Prospective clinicopathologic studies of schizophrenia: accrual and assessment of patients

OBJECTIVE

The purpose of this study was to characterize the neuropsychiatric profile of elderly patients with schizophrenia and establish a patient registry for prospective ante-mortem and post-mortem studies.

METHOD

Medical records of all chronically institutionalized patients in eight state hospitals who were over the age of 65 and had a chart diagnosis of schizophrenia (N = 528) were reviewed. Of the potential subjects, 192 were excluded because of clinical histories inconsistent with a diagnosis of schizophrenia, 56 because of insufficient information to establish a psychiatric diagnosis, and 122 because of family members' refusal to give consent for autopsy in the event of death. To date, 81 of the remaining 158 patients have undergone neuropsychiatric evaluation with standard assessment instruments.

RESULTS

Mini-Mental State scores of the 81 patients indicated severe dementia, and Functional Assessment Scale scores showed that patients required assistance with activities of daily living. All patients were rated as severely ill on the Brief Psychiatric Rating Scale. Ratings on the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms indicated a predominance of negative symptoms over positive. Of 30 patients who have died to date, research autopsies have been conducted on 26.

CONCLUSIONS

Establishing a well characterized, prospective patient registry for clinicopathologic studies of schizophrenia is feasible but labor intensive. Diagnosis of schizophrenia with a high degree of confidence can be achieved by means of detailed chart review and assessment of current neuropsychiatric functioning with standard rating instruments. These data provide a basis for correlations of clinicopathologic factors.

Smaller neuron size in schizophrenia in hippocampal subfields that mediate cortical-hippocampal interactions

OBJECTIVE

The goal of this study was to characterize the hippocampal formation in patients with schizophrenia by measuring neuron density, neuron size, and variability of neuronal axis orientation.

METHOD

Brain tissue was obtained at autopsy from 14 prospectively accrued elderly patients with chronic schizophrenia and 10 age-compatible individuals without psychiatric disorder. Eight hippocampal regions of interest and two internal control regions (primary motor and visual cortices) were identified on Nissl-stained sections. Morphometric measurements were made without knowledge of diagnosis by means of a computer-based image analysis system.

RESULTS

The patients exhibited smaller neuron size in the hippocampal regions relative to the control regions, which was significant only for the subiculum, CA1, and layer II of the entorhinal cortex. Neuron size in the control regions was nearly identical in the two groups. No significant differences in neuron density or in variability of neuronal axis orientation were identified for any region. There was no correlation between neuron size in any area and several potentially confounding variables (age, post-mortem interval, neuroleptic exposure, sex, brain hemisphere studied, duration of illness), with the exception of a negative correlation with age in layer II of the entorhinal cortex. Regression analyses indicated that the findings could not be attributed to these age effects.

CONCLUSIONS

The subiculum, entorhinal cortex, and CA1 are the major subfields of the hippocampal region that maintain the afferent and efferent connections of the hippocampus with widespread cortical and subcortical targets. The smaller size of neurons in these subfields may reflect the presence of structural or functional impairments that disrupt these connections, which in turn could have important behavioral sequelae.

Reading on the Wide Range Achievement Test-Revised and parental education as predictors of IQ: comparison with the Barona formula

It is frequently necessary in research and clinical evaluations to obtain estimates of premorbid intelligence (IQ) which are separate from measured IQ. There is evidence that word reading may be useful in this aim. In order to determine the potential of the Wide Range Achievement Test-Revised (WRAT-R) reading subtest (READ) as an estimate of premorbid IQ, the present study examined the relationship between READ and IQ in healthy subjects. Consistent with other findings, READ accounted for a significant amount of variance in Verbal, Performance, and Full Scale IQ. Race and parental education, the latter being a variable not previously examined in this literature, accounted for incrementally valid variance in IQ beyond READ. The predictive power of these variables compares favorably with estimates made by the Barona IQ estimation formula, which uses only demographic information.

Evaluation of age-related changes in serotonin 5-HT2 and dopamine D2 receptor availability in healthy human subjects

We assessed the relation between serotonin 5-HT2 receptor availability and aging and compared it with that for dopamine D2 receptors on 19 healthy male volunteers (age range, 21-49 years) using positron emission tomography (PET) and F-18 N-methylspiperone (NMS). 5-HT2 Receptor availability was obtained using the ratio of the distribution volume in the region of interest to that in the cerebellum (Bmax'/Kd' + 1). 5-HT2 Receptor measures were obtained in frontal and occipital cortices. D2 receptor availability in striatum was measured using the "ratio index". 5-HT2 Receptor availability decreased significantly with age. This effect was significantly more accentuated for 5-HT2 receptor availability in the frontal (r = 0.92, p < or = 0.0001) than in the occipital (r = 0.67, p < or = 0.0016) cortex (df = 1, p < 0.025). Dopamine D2 receptors were also found to decrease significantly with age (r = 0.63, p < or = 0.007). In a given subject, striatal D2 receptor availability significantly correlated with 5-HT2 receptor availability in the frontal (r = 0.51, p < or = 0.035) but not in the occipital cortex. These results document a decline in 5-HT2 and D2 receptor availability with age and showed an association between frontal 5-HT2 and striatal D2 receptors.

Sex differences in regional cerebral glucose metabolism during a resting state

Positron emission tomography was used to evaluate the regional distribution of cerebral glucose metabolism in 61 healthy adults at rest. Although the profile of metabolic activity was similar for men and women, some sex differences and hemispheric asymmetries were detectable. Men had relatively higher metabolism than women in temporal-limbic regions and cerebellum and relatively lower metabolism in cingulate regions. In both sexes, metabolism was relatively higher in left association cortices and the cingulate region and in right ventro-temporal limbic regions and their projections. These results are consistent with the hypothesis that differences in cognitive and emotional processing have biological substrates.

The stability of tachistoscopic measures of hemispheric specialization

Two-week test-retest reliabilities were determined for two tachistoscopic tasks, consonant-vowel-consonant trigrams and dot location, in 48 right-handed university students. Both visual field and laterality scores were examined. Analysis of variance showed no significant main effects or interactions of session for either task, indicating stability of mean performance and laterality scores. Likewise, grouping subjects as "high" or "low" by median laterality scores showed concordance across sessions for both tasks. Test-retest correlations were moderately high for all verbal task measures and for visual field scores for the dot location test. However, laterality indices for dot location showed low stability despite comparable within-session reliabilities of laterality scores for the two tasks. These findings suggest stability of group means and subgroups for verbal and dot location tachistoscopic measures. However, the degree to which individual scores are predictable from one session to the next differs between the two tasks.

MMPI characteristics in adults diagnosed with ADD: a preliminary report

Characterization of Attention Deficit Disorder (ADD) in adults has been hampered by an absence of well-defined clinical profiles on objective personality measures. A sample of 22 ADD adults completed personality testing (MMPI) in conjunction with cognitive assessment. A sample of 30 normal controls and 20 patients diagnosed with schizophrenia, who had completed the MMPI as part of a larger research protocol, were utilized as comparison groups. Validity and clinical scales revealed multiple elevations in the ADD group which were similar in nature but not to the same degree as elevations observed in the schizophrenia group. Harris-Lingoes subscales identified the sources of clinical scale elevations indicating a pattern of specific and nonspecific symptomatology which differentiated the three groups. The results may aid in identifying ADD in adults.

Neuropsychological functioning in siblings discordant for schizophrenia and healthy volunteers

OBJECTIVE

To determine whether schizophrenics and their nonschizophrenic siblings have a similar pattern of neuropsychological deficit when compared with normal controls.

DESIGN AND PARTICIPANTS

Fifteen probands with schizophrenia, 16 of their nonschizophrenic siblings, and 31 unrelated, demographically balanced, normal individuals underwent evaluation with a comprehensive neuropsychological test battery. All subjects were screened for history of head injury, neurologic illness, major medical conditions, substance use, and axis I psychiatric disorders other than schizophrenia. Probands underwent evaluation twice: once at intake when half had never received neuroleptic medication and the other half had received none for a minimum of 2 weeks, and again at the 2- to 4-week follow-up, after stabilization with neuroleptic medications.

RESULTS

Both schizophrenics and their nonschizophrenic siblings were impaired neuropsychologically compared with normal controls, with the nonschizophrenic siblings' performance intermediate between that of the schizophrenic siblings and the normal controls on all measures of functioning. The shapes of the deficit profiles of schizophrenic patients and their siblings were similar; in patients, verbal memory, abstraction, attention, and language functions were significantly more affected compared with spatial abilities, spatial memory, and sensory-motor functions, with a nonsignificant trend in the same direction in siblings. Cognitive functioning in patients was found to be stable across changes in medication status and clinical state. Four fifths of patients obtained more deviant scores than their nonschizophrenic siblings. Among the sibling group, those with probable and certain diagnoses of schizotypal personality disorder were more impaired compared with those without schizophrenia-spectrum symptoms.

CONCLUSION

These results support the hypothesis that impaired information processing aggregates in the family members of schizophrenics and may serve as an indicator of genetic vulnerability to the disorder. Further work is needed to establish whether particular areas of functioning are selectively impaired in relatives and to determine whether the performance deficits are mediated by structural and/or metabolic disturbances in specific brain regions.

Sex differences in aging of the human frontal and temporal lobes

This study investigated effects of age and sex on regional brain structure in humans, focusing on the frontal and temporal lobes. Hemispheric volumes were obtained from magnetic resonance images (MRIs) of 96 young (53 men, 43 women; aged 18-40 years) and 34 older (17 men, 17 women; aged 41-80) healthy volunteers. Images (5 mm axial spin-echo, repetition time of 3000 msec and echo times of 30 and 80 msec) were resliced along the anterior commissure-posterior commissure (AC-PC) axis to standardize for difference in head tilt, and imported into a computer program where borders of the frontal and temporal lobes were delineated. The program calculated regional brain volumes based on slice data from which CSF was segmented out. An age x sex x hemisphere x region interaction indicated that age-related reductions in brain volume were sexually dimorphic, lateralized, and region specific. Greater decrements in brain volume occurred with age in the frontal lobe than in the temporal lobe. Age-related reductions in both regions were greater in men than in women, demonstrating that sexual dimorphisms in human neuroanatomy are not fixed, but continue to change throughout adulthood. The possibility that gonadal hormones play a role in the promotion and/or prevention of neural atrophy with aging is discussed.

Effects of emotional discrimination tasks on cerebral blood flow: regional activation and its relation to performance

Facial discrimination tasks were applied as activation probes during physiologic neuroimaging ("neurobehavioral probes"). The stimuli pictured professional actors and actresses, posing degrees of happy and sad emotion. Cortical cerebral blood flow (CBF) was determined using the 133Xenon inhalation method during resting baseline, two emotional (happy from neutral and sad from neutral faces) and one nonemotional discrimination task (age). The three tasks produced CBF increase over baseline, which was greater in the right hemisphere (Task x Hemisphere interaction, p = .0001). There were regionally specific effects (Task x Region x Hemisphere interaction, p = .022). Relative to the age discrimination task, both emotion discrimination tasks were associated with greater right parietal activation. In addition, the happy discrimination task induced greater left frontal activation relative to the sad discrimination task. While overall magnitude of CBF increase did not show regionally specific correlations with performance, laterality did show such specificity. Sad discrimination performance correlated with greater right parietal activation, while performance on the happy discrimination task correlated with left frontal activation. Age discrimination performance correlated with higher activated right temporal CBF. These results support the hypothesis of right hemispheric involvement in facial processing and further suggest regionally specific hemispheric participation in happy and sad emotional discrimination. The study underscores the utility of performance measures for understanding the behavioral significance of activation effects in physiologic neuroimaging studies.

Magnetic resonance imaging in schizophrenia: relationship with clinical measures

Relationships were examined between clinical features of schizophrenia and cerebrospinal fluid (CSF) volume in brain obtained by magnetic resonance imaging (MRI) in a sample of 59 patients. The volumes of the cerebral hemispheres and CSF were measured with a computer program designed to separate reliably neural tissue from CSF. The CSF to cranial volume ratios were related to history, symptom profile and outcome functioning. Earlier age of onset was associated with higher sulcal CSF ratio, r = -0.40. The anatomic measures were unrelated to symptom severity. However, patient subtypes differed in the laterality of measures. Higher left hemispheric ratios were seen in patients with severe negative symptoms, and left predominance of ventricular relative to sulcal ratios was associated with the presence of hallucinations and delusions. The results suggest that while higher CSF is related to earlier age of onset, the clinical symptoms are more related to its lateralization. This is consistent with the hypothesis that schizophrenia is a lateralized brain disease.

Differential effects of mood on cortical cerebral blood flow: a 133xenon clearance study

Studies of healthy and clinical populations have suggested valence-specific cortical and subcortical neural systems regulating emotions. In a study of 12 normal volunteers, the 133xenon clearance method for measuring regional cerebral blood flow (CBF) was used to study the effects of experimentally controlled mood states on regional brain activity within superficial cortex. CBF was measured with 254 detectors and bolus infusion during a happy mood induction task, a sad mood induction task, a sex differentiation task, and a resting baseline condition. CBF increased during sad and decreased during happy mood induction, relative to the activated (sex differentiation) and the nonactivated (resting) nonemotional control conditions. Increased CBF during sad mood induction was correlated with greater negative mood changes. Conversely, increased CBF was associated with a stronger subjective experience of positive affect during happy mood induction. This suggests that cortical arousal may serve to intensify the conscious experience of emotion. Heart rate accelerated during happy and sad mood induction and during sex differentiation relative to a pretask baseline condition. Some regional specificity of effects was also observed. The occipital temporal region showed higher overall CBF during sad mood induction than during happy mood induction. The only region that showed specific lateralized changes in CBF which differentiated sad from happy states was the frontal pole, with left CBF being higher during sad and lower during happy mood induction relative to right CBF. For sad mood induction, there were significant regional differences among correlations between CBF and self-ratings. These were attributable to higher negative correlations (i.e., higher CBF correlates with negative self-rating) in midtemporal, occipital temporal, and postcentral regions. These correlations did not vary across the 15 regions for happy mood induction. For sad mood induction, heart rate correlated positively with CBF increase and with negative affect. Correlations were opposite for happy mood induction. The results suggest high cortical and autonomic arousal during negative/sad mood and low cortical and high autonomic arousal during positive/happy mood. They underscore the value of integrating emotional experience with physiologic measures in neuroimaging activation studies.

Clinical subtypes of schizophrenia: differences in brain and CSF volume

OBJECTIVE

Investigations of the relation of clinical features of schizophrenia to neuroanatomic measures have produced inconclusive results. The purpose of this study was to examine measures of whole-brain volume in men and women and relate them to clinical subtypes of schizophrenia.

METHOD

Magnetic resonance imaging measures of cranial, brain, and ventricular and sulcal CSF volume were examined in 81 patients with schizophrenia (50 men and 31 women), divided into subgroups based on their symptom profiles, and 81 demographically matched healthy comparison subjects.

RESULTS

The men had higher cranial and brain volumes than the women. The patients had smaller cranial and brain volumes than the comparison subjects; they also had higher ventricular CSF volumes and thus higher ventricle-brain ratios (VBRs). Ratio elevations were larger for the female than for the male schizophrenic patients. The patients with predominantly negative symptoms of schizophrenia had higher VBRs and sulcal CSF-brains ratios than the comparison subjects, although the component volumes did not differ. The patients with predominantly Schneiderian symptoms had higher VBRs than the comparison subjects but showed reduced cranial and brain volumes. The paranoid patients had normal VBRs, reduced sulcal CSF-brain ratios, and lower cranial and sulcal CSF volumes.

CONCLUSIONS

The results suggest two patterns of neuroanatomic whole-brain abnormalities that differ in severity according to the relative prominence of negative, Schneiderian, and paranoid symptoms. These patterns may reflect differential involvement of dysgenic and atrophic pathophysiological processes. Sex moderates abnormalities in the neuroanatomic features of schizophrenia.

Lateralized increases in cerebral blood flow during performance of verbal and spatial tasks: relationship with performance level

Physiologic neuroimaging studies have shown lateralized regional increase in brain activity during cognitive tasks, but the hypothesis that such changes are correlated with task performance has not been tested directly. We examined cerebral blood flow (CBF) changes induced by cognitive tasks in relation to performance. CBF was measured with the 133Xenon clearance method in 34 normal right-handed young (age < 30) volunteers during resting baseline and during the performance of a verbal analogies and a spatial line orientation test. Performance measures included "speed" and "power" estimates of both activation tasks. Resting CBF was moderately correlated with performance. The correlations were slightly higher with activated CBF for verbal but not spatial performance. The degree of increase (task-baseline) did not correlate with performance for either task. The highest and topographically specific correlations were obtained between laterality of CBF and verbal performance. Higher left hemispheric activation was correlated with verbal performance, and this correlation was significantly higher in the angular gyrus region. For the spatial task the correlations were with relatively higher right hemispheric activation but without regional specificity. The results underscore the importance of integrating behavioral performance data with physiologic measures in neuroimaging activation studies.

Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia

BACKGROUND

Medication and chronicity have complicated past attempts to characterize the neuropsychological performance of patients with schizophrenia. There have been inconsistencies regarding the pattern, selectivity, and sources of observed deficits. Our objective was to comprehensively examine neuropsychological function in patients with schizophrenia who had never been exposed to neuroleptic medication, and who were experiencing their first episode (FE) of psychosis.

METHODS

Subjects were consecutive recruitments that included 37 patients with FE schizophrenia who were never exposed to neuroleptics. These subjects were compared with 65 unmedicated, previously treated (PT) patients and 131 healthy controls.

RESULTS

The patients groups had nearly identical profiles showing generalized impairment, particularly in verbal memory and learning, attention-vigilance, and speeded visual-motor processing and attention. Verbal memory and learning accounted for most of the variance between patients and controls and removing this effect substantially attenuated all other differences. By contrast, both the FE group and PT group continued to show highly significant deficits in verbal memory and learning after controlling for attention, abstraction, and all other functions. Some functions not typically implicated in schizophrenia (spatial cognition, fine motor speed, and visual memory) were more impaired in the PT group than in the FE group.

CONCLUSIONS

Verbal memory, as a primary neuropsychological deficit present early in the course of schizophrenia, implicates the left temporal-hippocampal system. Neuropsychological evaluations before treatment permit differentiation of primary deficits from changes secondary to medication or chronicity. This is essential for developing a neurobehavioral perspective on schizophrenia.

Standardized mood induction with happy and sad facial expressions

The feasibility of applying ecologically valid and socially relevant emotional stimuli in a standardized fashion to obtain reliable mood changes in healthy subjects was examined. The stimuli consisted of happy and sad facial expressions varying in intensity. Two mood-induction procedures (happy and sad, each consisting of 40 slides) were administered to 24 young healthy subjects, who were instructed to look at each slide (self-paced) and try to feel the happy or sad mood expressed by the person in the picture. On an emotional self-rating scale, subjects rated themselves as relatively happier during the happy mood-induction condition and as relatively sadder during the sad mood-induction condition. Conversely, they reported that they were less happy during the sad mood-induction condition and less sad during the happy mood-induction condition. The effects were generalized to positive and negative affect as measured by the Positive and Negative Affect Scale. The intraindividual variability in the effect was very small. In a retest study after 1 month, the mood-induction effects showed good stability over time. The results encourage the use of this mood-induction procedure as a neurobehavioral probe in physiologic neuroimaging studies for investigating the neural substrates of emotional experience.

Cerebral blood flow in schizophrenia: effects of memory processing on regional activation

Regional cerebral blood flow (rCBF) was measured with the 133Xenon clearance technique and a high resolution (254 detectors) scanner during the performance of a verbal and a facial memory task in 18 patients with schizophrenia and 18 sociodemographically matched controls. Patients and controls had comparable resting rCBF, but differed in global and hemispheric rCBF changes induced by the memory tasks. Patients had less global increase, which was relatively higher in the left hemisphere, and this was more pronounced for the verbal task. Although controls showed appropriate laterality changes (L > R for verbal and R > L for facial memory) in the midtemporal region, patients failed to show such a focal pattern. They did not show appropriate laterality change in the midtemporal region, but instead showed such changes in other regions. Patients showed greatest impairment in specificity of verbal recognition performance, and this correlated with severity of hallucinations and delusions. This supports a model of left temporal lobe dysfunction in schizophrenia.

Effects of hypnosis on regional cerebral blood flow during ischemic pain with and without suggested hypnotic analgesia

Using 133Xe regional cerebral blood flow (CBF) imaging, two male groups having high and low hypnotic susceptibility were compared in waking and after hypnotic induction, while at rest and while experiencing ischemic pain to both arms under two conditions: attend to pain and suggested analgesia. Differences between low and highly-hypnotizable persons were observed during all hypnosis conditions: only highly-hypnotizable persons showed a significant increase in overall CBF, suggesting that hypnosis requires cognitive effort. As anticipated, ischemic pain produced CBF increases in the somatosensory region. Of major theoretical interest is a highly-significant bilateral CBF activation of the orbito-frontal cortex in the highly-hypnotizable group only during hypnotic analgesia. During hypnotic analgesia, highly-hypnotizable persons showed CBF increase over the somatosensory cortex, while low-hypnotizable persons showed decreases. Research is supportive of a neuropsychophysiological model of hypnosis (Crawford, 1991; Crawford and Gruzelier, 1992) and suggests that hypnotic analgesia involves the supervisory, attentional control system of the far-frontal cortex in a topographically specific inhibitory feedback circuit that cooperates in the regulation of thalamocortical activities.

Effects of memory processing on regional brain activation: cerebral blood flow in normal subjects

The role of the temporal lobe in memory has been implicated in lesion studies, which have also suggested the hypothesis of greater left hemispheric involvement in verbal, and right hemispheric involvement in facial memory. We tested these hypotheses in a sample of 27 normal right-handed subjects using the 133Xenon clearance method for measuring cerebral blood flow (CBF). The CBF was measured during resting baseline, word recognition, and face recognition conditions in counterbalanced order. CBF increased during recognition compared to baseline, and for the midtemporal lobe this increase was asymmetric to the left hemisphere for words and to the right for faces. While overall CBF levels and task related increases in CBF were uncorrelated either with performance or with delta performance (excess performance relative to basal memory abilities), laterality of task-related CBF correlated with both performance indices, showing regional specificity of correlations. This neurobehavioral probe paradigm can be applied in the study of neural substrates of normal and disturbed memory.

Asymmetrical visual deprivation: a technique to differentially influence lateral hemispheric function

This article describes a contact-lens method to sustain asymmetry in visual deprivation and the use of this method to test the general hypothesis that asymmetry in input deprivation can shift activation balance in the integrated brain, differentially influencing lateral hemispheric function. Effects of asymmetrical visual deprivation were as predicted on lateral asymmetry of EEG theta, producing more theta over the deprived hemisphere. Cross-modal influence of such visual deprivation was found in the perception of pleasantness of odors. An interaction was found between side of visual deprivation and performance on verbal reasoning and spatial orientation tasks. A line-bisection test of visual attention was not sensitive to the effects. Fatigue as rated on the Profile of Mood States was greatest when the left hemisphere was deprived.

Reliability of regional cerebral blood flow activation to cognitive tasks in elderly normal subjects

The assessment of cerebral blood flow (CBF) using noninvasive 133Xe techniques provides an indirect measurement of cortical metabolic activity. The utility of this method in longitudinal clinical studies depends on the stability and reproducibility of resting and activated flow measures. We evaluated CBF in a sample of 16 elderly normal subjects (aged 54-73 years) at rest and during task performance in two sessions separated by an average of 9 weeks. Resting global CBF was lower in the second session, a finding consistent with the known effects of habituation previously reported. Regionally specific activated CBF did not change with repeated measurements. The results provide evidence that the 133Xe technique is reliable and of potential utility in evaluating the effect of the natural course of brain disease, as well as the effects of therapeutic interventions on brain activity.

Gender differences in the clinical expression of schizophrenia

Gender differences have been reported for a variety of clinical measures in patients with schizophrenia. Clinical characterization may be helpful in identifying symptom clusters which can then be linked to underlying brain function. In this study 74 men and 33 women meeting DSM-IIIR criteria for schizophrenia were studied off medication and rated on measures of symptom type and severity, as well as premorbid and current function. Men were more severely impaired in ratings of negative symptoms, while positive symptoms were not significantly different. There were also differences in premorbid and current functioning, with women manifesting better social functioning than men.

Decreases in frontal and parietal lobe regional cerebral blood flow related to habituation

We previously reported decreased mean CBF between consecutive resting conditions, ascribed to habituation. Here we address the regional specificity of habituation over three consecutive flow studies. Regional CBF (rCBF) was measured in 55 adults (12 right-handed men, 12 right-handed women, 14 left-handed men, 17 left-handed women), with the 133Xe inhalation technique, during three conditions: resting, verbal tasks (analogies), and spatial tasks (line orientation). Changes in rCBF attributable to the cognitive tasks were eliminated by correcting these values to a resting equivalent. There was a progressive decrease in mean rCBF over time, reflecting habituation. This effect differed by region, with specificity at frontal (prefrontal, inferior frontal, midfrontal, superior frontal) and inferior parietal regions. In the inferior parietal region, habituation was more marked in the left than the right hemisphere. Right-handers showed greater habituation than did left-handers. There was no sex difference in global habituation, but males showed greater left whereas females showed greater right hemispheric habituation. The results suggest that habituation to the experimental setting has measurable effects on rCBF, which are differently lateralized for men and women. These effects are superimposed on task activation and are most pronounced in regions that have been implicated in attentional processes. Thus, regional decrement in brain activity related to habituation seems to complement attentional effects, suggesting a neural network for habituation reciprocating that for attention.