- Email: [email protected]
Delayed word recall in aged schizophrenia
638
BIOLPSYCHIATRY 1994;35:615-747
ment and coordination difficulties which clinically appear as negative schizophrenia symptoms.
85. NEUROPSYCHOLOGY OF OCD: PRELIMINARY FINDINGS B.R. Aronowitz, E. Hollander, C. DeCaria, L. Cohen, D. Stein, & D. Simeon Mount Sinai School of Medicine/Queens Hospital Center Jamaica, NY Neuropsychologicai findings in obsessive.compulsive disorder (OCD) have yielded inconsistent findings, in addition to methodological problems, an explanation accounting for differential neuropsychological findings is that OCD may be a heterogeneous disorder characterized by vari. ous homogeneous subgroups. The purpose of this study was to investigate. specific neuropsychological variables hypothesized to be deficient in OCD subjects in addition to more generalized performance variables which may underlie such compromised function. Specific variables ineluded visuospatial and visuoconstructional capacities and immediate visual recall while generalized performance variables included sustained attention and suppression of interference from irrelevant stimulus properties. in addition, since male OCD subjects are implicated as possibly representing a homogeneous subgroup with differing pathogenesis from female OCD subjects, the neuropsychological performance of male OCD patients was examined separately. Selected neuropsychological variables were examined in 31 DSM ilI-R diagnosed obsessive-compulsive disorder (OCD) patients and 22 age and sex-matched normal controls. OCD patients performed significantly more poorly than normal controls on specific visuospatial, visuopereeptual and visual discrimination tasks, in addition they demonstrated a more generalizable dysfunction, manifested by performance deficits in set shifting, sequencing and tracking tasks, requiring time-accuracy trade.offs. These findings were especially prominent in male OCD subjects vs. male controls, who demonstrated further impairment on visuoconstructional and visuospatial tasks, suggesting that males may represent a more neuropsychologically and neuropsychiatrically impaired OCD subgroup.
86. STABLE MANUAL DEXTERITY DISTURBANCE IN ASYMPTOMATIC HIV-I SEROPOSITIVE GAY MEN: A 12-MONTH FOLLOW-UP S.G. Silva l, R.A. Stem 2, N. Chaisson I, S.F. Baum I, E. Singer I, R.N. Golden I, & D.L. Evans 3 tDepartment of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599; 2Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI 02903; 3Department of Psychiatry, University of Florida School of Medicine, Gainesviile, FL 32610 Recent reports have suggested that subclinical motor slowing is one of the earliest signs of HIV infection in asymptomatic HIV seropositive individuals. To examine the nature of these early motor disturbances, we studied 58 asymptomatic seropositive and 45 seronegative gay men. Strict baseline exclusion criteria were used to preclude confounding effects of substance abuse, head injury, CNS disorder, learning disability, psychiatric illness, or zidovudine use. A principal components analysis was conducted on 26 baseline neuropsychological measures. Seven factor scores, accounting for 70% of the variance, were derived: general intellectual
THURSDAY,, MAY 19
ability, self-report mood, attention, verbal learning and memory, psychomotor speed, fine motor speed, and fine manual dexterity. These factor scores were then used to assess neurobehavioral functioning at baseline and the one year follow-up visit. ANCOVA procedures, adjusting for education, age, depression, and CD4 count, indicated significantly slower mean dexterity speed at baseline and month 12 in seroposifives, compared to seronegatives (p<.05). Although seropositives showed a slight decline in dexterity over the 12-month period, ANCOVA-RM did not demonsmite any group x time interactions. No group differences in fine motor speed were detected at either time point. These findings suggest that early neurobehavioral impairment in HIV infection seems limited to mild motor slowing, primarily affecting fme manual dexterity. Furthermore, this manual dexterity impairment remained constant across the ! 2-month period.
87. DELAYED WORD RECALL IN AGED SCHIZOPHRENIA J. Herreral. 2, H. Lee 2, D. Quinlan 4, J. Valance 2, M. Wielgus !. 2, E. Rotaru2, R. Mobs I, & M. Buchsbaum I t Department of Psychiatry, Mount Sinai School of Medicine, NY; 2Department of Psychiatry, Elmhurst Hospital Center, Elmhurst NY; 3Department of Nuclear Medicine, Elmhurst Hospital Center, Elmhurst NY; 4yale University, New Haven, CT SPECT brain imaging with Tc-99m-HMPAO as tracer was used to exam. ine the performance of a delayed word recall memory task by aged patients with schizophrenia (AS), Alzheimer's disease (AD) and aged normal controls (NA). In a recent study with adult and aged normals, the authors report that these tasks activate the frontoparietal cortex in the left hemisphere at the level of the superior frontal lobule (Herrem, Lee, Quinlan, et al., 1993). This study included two brain SPECT scans in a 3 (AS vs. AD vs. NA) X 2 (word recall vs. no recall) repeated measures design and it was hypothesized that AS and AD patients would fail to activate rCBF inthe frontoparietal cortex under the recall task condition. 10 AS (5 men, 5 women; mean age -67.8 years; mean Mini Mental Status Scale score - 28.2 (MMSE, Cockrell and Folstein, 1988)) were recruited for clinical and neumpsychological ratings and asked to consent to SPECT scans. 10 patients who met criteria for probable AD (NINCDS-ADRADAA, 5 men, 5 women; mean age = 76.8 years; mean MMSE score 17.8) and 10 NA (5 men, 5 women; mean age -70.4; MMSE score -29.0) were recruited from a sample of individuals entered into the multicenter CERAD (Morris, Heyman, Mohs, et al., 1989) project at the EHC site. The SPECT activation paradigm included four 5- minute blocks: t word list learning task; 2 intervening constructional task; 3 injection of radionuclide followed by delayed word recall task; and 4 delayed word list recognition task. Functional brain images were acquired using the Trionix Triad three-detector head digital SPECT camera and reconstructed from 30 camera views (30x3), incremented through 4 degrees of circumference around the subject's head, at 55 seconds per view. 12 transverse slices (4.5 mm/slice) were selected at 3 brain levels for data analysis. The statistical model employed was a repeated measures multivariate analysis of variance (MANOVA) with three between (AS, AD, NA) group by two within subject (No Recall and Recall) task conditions; the principal F ratio for assessment of the effects of memory task activation was the group by condition interaction. The repeated measures MANOVA for left hemisphere tCBF yielded a significant group by condition interaction effect (F,=4.48, p--.01) at the level of the superior frontal Iobule (upper brain area) and a priori comparisons revealed significant differences (p-.03) between both patient (AS, AD) groups and the NA group in the frontal association (F-8.07, p-.003) and anterior parietal (F-4.97, p-..018) cortex. Aged schizophrenic and Alzheimer's disease patients demonstrate similar hypofrontal activation patterns under the delayed word recall condition.
BIOLPSYCHIATRY 1994;35:615-747
ment and coordination difficulties which clinically appear as negative schizophrenia symptoms.
85. NEUROPSYCHOLOGY OF OCD: PRELIMINARY FINDINGS B.R. Aronowitz, E. Hollander, C. DeCaria, L. Cohen, D. Stein, & D. Simeon Mount Sinai School of Medicine/Queens Hospital Center Jamaica, NY Neuropsychologicai findings in obsessive.compulsive disorder (OCD) have yielded inconsistent findings, in addition to methodological problems, an explanation accounting for differential neuropsychological findings is that OCD may be a heterogeneous disorder characterized by vari. ous homogeneous subgroups. The purpose of this study was to investigate. specific neuropsychological variables hypothesized to be deficient in OCD subjects in addition to more generalized performance variables which may underlie such compromised function. Specific variables ineluded visuospatial and visuoconstructional capacities and immediate visual recall while generalized performance variables included sustained attention and suppression of interference from irrelevant stimulus properties. in addition, since male OCD subjects are implicated as possibly representing a homogeneous subgroup with differing pathogenesis from female OCD subjects, the neuropsychological performance of male OCD patients was examined separately. Selected neuropsychological variables were examined in 31 DSM ilI-R diagnosed obsessive-compulsive disorder (OCD) patients and 22 age and sex-matched normal controls. OCD patients performed significantly more poorly than normal controls on specific visuospatial, visuopereeptual and visual discrimination tasks, in addition they demonstrated a more generalizable dysfunction, manifested by performance deficits in set shifting, sequencing and tracking tasks, requiring time-accuracy trade.offs. These findings were especially prominent in male OCD subjects vs. male controls, who demonstrated further impairment on visuoconstructional and visuospatial tasks, suggesting that males may represent a more neuropsychologically and neuropsychiatrically impaired OCD subgroup.
86. STABLE MANUAL DEXTERITY DISTURBANCE IN ASYMPTOMATIC HIV-I SEROPOSITIVE GAY MEN: A 12-MONTH FOLLOW-UP S.G. Silva l, R.A. Stem 2, N. Chaisson I, S.F. Baum I, E. Singer I, R.N. Golden I, & D.L. Evans 3 tDepartment of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599; 2Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI 02903; 3Department of Psychiatry, University of Florida School of Medicine, Gainesviile, FL 32610 Recent reports have suggested that subclinical motor slowing is one of the earliest signs of HIV infection in asymptomatic HIV seropositive individuals. To examine the nature of these early motor disturbances, we studied 58 asymptomatic seropositive and 45 seronegative gay men. Strict baseline exclusion criteria were used to preclude confounding effects of substance abuse, head injury, CNS disorder, learning disability, psychiatric illness, or zidovudine use. A principal components analysis was conducted on 26 baseline neuropsychological measures. Seven factor scores, accounting for 70% of the variance, were derived: general intellectual
THURSDAY,, MAY 19
ability, self-report mood, attention, verbal learning and memory, psychomotor speed, fine motor speed, and fine manual dexterity. These factor scores were then used to assess neurobehavioral functioning at baseline and the one year follow-up visit. ANCOVA procedures, adjusting for education, age, depression, and CD4 count, indicated significantly slower mean dexterity speed at baseline and month 12 in seroposifives, compared to seronegatives (p<.05). Although seropositives showed a slight decline in dexterity over the 12-month period, ANCOVA-RM did not demonsmite any group x time interactions. No group differences in fine motor speed were detected at either time point. These findings suggest that early neurobehavioral impairment in HIV infection seems limited to mild motor slowing, primarily affecting fme manual dexterity. Furthermore, this manual dexterity impairment remained constant across the ! 2-month period.
87. DELAYED WORD RECALL IN AGED SCHIZOPHRENIA J. Herreral. 2, H. Lee 2, D. Quinlan 4, J. Valance 2, M. Wielgus !. 2, E. Rotaru2, R. Mobs I, & M. Buchsbaum I t Department of Psychiatry, Mount Sinai School of Medicine, NY; 2Department of Psychiatry, Elmhurst Hospital Center, Elmhurst NY; 3Department of Nuclear Medicine, Elmhurst Hospital Center, Elmhurst NY; 4yale University, New Haven, CT SPECT brain imaging with Tc-99m-HMPAO as tracer was used to exam. ine the performance of a delayed word recall memory task by aged patients with schizophrenia (AS), Alzheimer's disease (AD) and aged normal controls (NA). In a recent study with adult and aged normals, the authors report that these tasks activate the frontoparietal cortex in the left hemisphere at the level of the superior frontal lobule (Herrem, Lee, Quinlan, et al., 1993). This study included two brain SPECT scans in a 3 (AS vs. AD vs. NA) X 2 (word recall vs. no recall) repeated measures design and it was hypothesized that AS and AD patients would fail to activate rCBF inthe frontoparietal cortex under the recall task condition. 10 AS (5 men, 5 women; mean age -67.8 years; mean Mini Mental Status Scale score - 28.2 (MMSE, Cockrell and Folstein, 1988)) were recruited for clinical and neumpsychological ratings and asked to consent to SPECT scans. 10 patients who met criteria for probable AD (NINCDS-ADRADAA, 5 men, 5 women; mean age = 76.8 years; mean MMSE score 17.8) and 10 NA (5 men, 5 women; mean age -70.4; MMSE score -29.0) were recruited from a sample of individuals entered into the multicenter CERAD (Morris, Heyman, Mohs, et al., 1989) project at the EHC site. The SPECT activation paradigm included four 5- minute blocks: t word list learning task; 2 intervening constructional task; 3 injection of radionuclide followed by delayed word recall task; and 4 delayed word list recognition task. Functional brain images were acquired using the Trionix Triad three-detector head digital SPECT camera and reconstructed from 30 camera views (30x3), incremented through 4 degrees of circumference around the subject's head, at 55 seconds per view. 12 transverse slices (4.5 mm/slice) were selected at 3 brain levels for data analysis. The statistical model employed was a repeated measures multivariate analysis of variance (MANOVA) with three between (AS, AD, NA) group by two within subject (No Recall and Recall) task conditions; the principal F ratio for assessment of the effects of memory task activation was the group by condition interaction. The repeated measures MANOVA for left hemisphere tCBF yielded a significant group by condition interaction effect (F,=4.48, p--.01) at the level of the superior frontal Iobule (upper brain area) and a priori comparisons revealed significant differences (p-.03) between both patient (AS, AD) groups and the NA group in the frontal association (F-8.07, p-.003) and anterior parietal (F-4.97, p-..018) cortex. Aged schizophrenic and Alzheimer's disease patients demonstrate similar hypofrontal activation patterns under the delayed word recall condition.