Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-23T13:27:19.576Z Has data issue: false hasContentIssue false

Verbal memory in first-episode schizophrenia: Heterogeneity in performance?

Published online by Cambridge University Press:  11 April 2005

JASPER NUYEN
Affiliation:
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, Utrecht, the Netherlands
MARGRIET M. SITSKOORN
Affiliation:
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, Utrecht, the Netherlands
WIEPKE CAHN
Affiliation:
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, Utrecht, the Netherlands
RENÉ S. KAHN
Affiliation:
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, Utrecht, the Netherlands

Abstract

It is unclear if the commonly observed “subcortical” verbal memory profile in schizophrenic patients is present at the onset of the disease. Therefore, the performance of 43 first-episode patients with schizophrenia or schizophreniform disorder on the Dutch version of the California Verbal Learning Test (VLGT) was compared to that of 43 normal comparison participants. We hypothesized that the first-episode patients would exhibit a “subcortical” memory profile, that is, they would show a primary retrieval deficit. This hypothesis was not confirmed: the patients displayed a profile suggestive of a prominent storage deficit, that is, a “cortical” memory profile. Subsequently, patients' VLGT performance was cluster analyzed to determine whether subgroups could be identified exhibiting a cortical, subcortical, and normal profile, respectively. Two subgroups (N = 22; N = 13) exhibited memory impairments, while one subgroup (N = 8) was unimpaired. The memory profiles of the two impaired subgroups differed both qualitatively and quantitatively, but did not conform neatly to a cortical and a subcortical profile. Demographic and verbal fluency data provided limited validation of the subgroup classification. Our results may suggest that combining the verbal memory performance of first-episode patients obscures meaningful heterogeneity. Alternatively, the cluster solution could merely reflect a continuum of severity. (JINS, 2005, 11, 152–162.)

Type
Research Article
Copyright
© 2005 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Albus, M., Hubmann, W., Ehrenberg, Ch., Forcht, U., Mohr, F., Sobizack, N., Wahlheim, Ch., & Hecht, S. (1996). Neuropsychological impairment in first-episode and chronic schizophrenic patients. European Archives of Psychiatry and Clinical Neuroscience, 246, 249255.Google Scholar
Aldenderfer, M.S. & Blashfield, R.K. (1984). Cluster analysis. Newberry Park, California: Sage Publications.
Aleman, A., Hijman, R., De Haan, E.H.F., & Kahn, R.S. (1999). Memory impairment in schizophrenia: A meta-analysis. American Journal of Psychiatry, 156, 13581366.Google Scholar
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, (4th ed.). Washington, DC: American Psychiatric Association Press.
Andreasen, N.C. (1987). Comprehensive Assessment of Symptoms and History (CASH). Iowa City, IA: University of Iowa.
Bilder, R.M., Goldman, R.S., Robinson, D., Reiter, G., Bell, L., Bates, J.A., Pappadopulos, E., Willson, D.F., Alvir, J.M.J., Woerner, M.G., Geisler, S., Kane, J.M., & Lieberman, J.A. (2000). Neuropsychology of first-episode schizophrenia: Initial characterization and clinical correlates. American Journal of Psychiatry, 157, 549559.Google Scholar
Binder, J., Albus, M., Hubmann, W., Scherer, J., Sobizack, N., Franz, U., Mohr, F., & Hecht, S. (1998). Neuropsychological impairment and psychopathology in first-episode schizophrenic patients related to the early course of illness. European Archives of Psychiatry and Clinical Neuroscience, 248, 7077.Google Scholar
Buchsbaum, M.S., Haier, R.J., Potkin, S.G., Nuechterlein, K., Bracha, H.S., Katz, M., Lohr, J., Wu, J., Lottenberg, S., Jerabek, P.A., Trenary, M., Tafalla, R., Reynolds, C., & Bunney, W.E. (1992). Frontostriatal disorder of cerebral metabolism in never-medicated schizophrenics. Archives of General Psychiatry, 49, 935942.Google Scholar
Butters, N., Delis, D.C., & Lucas, J.A. (1995). Clinical assessment of memory disorders in amnesia and dementia. Annual Review of Psychology, 46, 493523.Google Scholar
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum.
Delis, D.C., Filoteo, J.V., Massman, P.J., Kaplan, E., & Kramer, J.L. (1994). The clinical assessment of memory disorders. In L.S. Cermark (Ed.), Neuropsychological explorations of memory and cognition: Essays in honor of Nelson Butters (pp. 223238). New York: Plenum Press.
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (1987). California Verbal Learning Test: Manual. San Antonio, TX: Psychological Corporation.
Delis, D.C., Massman, P.J., Butters, N., Salmon, D.P., Cermak, L.S., & Kramer, J.H. (1991). Profiles of demented and amnesic patients on the California Verbal Learning Test: Implications for the assessment of memory disorders. Psychological Assessment, 3, 1926.Google Scholar
Elvevåg, B., Weinstock, D.M., Akil, M., Kleinman, J.E., & Goldberg, T.E. (2001). A comparison of verbal fluency tasks in schizophrenic patients and normal controls. Schizophrenia Research, 51, 119126.Google Scholar
Fletcher, P., McKenna, P.J., Friston, K.J., Frith, C.D., & Dolan, R.J. (1999). Abnormal cingulate modulation of fronto-temporal connectivity in schizophrenia. Neuroimage, 9, 337342.Google Scholar
Gold, S., Arndt, S., Nopoulos, P., O'Leary, D.S., & Andreasen, N.C. (1999). Longitudinal study of cognitive function in first-episode and recent-onset schizophrenia. American Journal of Psychiatry, 156, 13421348.Google Scholar
Gourovitch, M.L., Goldberg, T.E., & Weinberger, D.R. (1996). Verbal fluency deficits in patients with schizophrenia: Semantic fluency is differentially impaired as compared with phonologic fluency. Neuropsychology, 10, 573577.Google Scholar
Gourovitch, M.L., Kirkby, B.S., Goldberg, T.E., Weinberger, D.R., Gold, J.M., Esposito, G., Van Horn, J.D., & Berman, K.F. (2000). A comparison of rCBF patterns during letter and semantic fluency. Neuropsychology, 14, 353360.Google Scholar
Harvey, P.D., Moriarty, P.J., Bowie, C., Friedman, J.I., Parrella, M., White, L., & Davis, K.L. (2002). Cortical and subcortical cognitive deficits in schizophrenia: convergence of classifications based on language and memory skill areas. Journal of Clinical and Experimental Neuropsychology, 24, 5566.Google Scholar
Heinrichs, R.W. & Zakzanis, K.K. (1998). Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12, 426445.Google Scholar
Hoff, A.L., Riordan, H., O'Donnell, D.W., Morris, L., & DeLisi, L.E. (1992). Neuropsychological functioning of first-episode schizophreniform patients. American Journal of Psychiatry, 149, 898903.Google Scholar
Hoff, A.L., Sakuma, M., Wieneke, M., Horon, R., Kushner, M., & DeLisi, L.E. (1999). Longitudinal neuropsychological follow-up study of patients with first-episode schizophrenia. American Journal of Psychiatry, 156, 13361341.Google Scholar
Keshavan, M.S., Rosenberg, D., Sweeney, J.A., & Pettegrew, J.W. (1998). Decreased caudate volume in neuroleptic-naive psychotic patients. American Journal of Psychiatry, 155, 774778.Google Scholar
Kremen, W.S., Seidman, L.J., Faraone, S.V., & Tsuang, M.T. (2003). Is there disproportionate impairment in semantic or phonemic fluency in schizophrenia? Journal of the International Neuropsychological Society, 9, 7988.Google Scholar
Manoach, D.S., Gollub, R.L., Benson, E.S., Searl, M.M., Goff, D.C., Halpern, E., Saper, C.B., & Rauch, S.L. (2000). Schizophrenic subjects show aberrant fMRI activation of dorsolateral prefrontal cortex and basal ganglia during working memory performance. Biological Psychiatry, 48, 99109.Google Scholar
Massman, P.J., Delis, D.C., Butters, N., Dupont, R.M., & Gillin, J.C. (1992). The subcortical dysfunction hypothesis of memory deficits in depression: Neuropsychological validation in a subgroup of patients. Journal of Clinical and Experimental Neuropsychology, 14, 687706.Google Scholar
Meyer-Lindenberg, A., Poline, J.-B., Kohn, P.D., Holt, J.L., Egan, M.F., Weinberger, D.R., & Berman, K.F. (2001). Evidence for abnormal cortical functional connectivity during working memory in schizophrenia. American Journal of Psychiatry, 158, 18091817.Google Scholar
Mohamed, S., Paulsen, J.S., O'Leary, D., Arndt, S., & Andreasen, N. (1999). Generalized cognitive deficits in schizophrenia. Archives of General Psychiatry, 56, 749754.Google Scholar
Monsch, A.U., Bondi, M.W., Butters, N., Paulsen, J.S., Salmon, D.P., Brugger, P., & Swenson, M.R. (1994). A comparison of category and letter fluency in Alzheimer's disease and Huntington's disease. Neuropsychology, 8, 2530.Google Scholar
Mulder, J.L., Dekker, R., & Dekker, P.H. (1996). Verbale Leer en Geheugen Test: Handleiding. Lisse: Swets & Zeitlinger.
Mummery, C.J., Patterson, K., Hodges, J.R., & Wise, R.J. (1996). Generating ‘tiger’ as an animal name or a word beginning with T: Differences in brain activation. Proceedings of the Royal Society of London. Series B: Biological Sciences, 263, 989995.Google Scholar
Nelson, M.D., Saykin, A.J., Flashman, L.A., & Riordan, H.J. (1998). Hippocampal volume reduction in schizophrenia as assessed by magnetic resonance imaging: A meta-analytic study. Archives of General Psychiatry, 55, 433440.Google Scholar
Paulesu, E., Goldacre, B., Scifo, P., Cappa, S.F., Gilardi, M.C., Castiglioni, I., Perani, D., & Fazio, F. (1997). Functional heterogeneity of left inferior frontal cortex as revealed by fMRI. Neuroreport, 8, 20112017.Google Scholar
Paulsen, J.S., Heaton, R.K., Sadek, J.R., Perry, W., Delis, D.C., Braff, D., Kuck, J., Zisook, S., & Jeste, D.V. (1995). The nature of learning and memory impairments in schizophrenia. Journal of the International Neuropsychological Society, 1, 8899.Google Scholar
Pujol, J., Vendrell, P., Deus, J., Kulisevsky, J., Marti-Vilalta, J.L., Garcia, C., Junque, C., & Capdevila, A. (1996). Frontal lobe activation during word generation studied by functional MRI. Acta Neurologica Scandinavica, 63, 109121.Google Scholar
Resnick, S.M. (1992). Matching for education in studies of schizophrenia [letter; comment]. Archives of General Psychiatry, 49, 246.Google Scholar
Rosser, A. & Hodges, J.R. (1994). Initial letter and semantic category fluency in Alzheimer's disease, Huntington's disease, and progressive supranuclear palsy. Journal of Neurology, Neurosurgery and Psychiatry, 57, 13891394.Google Scholar
Rund, B.R. (1998). A review of longitudinal studies of cognitive functions in schizophrenia patients. Schizophrenia Bulletin, 24, 425435.Google Scholar
Savage, C.R. (1997). Neuropsychology of subcortical dementias. Psychiatric Clinics of North America, 20, 911931.Google Scholar
Saykin, A.J., Gur, R.C., Gur, R.E., Mozley, P.D., Mozley, L.H., Resnick, S.M., Kester, D.B., & Stafiniak, P. (1991). Neuropsychological function in schizophrenia. Selective impairment in memory and learning. Archives of General Psychiatry, 48, 618624.Google Scholar
Saykin, A.J., Shtasel, D.L., Gur, R.E., Kester, D.B., Mozley, L.H., Stafiniak, P., & Gur, R.C. (1994). Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia. Archives of General Psychiatry, 51, 124131.Google Scholar
Schmand, B., Lindeboom, J., & Van Harskamp, F. (1992). Nederlandse Leestest voor Volwassenen. Lisse: Swets & Zeitlinger.
Seaton, B.E., Goldstein, G., & Allen, D.N. (2001). Sources of heterogeneity in schizophrenia: The role of neuropsychological functioning. Neuropsychology Review, 11, 4567.Google Scholar
Silverstein, A.B. (1982). Two- and four-subtest short forms of the Wechsler Adult Intelligence Scale–Revised. Journal of Consulting and Clinical Psychology, 50, 415418.Google Scholar
Sitskoorn, M.M., Nuyen, J., Appels, M.C.M., Van der Wee, N.J.A., & Kahn, R.S. (2002). Release from proactive inhibition in schizophrenia and its potential as a genotypic marker. Journal of Clinical and Experimental Neuropsychology, 24, 6781.Google Scholar
Sweeney, J.A., Haas, G.L., Keilp, J.G., & Long, M. (1991). Evaluation of the stability of neuropsychological functioning after acute episodes of schizophrenia: One-year followup study. Psychiatry Research, 38, 6376Google Scholar
Turetsky, B.I., Moberg, P.J., Mozley, L.H., Moelter, S.T., Agrin, R.N., Gur, R.C., & Gur, R.E. (2002). Memory-delineated subtypes of schizophrenia: Relationship to clinical, neuroanatomical, and neurophysiological measures. Neuropsychology, 16, 481490.Google Scholar
Verhage. (1983). Revised scoring method for educational level. University Hospital Groningen: Department of Neuropsychology.
Zakzanis, K.K. & Heinrichs, R.W. (1999). Schizophrenia and the frontal brain: A quantitative review. Journal of the International Neuropsychological Society, 5, 556566.Google Scholar
Zakzanis, K.K., Poulin, P., Hansen, K.T., & Jolic, D. (2000). Searching the schizophrenic brain for temporal lobe deficits: A systematic review and meta-analysis. Psychological Medicine, 30, 491504.Google Scholar