Emma E M Knowles1, Mark Weiser2, Anthony S David3, David C Glahn4, Michael Davidson2, Abraham Reichenberg5. 1. Department of Psychiatry, Yale University School of Medicine, New Haven; Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut. Electronic address: emma.knowles@yale.edu. 2. Department of Psychiatry, Sheba Medical Centre, Ramat-Gan, Israel. 3. Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom. 4. Department of Psychiatry, Yale University School of Medicine, New Haven; Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut. 5. Departments of Psychiatry and Preventive Medicine and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
BACKGROUND: Substantial impairment in performance on the digit-symbol substitution task in patients with schizophrenia is well established, which has been widely interpreted as denoting a specific impairment in processing speed. However, other higher order cognitive functions might be more critical to performance on this task. To date, this idea has not been rigorously investigated in patients with schizophrenia. METHODS: Neuropsychological measures of processing speed, memory, and executive functioning were completed by 125 patients with schizophrenia and 272 control subjects. We implemented a series of confirmatory factor and structural regression modeling to build an integrated model of processing speed, memory, and executive function with which to deconstruct the digit-symbol substitution task and characterize discrepancies between patients with schizophrenia and control subjects. RESULTS: The overall structure of the processing speed, memory, and executive function model was the same across groups (χ(2) = 208.86, p > .05), but the contribution of the specific cognitive domains to coding task performance differed significantly. When completing the task, control subjects relied on executive function and, indirectly, on working memory ability, whereas patients with schizophrenia used an alternative set of cognitive operations whereby they relied on the same processes required to complete verbal fluency tasks. CONCLUSIONS: Successful coding task performance relies predominantly on executive function, rather than processing speed or memory. Patients with schizophrenia perform poorly on this task because of an apparent lack of appropriate executive function input; they rely instead on an alternative cognitive pathway.
BACKGROUND: Substantial impairment in performance on the digit-symbol substitution task in patients with schizophrenia is well established, which has been widely interpreted as denoting a specific impairment in processing speed. However, other higher order cognitive functions might be more critical to performance on this task. To date, this idea has not been rigorously investigated in patients with schizophrenia. METHODS: Neuropsychological measures of processing speed, memory, and executive functioning were completed by 125 patients with schizophrenia and 272 control subjects. We implemented a series of confirmatory factor and structural regression modeling to build an integrated model of processing speed, memory, and executive function with which to deconstruct the digit-symbol substitution task and characterize discrepancies between patients with schizophrenia and control subjects. RESULTS: The overall structure of the processing speed, memory, and executive function model was the same across groups (χ(2) = 208.86, p > .05), but the contribution of the specific cognitive domains to coding task performance differed significantly. When completing the task, control subjects relied on executive function and, indirectly, on working memory ability, whereas patients with schizophrenia used an alternative set of cognitive operations whereby they relied on the same processes required to complete verbal fluency tasks. CONCLUSIONS: Successful coding task performance relies predominantly on executive function, rather than processing speed or memory. Patients with schizophrenia perform poorly on this task because of an apparent lack of appropriate executive function input; they rely instead on an alternative cognitive pathway.
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