精神分裂症首次发病患者及其健康同胞认知功能的比较研究

目的 比较精神分裂症首次发病患者与健康同胞及正常对照认知功能的差异,探讨精神分裂症在认知功能领域的内表型.方法 采用目前常用的范畴流畅测验(CFT)、数字符号编码测验(DSCT)、连线测验(TMT)、韦克斯勒记忆量表第3版(WMS-Ⅲ)空间广度测验(WMS-ⅢSST)、霍普金斯词汇学习测验-修订版(HVLT-R)、简易视觉空间记忆测验-修订版(BVMT-R)、定步调听觉连续加法测验(PASAT)和威斯康星卡片分类测验-64(WCST-64)对92例精神分裂症首次发病患者(患者组)、56例健康同胞(同胞组)和62名健康对照者(对照组)的认知功能进行检测.结果 (1)患者组所有神经心理测验成绩均差于对照组,差异有统计学意义(P＜0.01).(2)同胞组的CFT、DSCT、TMT、HVLT-R即刻记忆和延迟记忆、BVMT-R即刻记忆、PASAT、WCST-64持续错误数、持续反应数和完成分类数的测验成绩差于对照组,差异有统计学意义(P＜0.05).(3)患者组与同胞组的CFT、WCST-64中的持续错误数、持续反应数和完成分类数测验成绩分别为(18.40±12.12)分比( 18.86±5.19)分、(16.48±8.19)分比(14.80±5.86)分、(18.76±10.91)分比(16.86 ±7.73)分、(1.33±2.81)分比(1.63±1.36)分,2组比较差异无统计学意义(P＞0.05),其他神经心理测验成绩比较,患者组差于同胞组,差异有统计学意义(P＜0.05).结论 精神分裂症首次发病患者存在处理速度、工作记忆、言语记忆、空间记忆、注意警觉和执行功能广泛性的认知功能损害,精神分裂症健康同胞存在处理速度、言语记忆、视觉记忆、注意警觉、执行功能的认知缺陷;语义流畅性功能和执行功能可能是精神分裂症的潜在内表型.     

Assessing declarative memory in schizophrenia using Wisconsin Card Sorting Test stimuli: the Paired Associate Recognition Test

The Paired Associate Recognition Test (PART) was developed to measure declarative memory using Wisconsin Card Sorting Test (WCST) stimuli, so that both tasks could be administered during functional neuroimaging to differentiate memory and executive function, and associated frontal and temporal lobe activation in schizophrenia. The current study was designed to compare PART and WCST performance in schizophrenic patients and to examine effects of medication and symptomatology. The PART, WCST, and standard declarative memory tasks were administered to 30 chronic schizophrenic patients and 30 matched healthy control subjects. Supporting task validity was the finding that patients were equally impaired on the PART and the WCST. Neuroleptics did not appear to affect performance. The effect of anticholinergic medication correlated negatively with WCST performance in a small subsample. Severity of schizophrenia-specific symptoms measured at intake on the Brief Psychiatric Rating Scale correlated negatively with performance on the WCST. These results support the application of the PART and WCST in future functional neuroimaging studies.     

Use of the WCST and the WCST-64 in the Assessment of Traumatic Brain Injury

The Wisconsin Card Sorting Test (WCST) has been found to be valid in characterizing cognitive dysfunction in a variety of neurological disorders including traumatic brain injury (TBI). However, the test has been criticized as being too lengthy and frustrating for severely impaired patients. As a result, shortened versions of the WCST have been proposed. The utility of one of these shortened versions, the Wisconsin Card Sorting Test-64 (WCST-64), was examined in 106 persons with TBI. Findings showed strong associations between scores derived from the two tests. WCST scores were predicted from WCST-64 scores with sufficient accuracy for research purposes with adjusted R -squared values ranging from .74 to .87. Using the standard cutpoint of < 40T to indicate impairment or normal performance for perseverative responses from each of the two tests, 91 (86%) of 106 subjects received the same classification showing substantial agreement (Kappa statistic 0.71; 95% CI 0.58–0.84). The WCST and the WCST-64 also performed comparably in predicting functional status at discharge from inpatient rehabilitation using the first score from a principal components analysis as a summary measure (both significant with p =.0002). These findings support the use of the WCST-64 in early evaluations of persons with moderate and severe TBI.     

Cannabis‐related episodic memory deficits and hippocampal morphological differences in healthy individuals and schizophrenia subjects

Cannabis use has been associated with episodic memory (EM) impairments and abnormal hippocampus morphology among both healthy individuals and schizophrenia subjects. Considering the hippocampus' role in EM, research is needed to evaluate the relationship between cannabis‐related hippocampal morphology and EM among healthy and clinical groups. We examined differences in hippocampus morphology between control and schizophrenia subjects with and without a past (not current) cannabis use disorder (CUD). Subjects group‐matched on demographics included 44 healthy controls (CON), 10 subjects with a CUD history (CON‐CUD), 28 schizophrenia subjects with no history of substance use disorders (SCZ), and 15 schizophrenia subjects with a CUD history (SCZ‐CUD). Large‐deformation, high‐dimensional brain mapping with MRI produced surface‐based representations of the hippocampus that were compared across all four groups and correlated with EM and CUD history. Surface maps of the hippocampus were generated to visualize morphological differences. CON‐CUD and SCZ‐CUD were characterized by distinct cannabis‐related hippocampal shape differences and parametric deficits in EM performance. Shape differences observed in CON‐CUD were associated with poorer EM performance, while shape differences observed in SCZ‐CUD were associated with a longer duration of CUD and shorter duration of CUD remission. A past history of CUD may be associated with notable differences in hippocampal morphology and EM impairments among adults with and without schizophrenia. Although the results may be compatible with a causal hypothesis, we must consider that the observed cannabis‐related shape differences in the hippocampus could also be explained as biomarkers of a neurobiological susceptibility to poor memory or the effects of cannabis. © 2015 Wiley Periodicals, Inc.     

The relations between cognition and the independent living skill of shopping in people with schizophrenia

A great deal of interest has developed regarding the impact of cognitive deficits on the everyday functioning of people with schizophrenia. This study examined the relationships between cognitive functioning and the performance of a specific independent living skill (grocery shopping) in a sample of 73 individuals with schizophrenia or schizoaffective disorder. Cognitive variables included tests of verbal memory, executive functioning, verbal fluency, sustained attention and visual motor skill. Functional outcome was measured with the Test of Grocery Shopping Skills, which is an ecologically based performance measure that requires participants to shop for 10 items within an actual grocery store. Accuracy on the shopping task was significantly associated with fewer perseverative responses on the Wisconsin Card Sorting Test, better verbal memory and faster processing speed. Shopping efficiency (i.e. less redundancy) was associated with better performance on several cognitive tasks, including verbal memory, verbal fluency, sustained attention and executive functioning. Results of this study extend previous research by examining the relation between cognition and the actual performance of daily living skills under natural circumstances.     

A study of visual and auditory verbal working memory in schizophrenic patients compared to healthy subjects

Impaired working memory (WM) performance is considered as a central feature of schizophrenia. Divided into two components, verbal and spatial, WM has been shown to involve frontal and parietal regions. Verbal WM can be tested either visually or aurally. The present study aimed to test schizophrenic patients in both visual and auditory verbal WM in order to assess a possible distinct pattern of alteration of these two modalities. Twenty-four schizophrenic patients and 24 healthy controls were compared with 2-back continuous visual and auditory verbal WM testing. Both groups were also tested on a neuropsychological battery including Wisconsin Card Sorting Test (WCST). Schizophrenic patients were less efficient in both verbal WM tests. When taking age and educational level as covariates and both WM modalities as dependent variables, there was no differential effect of modalities across groups. In further exploratory analyses, partial correlations brought association between verbal WM and psychosocial adaptation, WCST and length of illness. These results suggest a similar pattern of alteration of both modalities of verbal WM in schizophrenic patients. The implications of this finding are discussed. Received: 16 February 1999 / Accepted: 20 December 1999     

Use of the WCST and the WCST-64 in the assessment of traumatic brain injury

The Wisconsin Card Sorting Test (WCST) has been found to be valid in characterizing cognitive dysfunction in a variety of neurological disorders including traumatic brain injury (TBI). However, the test has been criticized as being too lengthy and frustrating for severely impaired patients. As a result, shortened versions of the WCST have been proposed. The utility of one of these shortened versions, the Wisconsin Card Sorting Test-64 (WCST-64), was examined in 106 persons with TBI. Findings showed strong associations between scores derived from the two tests. WCST scores were predicted from WCST-64 scores with sufficient accuracy for research purposes with adjusted R-squared values ranging from .74 to .87. Using the standard cutpoint of < 40T to indicate impairment or normal performance for perseverative responses from each of the two tests, 91 (86%) of 106 subjects received the same classification showing substantial agreement (Kappa statistic 0.71; 95% CI 0.58-0.84). The WCST and the WCST-64 also performed comparably in predicting functional status at discharge from inpatient rehabilitation using the first score from a principal components analysis as a summary measure (both significant with p = .0002). These findings support theuse of the WCST-64 in early evaluations of persons with moderate and severe TBI.     

Neuropsychological and oculomotor correlates of spatial working memory performance in schizophrenia patients and controls.

Recent reports of spatial working memory deficits in schizophrenia provide evidence for dorsolateral prefrontal cortical (DLPFC) dysfunction. However, the question of how spatial working memory performance relates to other task impairments in schizophrenia considered reflective of frontal dysfunction, such as the Wisconsin Card Sorting Test (WCST) and smooth pursuit eye tracking, has been largely unexplored. Spatial working memory, as measured by a computerized visual-manual delayed response task (DRT), was evaluated in 42 schizophrenia patients and 54 normal controls. Subjects also completed a battery of neuropsychological and oculomotor tasks. Schizophrenia patients performed as accurately as controls on a no-delay, sensory-motor control condition, but showed a significant impairment in spatial accuracy with the addition of an 8-s delay and verbal distraction task. For the patients, working memory impairment was associated with fewer categories on the WCST, impaired eye tracking, fewer words learned on the Rey Auditory Verbal Learning Test, but not with measures of general cognitive and clinical functioning. Results suggest the presence of a sub-group of schizophrenia patients with common pathophysiology that accounts for the co-variance of several tasks implicating prefrontal dysfunction.     

Executive and amnestic functions of a group of first-degree relatives of schizophrenic patients

Several lines of evidence seem to indicate that some neurocognitive measures could be phenotypic markers of predisposition to schizophrenia. The aim of this study was to investigate 21 patients with schizophrenia, 51 of their first-degree relatives and 46 nonpsychiatric controls, with a series of tests known to be sensitive to prefrontal cortical damage--the Trail Making Test, part B (TMT B), the Wisconsin Card Sorting Test (WCST) and a verbal fluency test (VFT)- and/or sensitive to temporo-hippocampic dysfunctions: verbal and visual memory and verbal learning tests from the Wechsler Memory Scale-Revised (Wechsler, 1987). Since parents and siblings share on average 50% of their genes with the schizophrenic proband, firstly we predicted that the first-degree relatives' performance would be at an intermediate level between patients and control subjects and secondly, we expected that a higher proportion of relatives than of control subjects would be impaired. The patients demonstrated deviant patterns of neuropsychological performance on the three tests sensitive to frontal dysfunctions and on most of the memory and learning tests. In the relative group, performance on the TMT B, VFT, immediate verbal recall and verbal learning was at an intermediate level between both other groups and significantly impaired compared to control subjects. However, the relative group did not differ from the control group on the WCST, immediate visual recall, and delayed verbal and visual recalls. Furthermore, compared to the control group, the percentages of patients and relatives who scored one standard deviation below the mean control group were significantly higher for the VFT and immediate verbal recall scores. Among all the tests studied, the verbal fluency and the immediate verbal recall appeared to be valuable phenotypic markers of schizophrenia since: (i) their mean scores were poorer in the patient and in the relative groups, (ii) the percentages of patients and relatives with poor performance were higher than the percentage of controls, (iii) these deficits were not due to poorer general intellectual abilities in the relative group, (iv) these deficits did not correlate with anxiety or depression scores.     

Executive function in parents of patients with familial versus sporadic bipolar disorder

ObjectiveStudies investigating the cognitive function of healthy relatives of patients with bipolar disorder are conflicting, and the neurocognitive profile of relatives of bipolar disorder probands is still unclear. We aimed to evaluate executive function in unaffected parents of familial and sporadic patients with bipolar disorder.MethodsThe study included 24 unaffected familial parents (FP) of patients with bipolar disorder, 26 unaffected sporadic parents (SP) of patients with bipolar disorder and 26 controls matched with the parents for gender, age and duration of education (76 subjects in total). All of the subjects were interviewed with the Structured Clinical Interview for DSM-IV-Axis I. Executive function was assessed using the California Verbal Learning Test (CVLT), the Trail Making Test (TMT), the Wisconsin Card Sorting Test (WCST) and the Stroop test.ResultsIn comparison to their respective matched controls, FP performed significantly worse on the CVLT, TMT, WCST and Stroop test, whereas SP performed significantly worse only on WCST perseverative errors and Stroop color test. FP performed significantly worse than SP on the CVLT, TMT, and WCST.ConclusionThe present study investigated relatives with and without a family history of bipolar disorder separately and found that executive function was impaired in parents with a positive family history of bipolar disorder. These findings bring more evidence suggesting that deficits in prefrontal executive function and verbal memory are associated with familial vulnerability to bipolar disorder and that executive function and verbal memory impairments may represent a potential endophenotype of bipolar disorder.     

Dynamic testing in schizophrenia: does training change the construct validity of a test?

Dynamic testing typically involves specific interventions for a test to assess the extent to which test performance can be modified, beyond level of baseline (static) performance. This study used a dynamic version of the Wisconsin Card Sorting Test (WCST) that is based on cognitive remediation techniques within a test-training-test procedure. From results of previous studies with schizophrenia patients, we concluded that the dynamic and static versions of the WCST should have different construct validity. This hypothesis was tested by examining the patterns of correlations with measures of executive functioning, secondary verbal memory, and verbal intelligence. Results demonstrated a specific construct validity of WCST dynamic (i.e., posttest) scores as an index of problem solving (Tower of Hanoi) and secondary verbal memory and learning (Auditory Verbal Learning Test), whereas the impact of general verbal capacity and selective attention (Verbal IQ, Stroop Test) was reduced. It is concluded that the construct validity of the test changes with dynamic administration and that this difference helps to explain why the dynamic version of the WCST predicts functional outcome better than the static version.     

A diffusion tensor imaging study of the anterior limb of the internal capsule in schizophrenia

Frontal-subcortical cognitive and limbic feedback loops modulate higher cognitive functioning. The final step in these feedback loops is the thalamo-cortical projection through the anterior limb of the internal capsule (AL-IC). Using diffusion tensor imaging (DTI), we evaluated abnormalities in the AL-IC fiber tract in schizophrenia. Participants comprised 16 chronic schizophrenia patients and 19 male, normal controls, who were group matched for handedness, age, and parental socioeconomic status, and underwent DTI on a 1.5 Tesla GE system. We measured the diffusion indices, fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD), and manually segmented, based on FA maps, AL-IC volume, normalized for intracranial contents (ICC). The results showed a significant reduction in the ICC-corrected volume of the AL-IC in schizophrenia, but did not show diffusion measure group differences in the AL-IC in FA, MD, RD or AD. In addition, in the schizophrenia patients, AL-IC FA correlated positively with performance on measures of spatial and verbal declarative/episodic memory, and right AL-IC ICC-corrected volume correlated positively with more perseverative responses on the Wisconsin Card Sort Test (WCST). We found a reduction in AL-IC ICC-corrected volume in schizophrenia, without FA, MD, RD or AD group differences, implicating the presence of a structural abnormality in schizophrenia in this subcortical white matter region which contains important cognitive, and limbic feedback pathways that modulate prefrontal cortical function. Despite not demonstrating a group difference in FA, we found that AL-IC FA was a good predictor of spatial and verbal declarative/episodic memory performance in schizophrenia.     

Does cognition predict community function only in schizophrenia?: a study of schizophrenia patients, bipolar affective disorder patients, and community control subjects

Cognitive deficits predict functioning in schizophrenia; however, little is known as to whether the association is present in other mental disorders. If specific cognitive deficits uniquely predict functional impairment in schizophrenia the association of select aspects of brain dysfunction with daily living would suggest an intervention target and perhaps a means by which to improve the functioning of schizophrenia patients. The relationship of cognition and functioning was investigated in schizophrenia (n=39), bipolar affective disorder (n=27), and nonpsychiatric control (n=38) participants to determine whether the associations varied across groups. We examined verbal memory, verbal learning, verbal fluency, vigilance, executive functioning, symptomatology, and generalized cognitive functioning for associations with social function. Correlational analyses revealed particular cognitive domains (e.g., verbal memory) to be associated with social functioning in schizophrenia, bipolar, and control subjects; however generalized cognitive function and symptomatology were also associated with social functioning in patients. Multiple regression analyses revealed that in schizophrenia poor verbal memory predicted worse social functioning even after the effects of generalized cognitive dysfunction were considered. Verbal memory indices failed to account for variance in social function in bipolar patients and control subjects after consideration of generalized cognitive function. Bipolar patients with worse planning and problem solving tended to have worse social functioning. Therefore, unlike schizophrenia patients who may fail to process verbally mediated material, bipolar patients' difficulty with logical approaches to problems in daily living may have the greatest impact on their community function.     

Are normative data from the 64-card version of the WCST comparable to the full WCST?

A retrospective study of Wisconsin Card Sorting Test (WCST) protocols was undertaken to determine the equivalence of the full WCST (Heaton, Chelune, Talley, Kay, & Curtiss, 1993) with the single-deck version of the WCST. Census-matched and demographically adjusted standardized scores for the full WCST were compared to the single deck WCST (WCST-64) with 332 clinical protocols using two methods. The comparisons were made using (1) standard scores derived from the new WCST-64 norms (Kongs, Thompson, Iverson, & Heaton, 2000) and from (2) WCST-64 percent scores standardized with the norms intended for the full WCST. The results revealed adequate correlations and accuracy scores for both census-based norms, although WCST-64 scores adjusted for demographic information were not comparable to full WCST scores. Furthermore, the number of cases in which estimated scores performed within an acceptable range of actual full-version WCST scores fell below acceptable ranges. Clinicians are encouraged to use data from the WCST-64 with caution.     

Spatial working memory performance in patients with schizoaffective psychosis versus schizophrenia: a tale of two disorders?

We explored the relationship between schizophrenia and schizoaffective disorder by comparing the two patient groups in terms of their performance on measures of executive functioning (spatial working memory and Wisconsin Card Sorting Test). Patients with schizophrenia (N=34) and those with schizoaffective disorder (N=23) performed significantly poorer than community controls (N=30). However, the schizoaffective and schizophrenia groups did not differ from each other in terms of working memory accuracy or mean response latencies. Similarly, the two patient groups did not differ in terms of the number of categories achieved or number of perseverative errors on the Wisconsin Card Sorting Test. Among the patients, working memory accuracy was associated with number of WCST perseverative errors and number of categories achieved, though working memory performance was not associated with number of WCST nonperseverative errors. These findings indicate that both schizophrenia and schizoaffective disorder are associated with executive functioning deficits. The findings are discussed in the context of the ongoing debate regarding the conceptualization of schizoaffective disorder.     

Learning proficiency on the Wisconsin Card Sorting Test in people with serious mental illness: what are the cognitive characteristics of good learners?

Although it is widely accepted that schizophrenia and other serious mental illnesses (SMI) are associated with neurocognitive difficulties, there is great variability in neurocognitive functioning across individuals. In recent years, a growing number of schizophrenia studies have utilized the concept of learning potential to explore individual variation in cognition. Learning potential refers to the ability to benefit from instruction and is measured by assessing test performance before and after training. The present study was intended to explore the cognitive characteristics associated with learning potential in people with serious mental illness. Sixty individuals with schizophrenia, bipolar or major (unipolar) depression completed a learning potential assessment using the Wisconsin Card Sorting Test (WCST) and a battery of standard cognitive measures. Based on established criteria for WCST learner subgroups, participants were categorized as high achievers, learners or non-retainers. There were several significant cognitive differences among the three learner subgroups. Most notably, individuals who were categorized as learners on the WCST showed significantly better verbal and working memory compared to non-retainers. Secondary analyses revealed that the three SMI diagnostic groups (depression, bipolar, schizophrenia) were similar in learning potential and did not differ on any of the standard cognitive measures. This study provides support for learning potential classification in schizophrenia as well as other serious mental illnesses, and indicates that learning potential may specifically be related to verbal and working memory abilities.     

Verbal recall and recognition in twins discordant for schizophrenia

The nature, neural underpinnings, and etiology of deficits in verbal declarative memory in patients with schizophrenia remain unclear. To examine the contributions of genes and environment to verbal recall and recognition performance in this disorder, the California Verbal Learning Test was administered to a large population-based Finnish twin sample, which included schizophrenic and schizoaffective patients, their non-ill monozygotic (MZ) and dizygotic (DZ) co-twins, and healthy control twins. Compared with controls, patients and their co-twins showed relatively greater performance deficits on free recall compared with recognition. Intra-pair differences between patients and their non-ill co-twins in hippocampal volume and memory performance were highly positively correlated. These findings are consistent with the view that genetic influences are associated with reduced verbal recall in schizophrenia, but that non-genetic influences further compromise these abnormalities in patients who manifest the full-blown schizophrenia phenotype, with this additional degree of disease-related declarative memory deficit mediated in part by hippocampal pathology.     

Cognitive Functioning Predicts Outpatient Service Utilization in Schizophrenia

Aim of the study was to evaluate the cognitive and symptom predictors of outpatient service utilization in schizophrenia. The relationships between cognitive functioning (verbal learning and memory, executive functions), symptoms (positive symptoms, negative symptoms), and outpatient service utilization (case management, medication monitoring), were examined in 20 patients receiving outpatient services at a psychosocial clubhouse over a 12-month period. Executive functions, as measured on the Wisconsin Card Sorting Test (WCST), were the only significant predictor of outpatient service utilization, accounting for over 20% of the variance in total outpatient services used, with greater impairment associated with higher service utilization. Specifically, poorer performance on the WCST was associated with delivery of more case management services, but not medication management services. More case management services may be required to compensate for impairments in executive functioning in patients with schizophrenia.     

Memory and executive function impairments in deficit syndrome schizophrenia

The relationship between deficit syndrome schizophrenia, as determined by the Schedule for the Deficit Syndrome, and impairments in memory and executive function was investigated by administering the Wisconsin Card Sorting Test, the Wechsler Adult Intelligence Test, and the Wechsler Memory Scales to outpatients with deficit (n=33) and non-deficit (n=57) syndrome. A factor analysis of test variables revealed three factors: executive functioning; simple verbal memory; and semantic verbal memory. Results indicated that the deficit group performed significantly worse on the executive functioning factor, but not on either of the verbal memory factors. These findings support the hypothesis that deficit syndrome schizophrenia represents a specific cognitive impairment in executive processing and not necessarily graver global cognitive impairment.     

The WCST-64: a standardized short-form of the Wisconsin Card Sorting Test

The Wisconsin Cart Sorting Test (WCST) is a well-established measure of executive function. Practical and financial constraints have increased the need for abbreviated neuropsychological procedures. A number of abbreviated versions of the WCST have been introduced and cogent arguments can be made for one over another in certain situations. However, the single deck, 64-card WCST (WCST-64) is the most logical and practical short form. Psychological Assessment Resources (PAR) has recently published a new manual with comprehensive norms for the WCST-64. This paper reviews the new product, discusses the comparability of the WCST-64 and the standard version, and suggests directions for future research.