Amnesic syndrome in schizophrenia

Cortical thickness across the cingulate gyrus in schizophrenia and its association to illness duration and memory performance

Schizophrenia has been associated with structural brain abnormalities and cognitive deficits that partly change during the course of illness. In the present study, cortical thickness in five subregions of the cingulate gyrus was assessed in 44 patients with schizophrenia-spectrum disorder and 47 control persons and related to illness duration and memory capacities. In the patients group, cortical thickness was increased in the posterior part of the cingulate gyrus and related to illness duration whereas cortical thickness was decreased in anterior parts unrelated to illness duration. In contrast, cortical thickness was related to episodic and working memory performance only in the anterior but not posterior parts of the cingulate gyrus. Our finding of a posterior cingulate increase may point to either increased parietal communication that is accompanied by augmented neural plasticity or to effects of altered neurodegenerative processes in schizophrenia.

Impaired relational memory in the early stage of psychosis

BACKGROUND

Humans constantly take in vast amounts of information, which must be filtered, flexibly manipulated, and integrated into cohesive relational memories in order to choose relevant behaviors. Relational memory is impaired in chronic schizophrenia, which has been linked to hippocampal dysfunction. It is unclear whether relational memory is impaired in the early stage of psychosis.

METHODS

We studied eye movements during a face-scene pairs task as an indirect measure of relational memory in 89 patients in the early stage of psychosis and 84 healthy control participants. During testing, scenes were overlaid with three equally-familiar faces and participants were asked to recall the matching (i.e. previously-paired) face. During Match trials, one face had been previously paired with the scene. During Non-Match trials, no faces matched the scene. Forced-choice explicit recognition was recorded as a direct measure of relational memory.

RESULTS

Healthy control subjects rapidly (within 250-500 ms) showed preferential viewing of the matching face during Match trials. In contrast, preferential viewing was delayed in patients in the early stage of psychosis. Explicit recognition of the matching face was also impaired in the patient group.

CONCLUSIONS

This study provides novel evidence for a relational memory deficit in the early stage of psychosis. Patients showed deficits in both explicit recognition as well as abnormal eye-movement patterns during memory recall. Eye movements provide a promising avenue for the study of relational memory in psychosis, as they allow for the assessment of rapid, nonverbal memory processes.

A Multisite, Randomized Controlled Clinical Trial of Computerized Cognitive Remediation Therapy for Schizophrenia

The effectiveness of cognitive remediation therapy (CRT) for the neuropsychological deficits seen in schizophrenia is supported by meta-analysis. However, a recent methodologically rigorous trial had negative findings. In this study, 130 chronic schizophrenic patients were randomly assigned to computerized CRT, an active computerized control condition (CC) or treatment as usual (TAU). Primary outcome measures were 2 ecologically valid batteries of executive function and memory, rated under blind conditions; other executive and memory tests and a measure of overall cognitive function were also employed. Carer ratings of executive and memory failures in daily life were obtained before and after treatment. Computerized CRT was found to produce improvement on the training tasks, but this did not transfer to gains on the primary outcome measures and most other neuropsychological tests in comparison to either CC or TAU conditions. Nor did the intervention result in benefits on carer ratings of daily life cognitive failures. According to this study, computerized CRT is not effective in schizophrenia. The use of both active and passive CCs suggests that nature of the control group is not an important factor influencing results.

Are conceptual abilities impaired in schizophrenia?

Whereas semantic processing deficits are well-documented in schizophrenia, conceptual abilities have been poorly explored. This study aims at specifically exploring conceptualization abilities in 34 adults fulfilling schizophrenia according to DSM-IV and 34 healthy controls with similar socio-demographic characteristics. The 2 groups were assessed on the WAIS-R similarities test and the concept generation test (Raoux et al., 2014) consisting of free-sorting 6 cards of pictures of animals and geometric shapes to be separated in two groups or categories based on common attributes. After each sorting, the participant is asked to explain his/her sorting. Whereas the schizophrenic patients performed significantly poorer than the control participants in the semantic knowledge and lexico-semantic tests, there was no difference neither in the WAIS-R similarities test nor in the concept generation test, which supports the hypothesis of preserved high level conceptualization abilities in schizophrenia. However, qualitative differences in performing the concept generation test were evidenced. The patients used more often mixed criteria leading them to compare two different hierarchical levels (e.g., low-level physical attributes vs. high-level semantic criteria). Furthermore, the qualitative analysis based on the explanations provided by the participants shows that the categorizations achieved by schizophrenic patients are more often based on unexpected criteria.

Slow Progression of Cognitive Dysfunction of Alzheimer's Disease in Sexagenarian Women with Schizophrenia

Although both schizophrenia (SCZ) and Alzheimer's disease (AD) are among the most common psychiatric diseases, the interaction of these two is not well-understood. We investigated three women with SCZ who developed AD in their 60s. The patients presented with cognitive dysfunction such as loss of recent memory, which was confirmed by both clinical observations and neuropsychological tests. Their magnetic resonance and functional imaging findings were consistent with AD. Their brain atrophy advanced significantly during a 6-year observation period. However, their global cognitive function did not deteriorate significantly during this period. Although the cognitive reserve model might account for this discrepancy, our results suggest some interactions between the neuropathology of SCZ and AD and warrant further research.

The linguistics of schizophrenia: thought disturbance as language pathology across positive symptoms

We hypothesize that linguistic (dis-)organization in the schizophrenic brain plays a more central role in the pathogenesis of this disease than commonly supposed. Against the standard view, that schizophrenia is a disturbance of thought or selfhood, we argue that the origins of the relevant forms of thought and selfhood at least partially depend on language. The view that they do not is premised by a theoretical conception of language that we here identify as 'Cartesian' and contrast with a recent 'un-Cartesian' model. This linguistic model empirically argues for both (i) a one-to-one correlation between human-specific thought or meaning and forms of grammatical organization, and (ii) an integrative and co-dependent view of linguistic cognition and its sensory-motor dimensions. Core dimensions of meaning mediated by grammar on this model specifically concern forms of referential and propositional meaning. A breakdown of these is virtually definitional of core symptoms. Within this model the three main positive symptoms of schizophrenia fall into place as failures in language-mediated forms of meaning, manifest either as a disorder of speech perception (Auditory Verbal Hallucinations), abnormal speech production running without feedback control (Formal Thought Disorder), or production of abnormal linguistic content (Delusions). Our hypothesis makes testable predictions for the language profile of schizophrenia across symptoms; it simplifies the cognitive neuropsychology of schizophrenia while not being inconsistent with a pattern of neurocognitive deficits and their correlations with symptoms; and it predicts persistent findings on disturbances of language-related circuitry in the schizophrenic brain.

Screening of Cognitive Impairment in Schizophrenia: Reliability, Sensitivity, and Specificity of the Repeatable Battery for the Assessment of Neuropsychological Status in a Spanish Sample

BACKGROUND

In recent years, a number of studies focusing on the evaluation of neuropsychological deficits in individuals with schizophrenia have shown deficits that include several cognitive functions. Attention deficits as well as memory or executive function deficits are common in this kind of disorder together with sustained attention problems, working memory deficiencies, and problem-solving difficulties, among many others. Currently, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is gaining special importance in the evaluation of the cognitive deficits associated with schizophrenia.

METHOD

In this article, we describe an RBANS screening in a sample of 88 Spanish patients diagnosed with schizophrenia. We also aimed to check the battery's reliability, sensitivity, and specificity in the studied sample. We performed a comparative study with 88 healthy participants.

RESULTS

The results showed a reliability index value of α = .795 and an item value of α = .762. For total test reliability, we obtained an index value of α = .761 and an item value of α = .762. Sensitivity score was 87.5% and specificity 86.4%.

CONCLUSIONS

RBANS obtained good reliability, sensitivity, and specificity scores and represents a good screening tool in detecting cognitive deficits associated with schizophrenia.

Neurocognitive similarities between severe chronic schizophrenia and behavioural variant frontotemporal dementia

This study focuses on a group of patients with chronic schizophrenia who have a more severe form of the disorder, as indicated by socio-functional decline, treatment resistance, and recurrent hospitalisation. Previous research has suggested that the pattern and severity of cognitive deficits in people with severe chronic schizophrenia is similar to that observed in behavioural variant frontotemporal dementia (bvFTD). In the current study, we compared neurocognitive performance in 16 cognitive domains in 7 inpatients with severe chronic schizophrenia, 13 community-dwelling outpatients with chronic schizophrenia, 12 patients with bvFTD, and 18 healthy controls. Our findings revealed more similar cognitive profiles between the schizophrenia inpatient and bvFTD groups compared to the schizophrenia outpatient group, who outperformed the former groups. The current results provide preliminary evidence for a distinct schizophrenia subgroup, distinguishable from other chronic schizophrenia patients by poorer clinical and functional status, who have levels of cognitive impairment comparable to those seen in bvFTD patients.

Mismatch negativity indexes illness-specific impairments of cortical plasticity in schizophrenia: a comparison with bipolar disorder and Alzheimer's disease

Cognitive impairment is an important predictor of functional outcome in patients with schizophrenia, yet its neurobiology is still incompletely understood. Neuropathological evidence of impaired synaptic connectivity and NMDA receptor-dependent transmission in superior temporal cortex motivated us to explore the correlation of in vivo mismatch negativity (MMN) with cognitive status in patients with schizophrenia. MMN elicited in a roving stimulus paradigm displayed a response proportional to the number of stimulus repetitions (memory trace effect). Preliminary evidence in patients with chronic schizophrenia suggests that attenuation of this MMN memory trace effect was correlated with the degree of neuropsychological memory dysfunction. Here we present data from a larger confirmatory study in patients with schizophrenia, bipolar disorder, probable Alzheimer's disease and healthy controls. We observed that the diminution of the MMN memory trace effect and its correlation with memory impairment was only found in the schizophrenia group. Recent pharmacological studies using the roving paradigm suggest that attenuation of the MMN trace effect can be understood as abnormal modulation of NMDA receptor-dependent plasticity. We suggest that the convergence of the previously identified synaptic pathology in supragranular cortical layers with the intracortical locus of MMN generation accounts for the remarkable robustness of MMN impairments in schizophrenia. We further speculate that this layer-specific synaptic pathology identified in supragranular neurons plays a pivotal computational role, by weakening the encoding and propagation of prediction errors to higher cortical modules. According to predictive coding theory such breakdown will have grave implications not only for perception, but also for higher-order cognition and may thus account for the MMN-cognition correlations observed here. Finally, MMN is a sensitive and specific biomarker for detecting the early prodromal phase of schizophrenia and is well suited for the exploration of novel cognition-enhancing agents in humans.

Electrophysiological investigation of source memory in early childhood

Recollection is well-characterized in adults and school-aged children, yet little is known about how this ability develops in early childhood. This study utilized a behavioral source memory paradigm and event-related potentials (ERPs) to examine recollection in early childhood. ERPs were compared between items whose context was remembered and forgotten as well as new items. Activity late in the electrophysiological response showed a "recollection" effect, which differentiated items with correct source judgments from all others. This study is unique in that it is the first to provide information regarding the spatiotemporal dynamics of the neural networks underlying recollection during early childhood.

Verbal learning and memory and their associations with brain morphology and illness course in schizophrenia spectrum psychoses

The California Verbal Learning Test and structural brain imaging were administered to 57 subjects with schizophrenia spectrum disorders and 94 controls in a general population sample. Cases had lower semantic cluster scores. Poorer verbal memory strategies were associated with longer duration of illness and heavier use of antipsychotic medication. After controlling for duration of illness, sex, and total gray matter, poorer verbal memory was associated with lower gray matter volume in the cingulate cortex, juxtapositional lobule, right superior temporal gyrus, and precuneus. After controlling for use of antipsychotic medication, there was an association between higher serial clustering and smaller anterior cingulate gyrus and larger intracalcarine cortex.

Use of eye movement monitoring to examine item and relational memory in schizophrenia

BACKGROUND

Patients with schizophrenia may be impaired at remembering interitem and item-context relationships (relational memory), even when memory for items is intact. Here, we applied the novel approach of using eye movements to assess integrity of item and relational memory in schizophrenia. This method does not rely on introspection and may be more readily translated to animal models than traditional behavioral methods.

METHODS

Sixteen healthy control subjects and 16 patients were administered a scene memory task while eye movements were monitored. During testing, participants indicated whether the scenes were unchanged, contained a new item (item manipulation), had a change in item location (relational manipulation), or were new. It was predicted that memory would be disproportionately impaired when relational changes were made.

RESULTS

Results confirmed that tasks were equally difficult and showed that patients were impaired identifying all scene types. These behavioral impairments were associated with more severe disorganization and negative symptoms. Eye movement results were more specific. Both groups looked disproportionately at critical regions of repeated versus novel scenes-an effect of scene repetition. However, in contrast with predictions, patients showed equivalent eye-movement-based memory impairment whether changes were relational or item-based.

CONCLUSIONS

This is the first experiment to demonstrate that eye movements can be used to investigate item and relational memory in schizophrenia. The eye movement procedure was well tolerated and was more specific than behavioral measures with respect to memory impairment. Results suggest that eye movements may be of use in clinical trials and translational studies employing animal models.

An investigation of 3 neurocognitive subtypes in schizophrenia

The purpose of this investigation was to identify patients with cognitively impaired, cognitively normal and verbal memory-impaired subtypes of schizophrenia and to examine their clinical and functional validity as distinct forms of the disorder. These subtypes occurred in 73 of 154 patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder. A control group comprised of 18 healthy participants was also analyzed. Patient subtype and healthy groups were compared on adjunct cognitive as well as clinical and functional measures. The data support the cognitive validity and differentiation of these subtypes, with evidence that the generalized cognitive normality/impairment distinction associates with important aspects of symptom severity and functional outcome. Support for the clinical and functional validity of the verbal memory subtype was more equivocal. Overall, cognitively-based subtyping merits additional attention in efforts to organize the heterogeneity of the schizophrenia syndrome.

The impact of blood pressure on hippocampal glutamate and mnestic function

Hypertension is associated with an increased risk of cognitive decline, which is generally regarded as a consequence of advanced cerebral atherosclerosis. Many hypertensive patients, however, suffer from cognitive decline long before they have any signs of cerebrovascular disease. Therefore, this study examines direct effects of blood pressure on neurotransmitter status in the hippocampus, a vulnerable cerebral structure relevant for memory consolidation. Absolute glutamate concentration and N-acetylaspartate (NAA) concentration as an alternative marker of neuronal integrity were determined in the hippocampus and the cerebral cortex (anterior cingulate cortex; ACC) by 3-T proton magnetic resonance spectroscopy in 16 probands without any history of cerebrovascular disease. Memory function was tested by the auditory verbal learning test (AVLT) and the rivermead behavioural memory test (RBMT). Arterial stiffness was assessed by augmentation index (AI). Mean arterial pressure showed a significant negative age-adjusted correlation to absolute glutamate concentrations in the hippocampus (R=-0.655, P=0.011), but not in the ACC. There was no significant correlation of mean arterial pressure and NAA in either hippocampus or ACC. AI did not affect hippocampal glutamate. Moreover, there was a significant negative correlation between mean arterial pressure and AVLT (r=-0.558, P=0.025) and RBMT score (r=-0.555, P=0.026). There is an inverse relation between blood pressure and the concentration of hippocampal glutamate. Glutamate is essential for long-term potentiation, the neurobiological correlate for memory formation in the hippocampus. Thus, hypertension-associated cognitive decline may not only be mediated by structural atherosclerotic wall changes, but also by functional changes in neurotransmission.

Cognitive function, social functioning and quality of life in first-episode psychosis: A 1-year longitudinal study

Abstract Objective. The majority of patients with schizophrenia have cognitive deficits early in the disease. We evaluated the relationship between cognitive function, social functioning and quality of life in patients with first-episode psychosis. Methods. This was a longitudinal study in 15 patients aged 18-30 years who had recently experienced a first psychotic episode and were treated with the atypical antipsychotic aripiprazole, cognitive-behavioural therapy, psycho-educational sessions, family supportive sessions and social interventions. Patients were evaluated at baseline and after 1 year. Cognitive assessment included attention, memory, language skills and problem solving. Social functioning, quality of life, and psychopathological evaluation were performed with validated tools. Results. At baseline, patients had a severe impairment of social functioning and a low quality of life, while a specific pattern of cognitive functions was not identified. After 1-year, we observed a significant improvement in social functioning and quality of life, without a significant decrease in cognitive function. Conclusion. Contrary to previous findings, we found that social functioning and quality of life are related, but independent of cognitive impairment. The use of antipsychotic agents that do not interefere with cognitive function plus psychological assistance is a valuable treatment approach in patients with first-episode schizophrenia.

On giving a more active and selective role to consciousness

An active role for conscious processes in the production of behaviour is proposed, involving top level controls in a hierarchy of behavioural control. It is suggested that by inhibiting or sensitizing lower levels in the hierarchy conscious processes can play a role in the organization of ongoing behaviour. Conscious control can be more or less evident, according to prevailing circumstances.

The control of consciousness via a neuropsychological feedback loop

Gray's neuropsychological model of consciousness uses a hierarchical feedback loop framework that has been extensively discussed by many others in psychology. This commentary therefore urges Gray to integrate with, or at least acknowledge previous models. It also points out flaws in his feedback model and suggests directions for further theoretical work.

Don't leave the “un” off “consciousness”

Gray extrapolates from circuit models of psychopathology to propose neural substrates for the contents of consciousness. I raise three concerns: (1) knowledge of synaptic arrangements may be inadequate to fully support his model; (2) latent inhibition deficits in schizophrenia, a focus of this and related models, are complex and deserve replication; and (3) this conjecture omits discussion of the neuropsychological basis for the contents of the unconscious.

Consciousness is for other people

Gray has expanded his account of schizophrenia to explain consciousness as well. His theory explains neither phenomenon adequately because he treats individual minds (and brains) in isolation. The primary function of consciousness is to permit high level interactions with other conscious beings. The key symptoms of schizophrenia reflect a failure of this mechanism.

Comparators, functions, and experiences

The comparator model is insufficient for three reasons. First, consciousness is involved in the process of comparison as well as in the output. Second, we still do not have enough neurophysiological information to match the events of consciousness, although such knowledge is growing. Third, the anatomical localisation proposed can be damaged bilaterally but consciousness will persist.

Possible roles for a predictor plus comparator mechanism in human episodic recognition memory and imitative learning

This commentary is divided into two parts. The first considers a possible role for Gray's predictor plus comparator mechanism in human episodic recognition memory. It draws on the computational specifications of recognition outlined in Humphreys et al. (1994) to demonstrate how the logically necessary components of recognition tasks might be mapped onto the mechanism. The second part demonstrates how the mechanism outlined by Gray might be implicated in a form of imitative learning suitable for the acquisition of complex tasks.

Consciousness does not seem to be linked to a single neural mechanism

On the basis of neuropsychological evidence, it is clear that attention should be given a role in any model (or conjecture) of consciousness. What is known about the many instances of dissociation between explicit and implicit knowledge after brain damage suggests that conscious experience might not be linked to a restricted area of the brain. Even if it were true that there is a single brain area devoted to consciousness, the subicular area would seem to be an unlikely possibility.

Segmentalized consciousness in schizophrenia

Segmentalized consciousness in schizophrenia reflects a loss of the normal Gestalt organization and contextualization of perception. Grays model explains such segmentalization in terms of septohippocampal dysfunction, which is consistent with known neuropsychological impairment in schizophrenia. However, other considerations suggest that everyday perception and its failure in schizophrenia also involve prefrontal executive mechanisms, which are only minimally elaborated by Gray.

Unitary consciousness requires distributed comparators and global mappings

Gray, like other recent authors, seeks a scientific approach to consciousness, but fails to provide a biologically convincing description, partly because he implicitly bases his model on a computationalist foundation that embeds the contents of thought in irreducible symbolic representations. When patterns of neural activity instantiating conscious thought are shorn of homuncular observers, it appears most likely that these patterns and the circuitry that compares them with memories and plans should be found distributed over large regions of neocortex.

On seeking the mythical fountain of consciousness

Because consciousness has an organizational, or functional, center, Gray supposes that there must be a corresponding physical center in the brain. He proposes further that since this center generates consciousness, ablating it would eliminate consciousness, while leaving behavior intact. But the center of consciousness is simply the product of the functional linkages among sensory input, memory, inner speech, and so on, and behavior.

Prospects for a cognitive neuroscience of consciousness

In this commentary, I point out some weaknesses in Gray's target article and, in the light of that discussion, I attempt to delineate the kinds of problem a cognitive neuroscience of consciousness faces on its way to a scientific understanding of subjective experience.

Septohippocampal comparator: Consciousness generator or attention feedback loop?

As Gray insists, his comparator model proposes a brute correlation only – of consciousness with septohippocampal output. I suggest that the comparator straddles a feedback loop that boosts the activation ofnovelrepresentations, thus helping them feature in present or recollected experience. Such a role in organizing conscious contents would transcend correlation and help explain how consciousness emerges from brain function.

Perspective, reflection, transparent explanation, and other minds

Perspective and reflection (whether involving conceptual or nonconceptual content) have each been considered in some way basic to phenomenal consciousness. Each has possible evolutionary value, though neither seems sufficient for consciousness. Consider an account of consciousness in terms of the combination of perspective and reflection, its relationship to the problem of other minds, and its capacity to inherit evolutionary explanation from its components.

Psychopathology and the discontinuity of conscious experience

It is accepted that “primary awareness” may emerge from the integration of two classes of information. It is unclear, however, why this cannot take place within the comparator rather than in conjunction with feedback to the perceptual systems. The model has plausibility in relation to the continuity of conscious experience in the normal waking state and may be extended to encompass certain aspects of the “sense of self” which are frequently disrupted in psychotic patients.

Consciousness, memory, and the hippocampal system: What kind of connections can we make?

Gray's account is remarkable in its depth and scope but too little attention is paid to poor correspondences with the literature on hippocampal/subicular damage, the theta rhythm, and novelty detection. An alternative account, focusing on hippocampal involvement in organizing memories in a way that makes them accessible to conscious recollection but not in access to consciousness per se, avoids each of these limitations.

Communication and consciousness: A neural network conjecture

The communicative aspects of the contents of consciousness are analyzed in the framework of a neural network model of animal communication. We discuss some issues raised by Gray, such as the control of the contents of consciousness, the adaptive value of consciousness, conscious and unconscious behaviors, and the nature of a model's consciousness.

Overworking the hippocampus

The postulated hippocampal comparator, like any other subsystem, must rely on “syntactic” patterns in its “input,” and hence could not have the extraordinary powers Gray supposes. It may play a more modest role, but it is not the place “where it all comes together” for consciousness.

Consciousness and its (dis)contents

The first claim in the target article was that there is as yet no transparent, causal account of the relations between consciousness and brain-and-behaviour. That claim remains firm. The second claim was that the contents of consciousness consist, psychologically, of the outputs of a comparator system; the third consisted of a description of the brain mechanisms proposed to instantiate the comparator. In order to defend these claims against criticism, it has been necessary to clarify the distinction between consciousness-as-such and the contents of consciousness, to widen the description of the neural machinery instantiating the comparator system, and to clarify the relationship between the contents of consciousness in the here-and-now and episodic memory.

The contents of consciousness: A neuropsychological conjecture

Drawing on previous models of anxiety, intermediate memory, the positive symptoms of schizophrenia, and goal-directed behaviour, a neuropsychological hypothesis is proposed for the generation of the contents of consciousness. It is suggested that these correspond to the outputs of a comparator that, on a moment-by-moment basis, compares the current state of the organism's perceptual world with a predicted state. An outline is given of the information-processing functions of the comparator system and of the neural systems which mediate them. The hypothesis appears to be able to account for a number of key features of the contents of consciousness. However, it is argued that neitherthis nor any existing comparable hypothesis is yet able to explain why the brain should generate conscious experience of any kind at all.

The elusive quale

If sensations were behaviorally conceived, as they should be, as complex functional patterns of interaction between overt behavior and the environment, there would be no point in searching for them as instantaneous psychic elements (qualia) within the brain or as internal products of the brain.

Information synthesis in cortical areas as an important link in brain mechanisms of mind

To explore the mechanism of sensation correlations between EP (evoked potential) component amplitude and signal detection indices (d' and criterion) were studied. The time of sensation coincided with the peak latency of those EP components that showed a correlation with both indices. The components presumably reflected information synthesis in projection cortical neurons. A mechanism providing the synthesis process is proposed.

The limits of neurophysiological models of consciousness

This commentary elaborates on Gray's conclusion that his neurophysiological model of consciousness might explain how consciousness arises from the brain, but does not address how consciousness evolved, affects behaviour or confers survival value. The commentary argues that such limitations apply to all neurophysiological or other thirdperson perspective models. To approach such questions the first-person nature of consciousness needs to be taken seriously in combination with third-person models of the brain.

Reticular-thalamic activation of the cortex generates conscious contents

Gray hypothesizes that the contents of consciousness correspond to the outputs of a subicular (hippocampal/temporal lobe) comparator that compares the current state of the organism's perceptual world with a predicted state. I argue that Gray has identified a key contributing system to conscious awareness, but that his model is inadequate for explaining how conscious contents are generated in the brain. An alternative model is offered.

Hunting for consciousness in the brain: What is (the name of) the game?

Robust theories concerning the connection between consciousness and brain function should derive not only from empirical evidence but also from a well grounded inind-body ontology. In the case of the comparator hypothesis, Gray develops his ideas relying extensively on empirical evidence, but he bounces irresolutely among logically incompatible metaphysical theses which, in turn, leads him to excessively skeptical conclusions concerning the naturalization of consciousness.

Mind – your head!

Gray takes an information-processing paradigm as his departure point, invoking a comparator as part of the system. He concludes that consciousness is to be found “in” the comparator but is unable to point to how the comparison takes place. Thus, the comparator turns out not to be an entity arising out of brain research per se, but out of the logic of the paradigm. In this way, Gray both reinvents dualism and remains trapped in the language game of his own model – ending up dealing with the unknowable.

The homunculus at home

In Gray's conjecture, mismatches in the subicular comparator (needing problem resolution) and matches (during appetitive approach) have equal prominence in consciousness. In rival cognitive views novelty and difficulty (i.e., information-processing mismatches) especially elicit more conscious modes of cognition and higher levels of self-regulation. The mismatch between Gray's conjecture and these views is discussed.

Working memory in schizophrenia: a meta-analysis

BACKGROUND

Memory impairment is being recognized increasingly as an important feature of the neuropsychology of schizophrenia. Dysfunction of working memory, a system for the short-term storage and manipulation of information, may relate to a number of core symptoms of schizophrenia. Many studies have examined working memory function in schizophrenia but a clear understanding of the nature and extent of any deficit has been elusive.

METHOD

A systematic review and meta-analysis of studies comparing working memory function in subjects with schizophrenia and healthy controls was performed. Following a comprehensive literature search, meta-analyses were conducted on 36 measures of phonological, visuospatial and central executive working memory functioning, encompassing 441 separate results from 187 different studies.

RESULTS

Statistically significant effect sizes were found for all working memory measures, indicating deficits in schizophrenia groups. Some of these were robust findings in the absence of evidence of significant heterogeneity or publication bias. Meta-regression analyses showed that the working memory deficit was not simply explained by discrepancies in current IQ between schizophrenia and control groups.

CONCLUSIONS

Large deficits in working memory were demonstrated in schizophrenia groups across all three working memory domains. There were, however, no clear differences across subdomains or between particular working memory tasks. There was substantial heterogeneity across results that could only be partly explained.

Recognition memory probes affect what is remembered in schizophrenia

Cognitive psychology offers tools to localize the memory processes most vulnerable to disruption in schizophrenia and to identify how patients with schizophrenia best remember. In this research, we used the University of Southern California Repeatable Episodic Memory Test (USC-REMT; Parker, E.S., Landau, S.M., Whipple, S.C., Schwartz, B.L., 2004. Aging, recall, and recognition: A study on the sensitivity of the University of Southern California Repeatable Episodic Memory Test (USC-REMT). Journal of Clinical and Experimental Neuropsychology 26(3), 428-440.) to examine how two different recognition memory probes affect memory performance in patients with schizophrenia and matched controls. Patients with schizophrenia studied equivalent word lists and were tested by yes-no recognition and forced-choice recognition following identical encoding and storage conditions. Compared with controls, patients with schizophrenia were particularly impaired when tested by yes-no recognition relative to forced-choice recognition. Patients had greatest deficits on hits in yes-no recognition but did not exhibit elevated false alarms. The data point to the importance of retrieval processes in schizophrenia, and highlight the need for further research on ways to help patients with schizophrenia access what they have learned.

Systemic hypotheses for generalized cognitive deficits in schizophrenia: a new take on an old problem

The schizophrenia research community, including government, industry, and academia, has made development of procognitive treatment strategies a priority. Much current research is directed at dividing broad impairments in cognition into more delineated components that might correspond to relatively specific neural systems and serve as targets for intervention. Sometimes overlooked in this ambitious agenda is the substantial neuropsychological literature that signals a more broadly generalized dysfunction in higher order cognitive functions in this illness. In this article, we argue that a generalized cognitive deficit is at the core of the disorder, is not a methodological artifact, and deserves more focused consideration from cognitive specialists in the field. Further, we weigh evidence that this broad deficit may have systemic biological underpinnings. At the level of the central nervous system, examples of findings that might help to account for broad cognitive impairment include gray and white matter irregularities, poor signal integration by neurons and neural networks, and abnormalities in glutamate and gamma-aminobutyric acid neurotransmission. Other, more speculative hypotheses focus on even broader somatic systems, including energy metabolism and inflammatory processes. Treatment implications of systemic conceptualizations of schizophrenia are also considered.

The cognitive neuroscience of memory function and dysfunction in schizophrenia

Patients with schizophrenia have pronounced deficits in memory for events--episodic memory. These deficits severely affect patients' quality of life and functional outcome, and current medications have only a modest effect, making episodic memory an important domain for translational development of clinical trial paradigms. The current article provides a brief review of the significant progress that cognitive neuroscience has made in understanding basic mechanisms of episodic memory formation and retrieval that were presented and discussed at the first CNTRICS (Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia) meeting in Washington, D.C. During that meeting a collaborative decision was made that measures of item-specific and relational memory were the most promising constructs for immediate translational development. A brief summary of research on episodic memory in schizophrenia is presented to provide a context for investigating item-specific and relational memory processes. Candidate brain regions are also discussed.

Interrelated neuropsychological and anatomical evidence of hippocampal pathology in the at-risk mental state

BACKGROUND

Verbal learning and memory deficits are frequent among patients with schizophrenia and correlate with reduced magnetic resonance imaging (MRI) volumes of the hippocampus in these patients. A crucial question is the extent to which interrelated structural-functional deficits of the hippocampus reflect a vulnerability to schizophrenia, as opposed to the disorder per se.

METHOD

We combined brain structural measures and the Rey Auditory Verbal Learning Test (RAVLT) to assess hippocampal structure and function in 36 never-medicated individuals suspected to be in early (EPS) or late prodromal states (LPS) of schizophrenia relative to 30 healthy controls.

RESULTS

Group comparisons revealed bilaterally reduced MRI hippocampal volumes in both EPS and LPS subjects. In LPS subjects but not in EPS subjects, these reductions were correlated with poorer performance in RAVLT delayed recall.

CONCLUSIONS

Our findings suggest progressive and interrelated structural-functional pathology of the hippocampus, as prodromal symptoms and behaviours accumulate, and the level of risk for psychosis increases. Given the inverse correlation of learning and memory deficits with social and vocational functioning in established schizophrenia, our findings substantiate the rationale for developing preventive treatment strategies that maintain cognitive capacities in the at-risk mental state.

Memory and executive impairment in schizophrenia: comparison with frontal and temporal brain damage

BACKGROUND

Although poor neuropsychological test performance is well documented in schizophrenia, how closely it resembles that seen in patients with brain damage in terms of cognitive failures in daily life and stability over time has been little studied.

METHOD

Thirty patients with chronic schizophrenia, 24 patients with frontal or temporal brain damage and 30 healthy controls were given a battery of memory and executive tests. Carers of the two patient groups also completed questionnaires rating memory and executive failures in daily life. Testing was repeated 6 weeks later.

RESULTS

The schizophrenia and the brain-damaged patients were significantly impaired on most, but not all tests. The degree of carer-rated memory or executive failure was similar in the two groups, but the schizophrenia patients were rated as having significantly more executive failures than memory failures, whereas the brain-damaged patients showed the reverse pattern. Both groups of patients showed similar consistency of performance across sessions.

CONCLUSIONS

Neuropsychological impairment in schizophrenia resembles that seen in patients with brain damage, not only in terms of overall severity, but also in terms of stability and the degree to which poor test performance translates into cognitive failures in daily life.

Disrupted memory inhibition in schizophrenia

A feature of schizophrenia is disrupted executive function leading to learning difficulties and memory problems. In two experiments we measured the ability of patients with schizophrenia to suppress irrelevant parts of acquired information by intentional (executive) and autonomic (non-executive) strategies. In the first experiment using directed forgetting by lists patients were found to be unable to intentionally suppress recently acquired episodic memories. In a second experiment using a procedure that induces inhibition automatically schizophrenic patients showed levels of inhibition comparable to those of normal controls. These findings indicate that in schizophrenia memory is most impaired in tasks that load heavily on control or executive processes.

Pattern of memory compromise in chronic geriatric schizophrenia, frontotemporal dementia and normal geriatric controls

OBJECTIVE

The purpose of this study was to explore whether memory deficits in schizophrenia are attributable to poor organisation/encoding during initial learning vs. memory decay.

METHODS

Subjects included geriatric schizophrenia/schizoaffective disorders [SSD; n = 37; age = 59.92 (55-74); education = 11.70 (7-18)]; frontotemporal dementia [FTD; n = 41; age = 76.59 (64-83); education = 14.61 (12-20)] and geriatric controls [n = 107; age = 70.97 (55-93); education = 13.76 (6-20)]. Subjects were administered the Wechsler Memory Scale, Third Edition and discrepancy scores between immediate and delayed subtests/indices were used to explore possible differences between groups in pattern of impairment.

RESULTS

Significant differences were found between groups on age/education and these variables were related to several outcome measures. Gender was not related to diagnostic group and there were no gender differences on study variables. There were differences between the SSD subjects on several variables, with the schizoaffective subjects performing worse despite equivalence on global cognitive function, living status and chronicity. Seven one-way between-subjects ANCOVAs compared groups on discrepancy scores. RESULTS failed to suggest differences between groups on immediate-delayed memory discrepancy scores (p > 0.05). Subsequent analyses revealed differences in percentage retention scores between SSD and FTD on the faces subtest (p = 0.040), with SSD retaining greater information over time.

CONCLUSION

RESULTS failed to show distinctions between groups on pattern of memory impairment when using discrepancy comparisons. However, an analysis examining percentage retention scores revealed better maintenance of non-contextual visual information over time in SSD. Findings may suggest deficits in immediate encoding rather than memory decay for some types of memory ability among geriatric SSD. Our failure to document group differences when using discrepancy comparisons may be attributable to relative similarity in pattern between groups or the limited sensitivity of this technique.