Neuropsychological correlates of eye movement abnormalities in schizophrenic patients and their unaffected relatives

Eye movement abnormalities and their association with cognitive impairments in schizophrenia

BACKGROUND

Eye movement abnormalities have been identified in schizophrenia; however, their relevance to cognition is still unknown. In this study, we explored the general relationship between eye movements and cognitive function.

METHODS

The three eye movement measures (scanpath length, horizontal position gain, and duration of fixations) that were previously reported to be useful in distinguishing subjects with schizophrenia from healthy subjects, as well as Wechsler Adult Intelligence Scale-III (WAIS-III) scores, were collected and tested for association in 113 subjects with schizophrenia and 404 healthy subjects.

RESULTS

Scanpath length was positively correlated with matrix reasoning and digit symbol coding in subjects with schizophrenia and correlated with vocabulary and symbol search in healthy subjects. Upon testing for interaction effects of diagnosis and scanpath length on correlated WAIS-III scores, a significant interaction effect was only observed for matrix reasoning. The positive correlation between scanpath length and matrix reasoning, which was specific to subjects with schizophrenia, remained significant after controlling for demographic confounders such as medication and negative symptoms. No correlation was observed between the two other eye movement measures and any of the WAIS-III scores.

CONCLUSIONS

Herein, we reveal novel findings on the association between eye-movement-based measures of visual exploration and cognitive scores requiring visual search in subjects with schizophrenia and in healthy subjects. The association between scanpath length and matrix reasoning, a measure of perceptual organization in subjects with schizophrenia, implies the existence of common cognitive processes, and subjects with longer scanpath length may be advantageous in performance of perceptual organization tasks.

Working Memory and Attention Influence Antisaccade Error Rate in Schizophrenia

Objectives: Antisaccade error rate has been proposed to be one of the most promising endophenotypes for schizophrenia. Increased error rate in patients has been associated with working memory, attention and other executive function impairments. The relationship between antisaccade error rate and other neuropsychological processes in patients compared to healthy controls has not been explored in depth. This study aimed to replicate the finding of heightened antisaccade error rate in patients and determine which cognitive processes were most strongly associated with antisaccade error rate in both patients and controls. In addition, the study investigated whether different antisaccade task paradigms engage different cognitive processes. Methods: One hundred and ninety-one participants (54 patients with schizophrenia/schizoaffective disorder and 137 controls) completed the antisaccade task, which included both gap and step task parameters. Neuropsychological measures were obtained using the MCCB and the Stroop task. Results: The current study replicated a pronounced antisaccade error rate deficit in patients. In patients, working memory variance was most significantly associated with antisaccade errors made during the step condition, while attentional processes were most associated with errors made during the gap condition. In controls, overall global cognitive performance was most associated with antisaccade rates for both gap and step conditions. Conclusions: The current study demonstrates that in schizophrenia patients, but not controls, elevated antisaccade error rate is associated with attention and working memory, but not with global cognitive impairment or psychopathological processes. Our novel findings demonstrate that the gap and step conditions of the antisaccade task engage different cognitive processes. (JINS, 2019, 25, 174-183).

Behavioural and computational varieties of response inhibition in eye movements

Response inhibition is the ability to override a planned or an already initiated response. It is the hallmark of executive control as its deficits favour impulsive behaviours, which may be detrimental to an individual's life. This article reviews behavioural and computational guises of response inhibition. It focuses only on inhibition of oculomotor responses. It first reviews behavioural paradigms of response inhibition in eye movement research, namely the countermanding and antisaccade paradigms, both proven to be useful tools for the study of response inhibition in cognitive neuroscience and psychopathology. Then, it briefly reviews the neural mechanisms of response inhibition in these two behavioural paradigms. Computational models that embody a hypothesis and/or a theory of mechanisms underlying performance in both behavioural paradigms as well as provide a critical analysis of strengths and weaknesses of these models are discussed. All models assume the race of decision processes. The decision process in each paradigm that wins the race depends on different mechanisms. It has been shown that response latency is a stochastic process and has been proven to be an important measure of the cognitive control processes involved in response stopping in healthy and patient groups. Then, the inhibitory deficits in different brain diseases are reviewed, including schizophrenia and obsessive-compulsive disorder. Finally, new directions are suggested to improve the performance of models of response inhibition by drawing inspiration from successes of models in other domains.This article is part of the themed issue 'Movement suppression: brain mechanisms for stopping and stillness'.

Smooth pursuit eye movements and schizophrenia: literature review

OBJECTIVE

To review the scientific literature about the relationship between impairment on smooth pursuit eye movements and schizophrenia.

METHODS

Narrative review that includes historical articles, reports about basic and clinical investigation, systematic reviews, and meta-analysis on the topic.

RESULTS

Up to 80% of schizophrenic patients have impairment of smooth pursuit eye movements. Despite the diversity of test protocols, 65% of patients and controls are correctly classified by their overall performance during this pursuit. The smooth pursuit eye movements depend on the ability to anticipate the target's velocity and the visual feedback, as well as on learning and attention. The neuroanatomy implicated in smooth pursuit overlaps to some extent with certain frontal cortex zones associated with some clinical and neuropsychological characteristics of the schizophrenia, therefore some specific components of smooth pursuit anomalies could serve as biomarkers of the disease. Due to their sedative effect, antipsychotics have a deleterious effect on smooth pursuit eye movements, thus these movements cannot be used to evaluate the efficacy of the currently available treatments.

CONCLUSION

Standardized evaluation of smooth pursuit eye movements on schizophrenia will allow to use specific aspects of that pursuit as biomarkers for the study of its genetics, psychopathology, or neuropsychology.

Multicenter validation of a bedside antisaccade task as a measure of executive function

OBJECTIVE

To create and validate a simple, standardized version of the antisaccade (AS) task that requires no specialized equipment for use as a measure of executive function in multicenter clinical studies.

METHODS

The bedside AS (BAS) task consisted of 40 pseudorandomized AS trials presented on a laptop computer. BAS performance was compared with AS performance measured using an infrared eye tracker in normal elders (NE) and individuals with mild cognitive impairment (MCI) or dementia (n = 33). The neuropsychological domain specificity of the BAS was then determined in a cohort of NE, MCI, and dementia (n = 103) at UCSF, and the BAS was validated as a measure of executive function in a 6-center cohort (n = 397) of normal adults and patients with a variety of brain diseases.

RESULTS

Performance on the BAS and laboratory AS task was strongly correlated and BAS performance was most strongly associated with neuropsychological measures of executive function. Even after controlling for disease severity and processing speed, BAS performance was associated with multiple assessments of executive function, most strongly the informant-based Frontal Systems Behavior Scale.

CONCLUSIONS

The BAS is a simple, valid measure of executive function in aging and neurologic disease.

Ocular convergence deficits in schizophrenia

Individuals with schizophrenia (SZ) have been reported to exhibit a higher prevalence of convergence insufficiency (CI) than the "normal" adult population. The purpose of this study was to determine if individuals with SZ exhibit clinical signs of CI and to determine if the Convergence Insufficiency Symptom Survey (CISS) is an effective instrument for identifying CI in this population. Twenty participants with SZ and 20 healthy controls (HC) completed the study. The prevalence of CI (15%) in the SZ group was slightly higher than reported norms, but the difference was not significant. The SZ group had significantly higher scores on the CISS than the HC group, but the CISS scores did not correlate with clinical measures of CI in individuals with SZ. The only exception was that SZ patients had a significantly reduced fusional reserve as determined by Sheard's criteria. Further study is needed to determine why individuals with SZ reported symptoms associated with CI even though clinical measures did not support this diagnosis.

Anti-saccade performance predicts executive function and brain structure in normal elders

OBJECTIVE

To assess the neuropsychological and anatomical correlates of anti-saccade (AS) task performance in normal elders.

BACKGROUND

The AS task correlates with neuropsychological measures of executive function and frontal lobe volume in neurological diseases, but has not been studied in a well-characterized normal elderly population. Because executive dysfunction can indicate an increased risk for cognitive decline in cognitively normal elders, we hypothesized that AS performance might be a sensitive test of age-related processes that impair cognition.

METHOD

The percentage of correct AS responses was evaluated in 48 normal elderly subjects and associated with neuropsychological test performance using linear regression analysis and gray matter volume measured on magnetic resonance imaging scans using voxel-based morphometry.

RESULTS

The percentage of correct AS responses was associated with measures of executive function, including modified trails, design fluency, Stroop inhibition, abstraction, and backward digit span, and correlated with gray matter volume in 2 brain regions involved in inhibitory control: the left inferior frontal junction and the right supplementary eye field. The association of AS correct responses with neuropsychological measures of executive function was strongest in individuals with fewer years of education.

CONCLUSIONS

The AS task is sensitive to executive dysfunction and frontal lobe structural alterations in normal elders.