Failure of schizophrenia patients to overcome salient distractors during working memory encoding

Schizophrenia and emotional rubbernecking

Orienting toward emotionally salient information can be adaptive, as when danger needs to be avoided. Consistent with this idea, research has shown that emotionally valenced information draws attention more so than does neutral information in healthy individuals. However, at times this tendency is not adaptive, and it may distract the individual from goals. People with schizophrenia (PSZ), though they frequently show deficits in attentional control, have also been shown to exhibit diminished recognition of and attention to emotional information. In the present study, we investigated how the presentation of emotionally salient information affected performance on a working memory task for PSZ and healthy controls (HC). We found that although hit rates were equal to those of HCs for PSZ, the PSZ made fewer false alarms-resulting in overall better performance-than did the HCs. Deficits in emotional processing in PSZ appear to provide an advantage to them in situations in which salient emotional information competes with active cognitive goals.

A test of the cognitive self-medication hypothesis of tobacco smoking in schizophrenia

BACKGROUND

Heavier tobacco smoking among people with schizophrenia (SCZ) has been suggested to reflect self-medication of cognitive deficits. The idea that cognitive-enhancing effects of nicotine are a primary motivator of tobacco consumption in SCZ and that abstinence would deprive SCZ of such beneficial effects might explain hesitation among providers to pursue smoking cessation in SCZ. This study tested predictions of the cognitive self-medication hypothesis.

METHODS

In three counterbalanced sessions, 17 SCZ and 17 healthy control subjects (HCS), all smokers, were tested under ad libitum smoking or 3.5 hours after abstaining and receiving a nicotine (14 mg/24 hours) or placebo patch.

RESULTS

Attention task performance was improved by transdermal nicotine relative to placebo, with intermediate performance by ad libitum smoking. These effects were of similar size in SCZ and HCS and did not reflect remediation of functions disproportionately impaired in SCZ. Although more SCZ reported that the need to concentrate influenced their smoking, this was not reflected by the actual behavior of these patients. Self-reported ability to concentrate changed with nicotine status in HCS but not SCZ, suggesting insensitivity of SCZ to nicotine-derived performance benefits. Nicotine plasma concentrations after ad libitum smoking were not associated with performance benefits but instead with the propensity to experience nicotine withdrawal upon abstinence. This association was seen selectively in SCZ, suggesting a possible reason for heavier smoking.

CONCLUSIONS

These findings suggest that subjective or objective attentional benefits are unlikely the primary driving force of tobacco consumption in SCZ and should not discourage providers from supporting quit attempts.

Examination of affective and cognitive interference in schizophrenia and relation to symptoms

The nature of emotion deficits in schizophrenia and anhedonia is still unclear, and understanding the nature of these deficits could help improve treatment of chronic symptoms and functional disability. An important mechanism in emotional functioning is attention to affective information. People with schizophrenia (n = 48) and a nonpsychiatric comparison group (n = 28) completed an affective interference task, a task used to assess attention to affective information. Given that the affective interference task also involves prepotent response inhibition, participants also completed a very similar, but nonaffective, cognitive interference task that involves prepotent inhibition but does not require attention to affective information. Results revealed that people with schizophrenia exhibited decreased affective interference on trials with a shorter length of time between the onset of the cue and onset of the target but increased cognitive interference at all time lengths between the cue and target onsets used in the study. In addition, decreased affective interference was associated with increased anhedonia and increased reports of wanting to ignore positive emotions. In contrast, increased cognitive interference was associated with increased communication disturbances and alogia. Overall, these results suggest that there may be a decrease in attention to affective information in schizophrenia and that affective interference is related to anhedonia. At the same time, these results provide further evidence of cognitive control prepotent inhibition deficits in schizophrenia, which are related to communication disturbances and alogia.

Visual working memory capacity: from psychophysics and neurobiology to individual differences

Visual working memory capacity is of great interest because it is strongly correlated with overall cognitive ability, can be understood at the level of neural circuits, and is easily measured. Recent studies have shown that capacity influences tasks ranging from saccade targeting to analogical reasoning. A debate has arisen over whether capacity is constrained by a limited number of discrete representations or by an infinitely divisible resource, but the empirical evidence and neural network models currently favor a discrete item limit. Capacity differs markedly across individuals and groups, and recent research indicates that some of these differences reflect true differences in storage capacity whereas others reflect variations in the ability to use memory capacity efficiently.

Emotional prosody modulates attention in schizophrenia patients with hallucinations

Recent findings have demonstrated that emotional prosody (EP) attracts attention involuntarily (Grandjean et al., 2008). The automat shift of attention toward emotionally salient stimuli can be overcome by attentional control (Hahn et al., 2010). Attentional control is impaired in schizophrenia, especially in schizophrenic patients with hallucinations because the "voices" capture attention increasing the processing load and competing for top-down resources. The present study investigates how involuntary attention is driven by implicit EP in schizophrenia with auditory verbal hallucinations (AVH) and without (NAVH). Fifteen AVH patients, 12 NAVH patients and 16 healthy controls (HC) completed a dual-task dichotic listening paradigm, in which an emotional vocal outburst was paired with a neutral vocalization spoken in male and female voices. Participants were asked to report the speaker's gender while attending to either the left or right ear. NAVH patients and HC revealed shorter response times for stimuli presented to the attended left ear than the attended right ear. This laterality effect was not present in AVH patients. In addition, NAVH patients and HC showed faster responses when the EP stimulus was presented to the unattended ear, probably because of less interference between the attention-controlled gender voice identification task and involuntary EP processing. AVH patients did not benefit from presenting emotional stimuli to the unattended ear. The findings suggest that similar to HC, NAVH patients show a right hemispheric bias for EP processing. AVH patients seem to be less lateralized for EP and therefore might be more susceptible to interfering involuntary EP processing; regardless which ear/hemisphere receives the bottom up input.

Linking microcircuit dysfunction to cognitive impairment: effects of disinhibition associated with schizophrenia in a cortical working memory model

Excitation-inhibition balance (E/I balance) is a fundamental property of cortical microcircuitry. Disruption of E/I balance in prefrontal cortex is hypothesized to underlie cognitive deficits observed in neuropsychiatric illnesses such as schizophrenia. To elucidate the link between these phenomena, we incorporated synaptic disinhibition, via N-methyl-D-aspartate receptor perturbation on interneurons, into a network model of spatial working memory (WM). At the neural level, disinhibition broadens the tuning of WM-related, stimulus-selective persistent activity patterns. The model predicts that this change at the neural level leads to 2 primary behavioral deficits: 1) increased behavioral variability that degrades the precision of stored information and 2) decreased ability to filter out distractors during WM maintenance. We specifically tested the main model prediction, broadened WM representation under disinhibition, using behavioral data from human subjects performing a spatial WM task combined with ketamine infusion, a pharmacological model of schizophrenia hypothesized to induce disinhibition. Ketamine increased errors in a pattern predicted by the model. Finally, as proof-of-principle, we demonstrate that WM deteriorations in the model can be ameliorated by compensations that restore E/I balance. Our findings identify specific ways by which cortical disinhibition affects WM, suggesting new experimental designs for probing the brain mechanisms of WM deficits in schizophrenia.

Impaired contingent attentional capture predicts reduced working memory capacity in schizophrenia

Although impairments in working memory (WM) are well documented in schizophrenia, the specific factors that cause these deficits are poorly understood. In this study, we hypothesized that a heightened susceptibility to attentional capture at an early stage of visual processing would result in working memory encoding problems. 30 patients with schizophrenia and 28 demographically matched healthy participants were presented with a search array and asked to report the orientation of the target stimulus. In some of the trials, a flanker stimulus preceded the search array that either matched the color of the target (relevant-flanker capture) or appeared in a different color (irrelevant-flanker capture). Working memory capacity was determined in each individual using the visual change detection paradigm. Patients needed considerably more time to find the target in the no-flanker condition. After adjusting the individual exposure time, both groups showed equivalent capture costs in the irrelevant-flanker condition. However, in the relevant-flanker condition, capture costs were increased in patients compared to controls when the stimulus onset asynchrony between the flanker and the search array was high. Moreover, the increase in relevant capture costs correlated negatively with working memory capacity. This study demonstrates preserved stimulus-driven attentional capture but impaired contingent attentional capture associated with low working memory capacity in schizophrenia. These findings suggest a selective impairment of top-down attentional control in schizophrenia, which may impair working memory encoding.

A broken filter: prefrontal functional connectivity abnormalities in schizophrenia during working memory interference

Characterizing working memory (WM) abnormalities represents a fundamental challenge in schizophrenia research given the impact of cognitive deficits on life outcome in patients. In prior work we demonstrated that dorsolateral prefrontal cortex (DLPFC) activation was related to successful distracter resistance during WM in healthy controls, but not in schizophrenia. Although understanding the impact of regional functional deficits is critical, functional connectivity abnormalities among nodes within WM networks may constitute a final common pathway for WM impairment. Therefore, this study tested the hypothesis that schizophrenia is associated with functional connectivity abnormalities within DLPFC networks during distraction conditions in WM. 28 patients and 24 controls completed a delayed non-verbal WM task that included transient visual distraction during the WM maintenance phase. We computed DLPFC whole-brain task-based functional connectivity (tb-fcMRI) specifically during the maintenance phase in the presence or absence of distraction. Results revealed that patients failed to modulate tb-fcMRI during distracter presentation in both cortical and sub-cortical regions. Specifically, controls demonstrated reductions in tb-fcMRI between DLPFC and the extended amygdala when distraction was present. Conversely, patients failed to demonstrate a change in coupling with the amygdala, but showed greater connectivity with medio-dorsal thalamus. While controls showed more positive coupling between DLPFC and other prefrontal cortical regions during distracter presentation, patients failed to exhibit such a modulation. Taken together, these findings support the notion that observed distracter resistance deficit involves a breakdown in coupling between DLPFC and distributed regions, encompassing both subcortical (thalamic/limbic) and control region connectivity.

Ventral striatal activation during attribution of stimulus saliency and reward anticipation is correlated in unmedicated first episode schizophrenia patients

Patients with schizophrenia show deficits in motivation, reward anticipation and salience attribution. Several functional magnetic resonance imaging (fMRI) investigations revealed neurobiological correlates of these deficits, raising the hypothesis of a common basis in midbrain dopaminergic signaling. However, investigations of drug-naïve first-episode patients with comprehensive fMRI tasks are still missing. We recruited unmedicated schizophrenia spectrum patients (N=27) and healthy control subjects (N=27) matched for sex, age and educational levels. An established monetary reward anticipation task in combination with a novel task aiming at implicit salience attribution without the confound of monetary incentive was applied. Patients showed reduced right ventral striatal activation during reward anticipation. Furthermore, patients with a more pronounced hypoactivation attributed more salience to neutral stimuli, had more positive symptoms and better executive functioning. In the patient group, a more differentially active striatum during reward anticipation was correlated positively to differential ventral striatal activation in the implicit salience attribution task. In conclusion, a deficit in ventral striatal activation during reward anticipation can already be seen in drug-naïve, first episode schizophrenia patients. The data suggest that rather a deficit in differential ventral striatal activation than a generally reduced activation underlies motivational deficits in schizophrenia and that this deficit is related to the aberrant salience attribution.

Working memory encoding and false memory in schizophrenia and bipolar disorder in a spatial delayed response task

Working memory (WM) impairment is a core feature of schizophrenia, but the contributions of different WM components are not yet specified. Here, we investigated the potential role of inefficient encoding in reduced WM performance in patients with schizophrenia (PSZ). Twenty-eight PSZ, 16 patients with bipolar disorder (PBP), 16 unaffected and unmedicated relatives of PSZ (REL), and 29 demographically matched healthy controls (HC) performed a spatial delayed response task with either low or high WM demands. The demands on attentional selection were also manipulated by presenting distractor stimuli during encoding in some of the trials. After each trial, participants rated their level of response confidence. This allowed us to analyze different types of WM responses. WM was severely impaired in PSZ compared to HC; this reduction was mainly due to an increase in the amount of false memory responses (incorrect responses that were given with high confidence) rather than an increase in the amount of incorrect and not-confident responses. Although PBP showed WM impairments, they did not have increased false memory errors. In contrast, reduced WM in REL was also accompanied by an increase in false memory errors. The presentation of distractors led to a decline in WM performance, which was comparable across groups indicating that attentional selection was intact in PSZ. These findings suggest that inefficient WM encoding is responsible for impaired WM in schizophrenia and point to differential mechanisms underlying WM impairments in PSZ and PBP.

Toward the neural mechanisms of reduced working memory capacity in schizophrenia

People with schizophrenia (PSZ) demonstrate reliable reductions in working memory (WM) capacity (i.e., the number of objects that can be held in memory). The present study asked whether WM impairments in PSZ can be explained by the same neural mechanisms that underlie individual differences in WM capacity among healthy individuals. Specifically, we examined event-related potentials in PSZ and healthy matched controls during a change detection task that required the storage of multiple objects in WM. The amplitude of contralateral delay activity (CDA), which correlates with WM capacity in healthy individuals, was larger in controls than in PSZ for memory loads of 3 and 5 objects, but larger in PSZ than in controls for a memory load of 1. This same pattern was found in the subgroups of PSZ and controls with an equivalent WM capacity. Moreover, the increase in CDA amplitude was correlated with individual differences in capacity in controls, but not in PSZ. These results demonstrate that WM impairment in PSZ is not associated with the same patterns of neural activity that characterize low WM capacity in healthy individuals. We propose that WM impairment in PSZ instead reflects a specific impairment in the ability to distribute attention broadly.

Control of working memory content in schizophrenia

People with schizophrenia (PSZ) exhibit signs of reduced working memory (WM) capacity. However, this may reflect an impairment in managing its content, e.g. preventing irrelevant information from taking up available storage space, rather than a true capacity reduction. We tested the ability to eliminate and update WM content in 38 PSZ and 30 healthy control subjects (HCS). Images of real-world objects were presented consecutively, and a tone cued the item most likely to be tested for memory. On half the trials, randomly intermixed, a second tone occurred. Participants were informed that the item cued by the second tone was now the most likely to be tested, and the item cued by the first tone now the least likely, providing incentive to eliminate the first cued item from WM. Both HCS and PSZ displayed a robust performance advantage for cued items. Unexpectedly, PSZ more efficiently removed the no-longer-essential item from WM than HCS. The magnitude of the WM clearance of this first cued item correlated with memory performance for the newly prioritized second cued item in PSZ, indicating that it was adaptive. However, WM clearance was not associated with WM capacity, ruling out the need to budget limited resources as an explanation for greater clearance in PSZ. A robust correlation between WM clearance and poverty of speech in PSZ instead suggests that the propensity to rapidly clear non-essential information and minimize the number of items in WM may be the reflection of a negative symptom trait. This finding may reflect a more general tendency of PSZ to focus processing more narrowly than HCS.

CNTRICS final biomarker selection: Control of attention

Attention is widely believed to be dysfunctional in schizophrenia. The Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) group previously concluded that the processes involved in the top-down control of attention are particularly impaired in schizophrenia and should be the focus of future research. These processes determine which sources of input should be attended, linking goal representations in prefrontal cortex with more posterior regions that implement the actual selection of attended information. A more recent meeting of the CNTRICS group assessed several paradigms that might be useful for identifying biomarkers of attentional control and that could be used for treatment development and assessment. Two types of paradigms were identified as being particularly promising. In one approach, neural activity is measured (using electroencephalography or functional magnetic resonance imaging) during the period between an attention-directing cue and a target. In a second approach, neural activity is measured under low- and high-distraction conditions. These approaches make it possible to identify the goal representations that guide attention and the interactions between these goal representations and the implementation of selection. Although more basic science research with healthy volunteers and preclinical research with schizophrenia patients is needed before these paradigms will be ready to provide clinically useful biomarkers, they hold substantial promise for aiding in the development and assessment of new treatments.

Cognition in schizophrenia: core psychological and neural mechanisms

The challenge in understanding cognitive impairment in schizophrenia is that people with this illness have deficits in an array of domains. Here, we briefly review evidence regarding the pattern of deficits within three domains: context processing, working memory and episodic memory. We suggest that there may be a common mechanism driving deficits in these domains - an impairment in the ability to actively represent goal information in working memory to guide behavior, a function we refer to as proactive control. We suggest that such deficits in proactive control reflect impairments in dorsolateral prefrontal cortex, its interactions with other brain regions, such as parietal cortex, thalamus and striatum, and the influence of neurotransmitter systems, such as dopamine, GABA and glutamate.

Negative and nonemotional interference with visual working memory in schizophrenia

BACKGROUND

Schizophrenia (SCZ) results in abnormalities affecting both working memory (WM) and emotional processing. Prior work suggests that individuals with SCZ exhibit increased effects of distraction on WM-a deficit that might be exacerbated via emotional interference. However, no study characterized effects of negative and nonemotional interference on visual WM in SCZ with functional magnetic resonance imaging. We tested the hypothesis that SCZ is associated with a general inability to filter distraction versus a specific deficit in the ability to filter aversive emotional distraction.

METHODS

Twenty-eight patients with DSM-IV-diagnosed SCZ and 24 matched control subjects underwent blood-oxygen-level-dependent imaging with functional magnetic resonance imaging at 3-T. Subjects performed a modified delayed-response visual WM task faced with affectively negative, neutral, or task-related interference.

RESULTS

Control subjects showed maximal interference after aversive distraction, whereas patients were more distracted irrespective of interference type. Importantly, aversive distraction resulted in similar across-group activation in regions previously showing robust effects of negative interference. Conversely, after any distraction, patients showed reduced blood-oxygen-level-dependent activity in prefrontal regions previously implicated in filtering interference. Particularly when distracted, SCZ subjects exhibited aberrant responses to nonemotional distraction across posterior cortical regions.

CONCLUSIONS

Results suggest that patients fail to deploy activity associated with distracter filtering exhibited by control subjects. Although SCZ subjects show similar responses to aversive interference across certain regions, there is also evidence of enhanced responses to nonemotional inputs. These results are consistent with a general deficit in the ability of patients to filter distraction, which might be in line with aberrant salience processing as a pathophysiological mechanism in SCZ.

Intact and impaired cognitive-control processes in schizophrenia

Deficits of cognitive-control in schizophrenia have been assumed to result from a single impairment that leads to widespread consequences. Contrary to this view, we hypothesized that different control processes operate at different stages of processing, and that only some of these processes may be impaired. We employed two selection tasks to test the hypothesis that patients with schizophrenia have deficits in selecting information in working memory (WM), but not in selecting perceptual information. In the "Ignore" task, which fosters perceptual selection, participants saw a cue to remember either red or blue words, followed by a memory-set (2 red, 2 blue), a brief delay, and then a probe. The "Suppress" task was similar, except the memory-set came before the instruction-cue, and hence selection had to occur in WM. We recorded reaction time and percentage errors for positive probes ("Valid"), and two kinds of negative probes, those that were supposed to have been dropped from WM ("Lures") and those that had not appeared in the memory-set ("Controls"). Compared to healthy controls, patients were impaired in the Suppress but not the Ignore task. This dissociation implies that there are two different selection mechanisms.