Craig Goodman

Brief emotion training improves recognition of facial emotions in chronic schizophrenia. A pilot study

Impaired emotional communication may be an important contributing factor to poor social function in schizophrenia. This pilot study examined the effect of emotion training exercises on the perception of facial emotional expression. Twenty male chronic schizophrenia patients underwent three training sessions using a computerized Emotion Training program, developed for teaching autistic children, which was adapted to the clinical setting. Patients were assessed before and after training with validated tests of identification of facial emotions (PEAT, ER40), differentiation of facial emotions (EmDiff) and working memory. In comparison to baseline, patients performed significantly better on the PEAT and ER40 tests after training. No change was observed in EmDiff or in cognitive test performance. Brief Emotion Training can improve recognition of facial emotional expressions in chronic schizophrenia patients. This may be due to increased patient awareness of emotional aspects of stimuli and/or improvement in specific emotional perceptual skills. Further studies of Emotion Training as a potential treatment modality are warranted.

Impaired recognition of happy, sad and neutral expressions in schizophrenia is emotion, but not valence, specific and context dependent.

It is not clear whether the deficits in emotion perception in schizophrenia are distinct from cognitive impairments or affect some emotions more than others. We tested the hypothesis that the emotion perception deficit in schizophrenia is valence specific. Participants comprised 75 chronic schizophrenia patients and 77 healthy controls who were asked to identify happy, sad and neutral facial emotional expressions. A test of facial identity recognition was also performed. Processing of happy, sad and neutral expressions differed in accuracy, processing strategy and efficiency. Patients were impaired on all parameters, but the valence-related pattern of performance did not differ in the two groups. Compared with healthy individuals, schizophrenia patients were more impaired in the processing of facial emotions than identity. Processing of neutral expressions was context dependent. Emotion impairment in schizophrenia appears to be selective for the emotion domain but not specific emotions. Test context influences how neutral facial expressions are processed.

Impaired error monitoring contributes to face recognition deficit in schizophrenia patients

BACKGROUND It has been proposed that social and cognitive deficits in schizophrenia may result from impaired error monitoring. OBJECTIVE We tested the hypothesis that among schizophrenia patients, impaired error monitoring contributes to poor face recognition, an important social skill. METHODS 79 schizophrenia patients and 57 healthy individuals were administered a computerized face recognition test which allowed collection of accuracy and latency performance parameters. Error monitoring was assessed by analyzing reaction times for correct (RTC) and incorrect (RTI) responses. Tests of working memory (WM) and processing speed were also administered. RESULTS RTI was longer than RTC in patients and controls and did not differ between the groups. RTC was significantly longer in patients than controls. Error monitoring effort, calculated by dividing the difference between RTI and RTC by the sum of RTC and RTI, was significantly smaller in patients than controls. A regression model with face recognition performance as dependent variable showed independent contributions of error monitoring effort, spatial working memory and group (patient/healthy) to test performance and explained 26.1% of the variance. CONCLUSION Error monitoring function influences face recognition accuracy and is impaired in schizophrenia. Impairments in error monitoring, and spatial WM contribute to face recognition deficits in schizophrenia.

Impairment in error monitoring predicts poor executive function in schizophrenia patients

BACKGROUND Impaired ability to detect and correct errors may contribute to poor cognitive and social function in schizophrenia. OBJECTIVE To test the hypothesis that impairment in error monitoring contributes to impaired executive function in schizophrenia. METHODS 56 schizophrenia patients and 77 healthy individuals were tested with the Penn Conditional Exclusion test (PCET), a computerised test of executive function which allowed collection of accuracy and latency performance parameters. Error monitoring was assessed by analyzing reaction times for correct (RTC) and incorrect (RTI) responses. Tests of face recognition, working memory (WM) and processing speed were also administered. RESULTS Executive error-monitoring effort (EXER), calculated by dividing the difference between RTI and RTC by the sum of RTC and RTI, was significantly smaller in patients than controls. A regression model with the executive function (PCET total errors) as dependent variable showed independent contributions of EXER, verbal WM and spatial WM to test performance and explained 35% of the variance. EXER showed significant association with error-monitoring effort for face recognition in patients but not controls. CONCLUSION Impaired error-monitoring contributes to poor executive function in schizophrenia. Independent contributions of error-monitoring effort and verbal WM to executive functions may reflect distinct contributions of prefrontal and medial frontal cortical dysfunctions. Error-monitoring mechanisms in different cognitive domains may share more neural resources in schizophrenia than in healthy individuals, reflecting inefficient processing.

Negative attitude towards medication is associated with working memory impairment in schizophrenia patients.

A lack of insight into illness and negative attitudes towards medication are common among individuals with schizophrenia and impact clinical outcomes. This study aimed to examine the relationships between attitudes towards medication and cognitive function in schizophrenia patients. Thirty-five male forensic inpatients who were suffering from chronic schizophrenia participated in the study. A drug attitude inventory was used to evaluate the attitudes of the patients towards medication. Neuropsychological function was assessed with a comprehensive battery of tests. Patients with positive attitudes towards medication performed significantly better than those with negative attitudes on tests of verbal working memory (digit span forwards and backwards), inhibition and set shifting (Penn Inhibition test), delayed object memory and overall mental status (Mini Mental State Examination). There were no differences in age, education, hospitalizations or clinical symptoms between the groups. Our findings support an association between negative attitudes towards medication and poor cognitive performance, particularly of working memory.

‘Executive’ Functions and Normal Aging: Selective Impairment in Conditional Exclusion Compared to Abstraction and Inhibition

Background: Some executive functions may be selectively impaired in normal aging over and above the general cognitive decline. Methods: We examined the performance of healthy high functioning young (n = 77) and older (n = 57) individuals on three ‘executive’ tests: conditional exclusion, abstraction, and inhibition of prepotent responses. We compared their relationships to each other and to other cognitive functions including attention, psychomotor speed and working memory. Results: Conditional exclusion was significantly more impaired than abstraction or inhibition in the elderly compared to the younger group and unlike them, showed a nonlinear relationship with age. These findings were independent of other cognitive functions. Analysis of PCET performance characteristics showed that older individuals were particularly impaired in attaining the last of the three achievable categories, were slower, and had fewer error monitoring resources compared to the younger group. Conclusions: Conditional exclusion shows an age-related pattern of impairment distinct from inhibition and abstraction. We propose that in healthy well-functioning individuals, it taps processes integrating task set establishment and shifting in context of accumulating information. It may thus be useful as a specific marker of complex cognitive functions in studies of normal cognitive aging and in early detection of cognitive dysfunction.

Age in high-functioning healthy men is associated with nonlinear decline in some 'executive' functions in late middle age.

Background/Aim: Age-related cognitive decline might involve selective deterioration of specific brain systems. We studied the relationship between age and cognition by comparing cognitive function of older and younger high functioning men. Methods: A cross-sectional study comparing neuropsychological test battery performance of younger (18–60 years) and older (61–85 years) men. Results: Older men showed impaired psychomotor speed, working memory, attention, declarative verbal memory and executive functions. Impairment in executive function was prominent and not explained by psychomotor slowing, impaired working memory or attention. Regression models showed a non-linear relationship between age and executive function with a change of slopes in the mid-50s. The relationship of age with verbal memory was linear. Conclusions: The nonlinear change in late middle age is consistent with the hypothesis that an age-related selective diatheses impacts selectively on executive function.

Impairment in associative memory in healthy aging is distinct from that in other types of episodic memory

There is evidence that age related changes in episodic memory are heterogeneous and result from diverse pathologies. To test this, we examined performance of healthy high-functioning younger (N=41, ages 18-60 y) and older (N=58, ages 61-83 y) individuals in tests of associative memory, logical memory and memory in executive and object-recognition domains. We compared their relationships to each other and to other cognitive functions, including, psychomotor speed and verbal and spatial working memory. Older individuals showed significantly greater reduction in an index of the ability to learn new associations (NAL) than for memory in executive and object-recognition domains. Age-related reduction in NAL and in logical memory was of similar severity, but the two measures showed only moderate correlation when age and other cognitive functions were controlled for. NAL shows an age-related pattern of change distinct from memory in executive and object-recognition domains and from logical (item) memory. We propose that in healthy well-functioning individuals, NAL taps processes which support binding of newly learned association in context of accumulating information, a key function of the hippocampus. NAL may thus serve as a selective marker of complex, hippocampus-based, cognitive functions in studies of normal cognitive aging and of its possible relationship to early dementia.