Dissociation of long-term verbal memory and fronto-executive impairment in first-episode psychosis.
BACKGROUND
Verbal memory is frequently and severely affected in schizophrenia and has been implicated as a mediator of poor clinical outcome. Whereas encoding deficits are well demonstrated, it is unclear whether retention is impaired. This distinction is important because accelerated forgetting implies impaired consolidation attributable to medial temporal lobe (MTL) dysfunction whereas impaired encoding and retrieval implicates involvement of prefrontal cortex.


METHODS
We assessed a group of healthy volunteers (n=97) and pre-morbid IQ- and sex-matched first-episode psychosis patients (n=97), the majority of whom developed schizophrenia. We compared performance of verbal learning and recall with measures of visuospatial working memory, planning and attentional set-shifting, and also current IQ.


RESULTS
All measures of performance, including verbal memory retention, a memory savings score that accounted for learning impairments, were significantly impaired in the schizophrenia group. The difference between groups for delayed recall remained even after the influence of learning and recall was accounted for. Factor analyses showed that, in patients, all variables except verbal memory retention loaded on a single factor, whereas in controls verbal memory and fronto-executive measures were separable.


CONCLUSIONS
The results suggest that IQ, executive function and verbal learning deficits in schizophrenia may reflect a common abnormality of information processing in prefrontal cortex rather than specific impairments in different cognitive domains. Verbal memory retention impairments, however, may have a different aetiology.
Institute of Neurology, University College London, UK. v.leeson@ion.ucl.ac.uk
V C
VC
Leeson
T W
TW
Robbins
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Franklin
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M
Harrison
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Harrison
M A
MA
Ron
T R E
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Barnes
E M
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Joyce
D000328:Adult; D001288:Attention / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007360:Intelligence / Q000502:physiology; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D009949:Orientation / Q000502:physiology; D010364:Pattern Recognition, Visual / Q000502:physiology; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D011618:Psychotic Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D012016:Reference Values; D012153:Retention, Psychology / Q000502:physiology*; D012193:Reversal Learning / Q000502:physiology; D012559:Schizophrenia / Q000175:diagnosis / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D012691:Serial Learning / Q000502:physiology; D013067:Speech Perception / Q000502:physiology; D013702:Temporal Lobe / Q000503:physiopathology; D014706:Verbal Learning / Q000502:physiology*; D055815:Young Adult