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Neuropsychological evidence for frontostriatal dysfunction in schizophrenia

Published online by Cambridge University Press:  09 July 2009

R. Elliott ,
P. J. McKenna ,
T. W. Robbins  and
B. J. Sahakian
R. Elliott
Affiliation:
Departments of Experimental Psychology and Psychiatry, University of Cambridge and Fulbourn Hospital, Cambridge
P. J. McKenna
Affiliation:
Departments of Experimental Psychology and Psychiatry, University of Cambridge and Fulbourn Hospital, Cambridge
T. W. Robbins
Affiliation:
Departments of Experimental Psychology and Psychiatry, University of Cambridge and Fulbourn Hospital, Cambridge
B. J. Sahakian*
Affiliation:
Departments of Experimental Psychology and Psychiatry, University of Cambridge and Fulbourn Hospital, Cambridge
*
1 Address for correspondence: Dr Barbara J. Sahakian, Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ.
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Synopsis

Schizophrenics and controls were compared on a computerized test of attentional set-shifting which provides a componential analysis of the Wisconsin Card Sort Test and has previously been shown to be sensitive to frontal lobe dysfunction and Parkinson's disease. The main test was of extra-dimensional shifting where subjects are required to shift reponse to an alternative perceptual dimension. In one condition, termed ‘perseveration’, subjects are required to shift to a novel dimension and ignore the previously relevant one. In the other condition, termed ‘learned irrelevance’, subjects are required to shift to the previously irrelevant dimension and ignore a novel one. Chronic medicated schizophrenics (N = 32) show a highly significant impairment on the perseveration but not the learned irrelevance condition, as compared to normal age and IQ matched controls (N = 24). This was true even of a subgroup of patients with preserved IQ. The impairments in attentional set-shifting failed to correlate with patients' scores on the Mini-Mental State Examination (mean; S.D. 26·8; 1·8) or with scores on a test of recognition memory. These results provide evidence for a specific deficit in a set-shifting test of executive function and support a hypothesis of frontostriatal dysfunction in schizophrenia.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 3 , May 1995 , pp. 619 - 630
Copyright
Copyright © Cambridge University Press 1995

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References

Antony, J. C., Lereche, L., Niaz, U., Van Korff, M. R. & Folstein, M. F. (1982). Limits of the ‘mini-mental state examination’ as a screening test for dementia and delirium among hospital patients. Psychological Medicine 2, 397–398.CrossRefGoogle Scholar
Bleuler, E. (1913). Dementia Praecox or the Group of Schizophrenias. (Translated 1950 by Zinkin, J..) International University Press: New York.Google Scholar
Braff, D. L., Heaton, R., Kuck, J., Cullum, M., Moranville, J., Grant, I. & Zisook, S. (1991). The generalised pattern of neuropsychological deficits in outpatients with chronic schizophrenia with heterogeneous Wisconsin Card Sorting Test results. Archives of General Psychiatry 48, 891–898.CrossRefGoogle ScholarPubMed
Cassens, G., Inglis, A. K., Appelbaum, P. S. & Gutheil, T. G. (1990). Neuroleptics: effects on neuropsychological function in chronic schizophrenic patients. Schizophrenia Bulletin 16, 477–499.CrossRefGoogle ScholarPubMed
Corcoran, R. & Upton, D. (1993). A role for the hippocampus in card sorting? Cortex 29, 293–304.CrossRefGoogle ScholarPubMed
Cutting, J. (1985). The Psychology of Schizophrenia. Churchill Livingstone: Edinburgh.Google Scholar
Downes, J. J., Roberts, A. C., Sahakian, B. J., Evenden, J. L., Morris, R. G. & Robbins, T. W. (1989). Impaired extra-dimensional shift performance in medicated and unmedicated Parkinson's disease: evidence for a specific attentional dysfunction. Neuropsychologia 27, 1329–1343.CrossRefGoogle ScholarPubMed
Faber, R., Abrams, R. & Taylor, M. A. (1983). A comparison of schizophrenic patients with formal thought disorder and neurologically impaired patients with aphasia. American Journal of Psychiatry 140, 1348–1357.Google ScholarPubMed
Faber, R. & Reichstein, M. B. (1981). Language dysfunction in schizophrenia. British Journal of Psychiatry 138, 519–522.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Frith, C. D. (1992). The Cognitive Neuropsychology of Schizophrenia. LEA: Hove, Sussex.Google Scholar
Frith, C. D. & Done, J. (1983). Stereotyped responding by schizophrenic patients on a two-choice guessing task. Psychological Medicine 13, 779–786.CrossRefGoogle ScholarPubMed
Frith, C. D. & Done, J. (1988). Towards a neuropsychology of schizophrenia. British Journal of Psychiatry 153, 437–443.CrossRefGoogle ScholarPubMed
Frith, C. D., Leary, J., Cahill, C. & Johnstone, E. C. (1991). Performance on psychological tests. Demographic and clinical correlates of the results of these tests. In Disabilities and Circumstances of Schizophrenic Patients: A Follow-up Study (ed. Johnstone, E. C.). British Journal of Psychiatry 159, supplement 13, 26–29.Google Scholar
Goldberg, T. E., Weinberger, D. R., Berman, K. F., Pliskin, N. H. & Podd, M. H. (1987). Further evidence for a dementia of the prefrontal type in schizophrenia? A controlled study of teaching the Wisconsin Card Sorting Test. Archives of General Psychiatry 44, 1008–1014.CrossRefGoogle ScholarPubMed
Goldberg, T. E., Greenberg, R. D., Griffin, S. J., Gold, J. M., Kleinman, J. E., Pickar, D., Schultz, D. & Weinberger, D. R. (1993). The effect of clozapine on cognition and psychiatric symptoms in patients with schizophrenia. British Journal of Psychiatry 162, 43–48.CrossRefGoogle ScholarPubMed
Goldman-Rakic, P. S. (1987). Circuitry of the prefrontal cortex and the regulation of behavior by representational knowledge. In Handbook of Physiology, vol. 5 (ed. Plum, F. and Mountcastle, V.), pp. 373–417. American Psychological Society: Bethesda, MD.Google Scholar
Hemsley, D. R. (1987). An experimental psychological model for schizophrenia. In Search for the Causes of Schizophrenia (ed. Hafner, H., Gattaz, W. F. and Janzarik, W.). Springer: Heidelberg.Google Scholar
Lange, K. W., Sahakian, B. J., Quinn, N. P., Marsden, C. D. & Robbins, T. W. (1995). Comparison of executive and visuospatial memory function in Huntington's disease and dementia of the Alzheimer-type matched for degree of dementia. Journal of Neurology, Neurosurgery and Psychiatry (in the press).CrossRefGoogle Scholar
Liddle, P. F. & Crow, T. J. (1984). Age disorientation in chronic schizophrenia is associated with global intellectual impairment. British Journal of Psychiatry 144, 193–199.CrossRefGoogle ScholarPubMed
Liddle, P. F. & Morris, D. L. (1991). Schizophrenic syndromes and frontal lobe performance. British Journal of Psychiatry 148, 340–345.CrossRefGoogle Scholar
Liepman, H. (1905). Ueber sturungen des handlens bei Gehirnkranken. Karger: Berlin.Google Scholar
McKenna, P. J. (1987). Pathology, phenomenology and the dopamine hypothesis of schizophrenia. British Journal of Psychiatry 151, 288–301.CrossRefGoogle ScholarPubMed
McKenna, P. J., Tamlyn, D., Lund, C. E., Mortimer, A. M., Hammond, S. & Baddeley, A. D. (1990). Amnesic syndrome in schizophrenia. Psychological Medicine 20, 967–972.CrossRefGoogle ScholarPubMed
McKenna, P. J., Lund, C. E., Mortimer, A. M. & Biggins, C. A. (1991). Motor, volitional and behavioural disorders in schizophrenia: the ‘conflict of paradigms’ hypothesis. British Journal of Psychiatry 158, 328–336.CrossRefGoogle ScholarPubMed
Milner, B. (1964). Some effects of frontal lobectomy in man. In The Frontal Granular Cortex and Behaviour (ed. Warren, J. M. and Akert, A.), pp. 313–331. McGraw-Hill: New York.Google Scholar
Milner, B. (1982). Some cognitive effects of frontal lobe lesions in man. Philosophical Transactions of the Royal Society B 298, 211–226.Google ScholarPubMed
Nelson, H. E. (1982). The National Adult Reading Test (NART). NFER-Nelson: Windsor.Google Scholar
Nelson, H. E., Pantelis, C., Carruthers, K., Speller, J., Baxendale, S. & Barnes, T. R. E. (1990). Cognitive functioning and symptomatology in chronic schizophrenia. Psychological Medicine 20, 357–365.CrossRefGoogle ScholarPubMed
Owen, A. M., Roberts, A. C., Polkey, C. E., Sahakian, B. J. & Robbins, T. W. (1991). Extra-dimensional versus intra-dimensional set shifting performance following frontal lobe excisions, temporal lobe excisions or amygdalo-hippocampectomy in Man. Neuropsychologia 29, 993–1006.CrossRefGoogle ScholarPubMed
Owen, A. M., Roberts, A. C., Hodges, J. R., Summers, B. A., Polkey, C. E. & Robbins, T. W. (1993). Contrasting mechanisms of attentional set-shifting in patients with frontal lobe damage or Parkinson's disease. Brain 116, 1159–1175.CrossRefGoogle ScholarPubMed
Owen, A. M., Sahakian, B. J., Semple, J., Polkey, C. E. & Robbins, T. W. (1995). Visuo-spatial short term recognition memory and learning after temporal lobe excisions, frontal lobe excisions or amygdalo-hippocampectomy in man. Neuropsychologia (in the press).CrossRefGoogle Scholar
Owens, D. G. C. & Johnstone, E. C. (1980). The disabilities of chronic schizophrenia: their nature and the factors contributing to their development. British Journal of Psychiatry 136, 384–393.CrossRefGoogle Scholar
Payne, R. W. (1973). Cognitive abnormalities. In Handbook of Abnormal Psychology (ed. Eysenck, H. J.), pp. 420–483. Pitman: London.Google Scholar
Robbins, T. W. (1990). The case for frontostriatal dysfunction in schizophrenia. Schizophrenia Bulletin 16, 391–402.CrossRefGoogle ScholarPubMed
Roberts, A. C., Robbins, T. W., Everitt, B. J. & Muir, J. L. (1992). A specific form of cognitive rigidity following excitotoxic lesions in the basal forebrain in marmosets. Neuroscience 47, 605–614.CrossRefGoogle ScholarPubMed
Roberts, A. C., De Salvia, M., Wilkinson, L. S., Collins, P., Muir, J. L., Everitt, B. J. & Robbins, T. W. (1994). Effects of prefrontal dopamine depletion on an analogue of the Wisconsin Card Sort Test in monkeys; possible interaction with subcortical dopamine system. Journal of Neuroscience 14, 2531–2544.CrossRefGoogle Scholar
Sahakian, B. J., Morris, R. G., Evenden, J. L., Heald, A., Levy, R., Philpot, M. & Robbins, T. W. (1988). A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain 111, 695–718.CrossRefGoogle ScholarPubMed
Sahakian, B. J., Downes, J. J., Eagger, S., Evenden, J. L., Levy, R., Philpot, M., Roberts, A. C. & Robbins, T. W. (1990). Sparing of attention relative to mnemonic function in a subgroup of patients with dementia of the Alzheimer type. Neuropsychologia 28, 1197–1213.CrossRefGoogle Scholar
Sandson, J. & Albert, M. L. (1984). Varieties of perseveration. Neuropsychologia 22, 715–732.CrossRefGoogle ScholarPubMed
Saykin, A. J., Gur, R. C., Gur, R. E., Mozley, P. D., Mozley, L. H., Resnick, S. M., Kester, B. & Stafinial, P. (1991). Neuropsychological function in schizophrenia. Archives of General Psychiatry 48, 618–624.CrossRefGoogle ScholarPubMed
Shallice, T. (1982). Specific impairments in planning. Philosophical Transactions of the Royal Society B 298, 199–209.Google ScholarPubMed
Shallice, T., Burgess, P. W. & Frith, C. D. (1991). Can the neuropsychological case-study approach be applied to schizophrenia? Psychological Medicine 21, 661–673.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robbins, E. (1978). Research diagnostic criteria (RDC): rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Stevens, M., Crow, T. J., Bowman, M. J. & Coles, E. C. (1978). Age disorientation in schizophrenia: a constant prevalence of about 25% in a chronic mental hospital population? British Journal of Psychiatry 133, 130–136.CrossRefGoogle Scholar
Tamlyn, D., McKenna, P. J., Mortimer, A. M., Lund, C. E., Hammond, S. & Baddeley, A. D. (1992). Memory impairment in schizophrenia: its extent, affiliations and neuropsychological character. Psychological Medicine 22, 101–115.CrossRefGoogle ScholarPubMed
Weinberger, D. R. (1988). Schizophrenia and the frontal lobe. Trends in the Neurosciences 11, 367–370.CrossRefGoogle ScholarPubMed
Weinberger, D. R., Berman, K. F. & Zec, R. F. (1986). Physiological significance of dorsolateral prefrontal cortex in schizophrenia: I. Regional cerebral blood flow evidence. Archives of General Psychiatry 43, 114–124.CrossRefGoogle Scholar
Weinberger, D. R., Berman, K. F., Suddath, R. & Torrey, E. F. (1992). Evidence of dysfunction of a prefrontal-limbic network in schizophrenia: a magnetic resonance imaging and regional cerebral blood flow study of discordant monozygotic twins. American Journal of Psychiatry 149, 890–897.Google ScholarPubMed