tasks. In a subsequent session, participants were given cards, each printed with one of their own words generated from previous fluency tasks. Participants were to sort the cards into categories (e.g. subcategories of 'animals'), thus defining their own semantic subcategories of words, and thereby eliminating experimenter assumptions about word relatedness. These clusters were matched with fluency output of each participant. The time spent searching through semantic networks within clusters and switching to other clusters when locating and producing associated words were measured.

RESULTS

Patients produced fewer words and spent more time switching to words within clusters and to different clusters than controls, but otherwise response profiles were similar. Although controls returned more frequently to clusters and consequently made more switches between these clusters than patients, this group difference disappeared when the total number of words produced was covaried.

CONCLUSIONS

Consistent with previous literature, patients produced fewer words and made more errors than controls. The absence of a group difference in number of different clusters or mean number of items per cluster suggests that patients are similar to controls with respect to number of ideas in their semantic network. Patients' longer between-cluster switching times indicate a general slowness that may be attributed to difficulties finding new words within a semantic field.

An investigation of the integrity of semantic boundaries in schizophrenia

Organizing information and knowledge, and hence categorization, requires specifying boundaries between items, concepts and words. Over-inclusiveness in categorization may be seen as looseness of association; over-inclusive thinking was an early description of schizophrenic thinking. Recent studies suggest semantic memory problems in schizophrenia, and that thought disorder is associated with a disorganized semantic network. One such study [Psychol. Med. 24 (1994) 193], using a word categorization task, found patients slowest to respond to items semantically related to, but outside the category, whereas controls were slower responding to items sharing less features of the category (i.e. borderline). The authors suggested that there is an outward shift of semantic category boundaries in schizophrenia. In Experiment 1, we replicated methods, but did not find this qualitative difference in patients (28 patients, 26 controls). We extended this question in Experiment 2 to a more visual domain using pictures that 'morphed' from one entity into another and asked participants to decide when they no longer considered an item to be that item (20 patients, 25 controls). We did not find a difference between patients and controls in their sensitivity to detect boundaries of representations. These two experiments do not support the notion that thought disorder with postulated looseness of association or over-inclusive thinking is related to reduced awareness of boundaries of semantic category membership or entities, and inferentially their featural network. Despite anomalies in the semantic system in schizophrenia, we found aspects to be intact. This specificity of semantic processing is promising, suggesting that research will be informative as to how semantic memory is constructed, and thus how it can selectively break down. Moreover, this study indicates that patients do not 'fail' semantic tasks (e.g. priming) because of globally disorganized decision-making: here their capability to make precise distinctions between representations was intact.

A comparison of verbal fluency tasks in schizophrenic patients and normal controls

Previous studies have reported significant impairment on verbal fluency tasks (semantic and letter) among schizophrenic subjects. However, the possibility of specific categorical deficits has not been adequately investigated. Nor have the effects of task duration, the stability between testing sessions, and the relationship between intelligence and performance on fluency been thoroughly studied. We performed a series of 3 min fluency tasks (semantic/syntactic and letter) to determine whether duration specific or category-specific differences exist between schizophrenic subjects and normal controls. Each subject was tested at three different times as a means of estimating word pool and assessing the stability of fluency output. Subjects were asked to generate exemplars from each of four semantic/syntactic categories (animals, tools, common nouns and verbs) and three letters (G, E and T). Data from 13 schizophrenic subjects and 15 sex-, age- and pre-morbid-IQ-matched control subjects revealed that patients' overall performance on both the semantic and letter fluency tasks was impaired. While differential impairment on specific semantic categories was noted between groups, no differential effects relating to task duration or testing session were present. Further, by comparing the number of novel words produced in the three testing sessions, we found the groups to be equivalent, a finding we take to suggest that schizophrenic patients' lexicon is intact. Covarying current IQ eliminated the group difference robustly for letter fluency, while only marginally for semantic fluency. Our data revealed the presence of impairment in semantic and letter fluency tasks in schizophrenic patients consistent with previous reports, and also that patients were differentially impaired on semantic categories.

Paired-associate learning and memory interference in schizophrenia

Patients with frontal lobe damage have been shown to exhibit disproportionate impairments of second list learning as a result of interference effects. Based upon the assumption that schizophrenia is associated with frontal dysfunction, we attempted to explore how various manipulations of paired-associate learning tasks would interfere with schizophrenic patients' memory performance. Patients with schizophrenia were administered four tests of paired-associate learning, in which cue and response words were manipulated to increase interference across two study lists. In two tests of paired-associate learning (AB-AC test), cue words used in one list were repeated in a second list but were associated with different response words (e.g. lion-hunter, lion-circus). One version of this test employed moderately related word pairs and the other version employed unrelated word pairs. In the other two tests (AB-ABr test), all words used in one list were repeated in a second list but were rearranged to form new pairs. Again, one version of this test used moderately related word pairs and the other version used unrelated word pairs. We hypothesized that patients with schizophrenia would exhibit disproportionate impairment of second-list learning as a result of interference effects and that they would do especially poorly in the AB-ABr task, where the word pairs were unrelated. However, these predictions were not supported. Furthermore, it was difficult to tease apart a specific problem in list discrimination from the generally poor memory of the schizophrenic patients. We suggest that the susceptibility to these interference effects in patients with schizophrenia is not a specific problem in cognition, but rather one that is confounded by general memory problems.

Cognitive impairment in schizophrenia is the core of the disorder

Patients with schizophrenia exhibit an exceedingly wide range of symptoms from a variety of domains. The cardinal features are abnormal ideas (such as delusions); abnormal perceptions (such as hallucinations); formal thought disorder (as evidenced by disorganized speech); motor, volitional, and behavioral disorders; and emotional disorders (such as affective flattening or inappropriateness). In addition to these diverse, and sometimes bizarre symptoms, it has become increasingly apparent that the disorder is, to variable degrees, accompanied by a broad spectrum of cognitive impairments. This review addresses the question of whether the cognitive deficits seen in schizophrenic patients are the core features of the disorder. In other words, we explore whether schizophrenia is best characterized by symptoms or cognitive deficits (we suggest the latter) and moreover, whether there is a specific cognitive deficit profile that may assist in diagnosis. First, we discuss what the cognitive deficits are. Then we address in turn the reality, frequency, predictive validity, specificity, course and susceptibility to neuroleptic effects of these cognitive impairments. In brief, we argue that various cognitive deficits are enduring features of the schizophrenia illness, that they are not state-related and are not specific to subtypes of the illness, and, more specifically, that working memory and attention are characteristically impaired in patients with schizophrenia, irrespective of their level of intelligence. Last, we conclude that problems in these cognitive domains are at the very core of the dysfunction in this disease.

Short-term memory for serial order in schizophrenia: a detailed examination of error types

Cognitive deficits in schizophrenia have been associated with working memory problems. Schizophrenic patients (n = 24) and controls (n = 29) participated in simple short-term memory tasks, recalling a list of letters from the first to last item in the order of presentation. The authors hypothesized that deficient sequential representations would increase movement errors (e.g., ABCD being recalled as ABDC) or intrusion errors (e.g., ABCD being recalled as ABCX), whereas simple trace decay would lead to omission errors (e.g., ABCD being recalled as ABC_). Patients made disproportionately more omissions toward the end of 6-item lists. There were no group differences in movements or intrusions as a function of serial position. Schizophrenic patients' limited short-term memory span may be due to greater forgetting during recall and not to a selective deficit in the mechanisms responsible for maintaining serial order information.

Short-term memory for serial order in schizophrenia: a detailed examination of error types

Cognitive deficits in schizophrenia have been associated with working memory problems. Schizophrenic patients (n = 24) and controls (n = 29) participated in simple short-term memory tasks, recalling a list of letters from the first to last item in the order of presentation. The authors hypothesized that deficient sequential representations would increase movement errors (e.g., ABCD being recalled as ABDC) or intrusion errors (e.g., ABCD being recalled as ABCX), whereas simple trace decay would lead to omission errors (e.g., ABCD being recalled as ABC_). Patients made disproportionately more omissions toward the end of 6-item lists. There were no group differences in movements or intrusions as a function of serial position. Schizophrenic patients' limited short-term memory span may be due to greater forgetting during recall and not to a selective deficit in the mechanisms responsible for maintaining serial order information.

Memory for temporal order in patients with schizophrenia

There is some evidence that memory for temporal order is a process that may be impaired independently of other forms of memory. For example, patients with Korsakoff's syndrome have been shown to have poorer temporal-order memory than other amnesic patients, despite item memory being equivalent. Patients with schizophrenia have been reported to have a variety of memory problems, although memory for the order of events has not been examined very frequently. In this study, we tested memory for temporal order in patients with schizophrenia and in control subjects. Subjects were presented with two lists of 15 words (at two different times) and were later asked to reproduce the order of each list from a random array of the words. In both versions of the test, patients with schizophrenia were impaired in placing the items in the correct temporal order. Recall and recognition of the actual words used to comprise the lists were also impaired in the schizophrenic patients. However, when recall measures were covaried, and when patients were matched with controls for recall, post-hoc group differences in temporal memory were eliminated. In contrast, covarying recognition (indexed by d' or matching for recognition) did not eliminate group differences. Therefore, although memory for temporal order is compromised in patients with schizophrenia, this deficit is highly correlated with generally poorer item-specific memory retrieval (i.e., recall). It is possible that both impairments are due to some third process that underlies and aids in the reconstruction of episodes.

The use of cognitive context in schizophrenia: an investigation

BACKGROUND

Cognitive deficits in schizophrenia have recently been ascribed to impaired representation and use of cognitive context. Context is defined as relevant information held temporarily in mind to mediate appropriate but often non-habitual responses.

METHODS

Parallel studies in a variety of cognitive domains were designed in order to explore the generality of any schizophrenic deficit in context use. In all of the tasks (a Stroop task, a Continuous Performance Task and a cued spatial location task), we examined how performance was affected by the time for which contextual information must be held in mind, and by whether context or task demands were consistent or varying between trials. It was predicted that manipulation of these variables would produce tests especially sensitive to schizophrenic attentional problems.

RESULTS

Predictions were partially confirmed. Although increasing contextual demands failed in most cases to produce disproportionate slowing of performance in patients, error data were largely in line with predictions. At the same time, the data did not suggest a simple unitary context deficit. Instead, different aspects of context--the time over which contextual information must be held in mind and the consistency of context--were differentially important in different tasks.

CONCLUSIONS

The cognitive impairments of schizophrenic patients cannot be simply characterized as a generalized context deficit. A more differentiated, if not task specific, picture of schizophrenic deficits is suggested.

Continuous performance test and schizophrenia: a test of stimulus-response compatibility, working memory, response readiness, or none of the above?

OBJECTIVE

Abnormalities of attention are considered the fundamental deficits in cognitive function manifested by patients with schizophrenia. The authors administered variations of two types of cognitive tasks to patients with schizophrenia (N=20) and normal comparison subjects (N=30) to test four possible cognitive mechanisms that might account for such abnormalities.

METHOD

Variations of the Continuous Performance Test were used to test the four mechanisms. Stimulus-response mapping was explored by comparing results on a task in which subjects were to make a response if the word "nine" was preceded by the word "one" with results on a task in which the required response was made explicit by the stimulus (the word "ready" followed by the word "press"). The building up of a prepotent response tendency was tested by manipulating the probability with which the cue and imperative stimulus appeared (17% or 50%). The amount of working memory required to maintain contextual information was tested by using different delay intervals (1000 msec and 3000 msec). The extent to which problems in vigilance might be attributable to problems in the "motoric" component of response readiness was operationalized by having subjects perform a secondary motor task concurrent with the attentional task.

RESULTS

Patients with schizophrenia performed significantly worse than the normal comparison subjects on all tasks. However, none of the four manipulations of the Continuous Performance Test tasks had a differential impact on the patients' performance speed or accuracy. In contrast, there was a significant interaction of group, delay interval, and target probability in which patients made disproportionately more omission errors at short delay intervals and at low target probabilities.

CONCLUSIONS

The findings may call into question the explanatory power of certain well-known contemporary mechanistic accounts of performance on the Continuous Performance Test in patients with schizophrenia. The findings suggest that a difficulty in rapidly encoding information (i.e., constructing a representation) in certain "unengaging" situations may be at the core of deficits on tasks associated with this attentional test.