Feldmann Deborah, Schuepbach Daniel, von Rickenbach Bettina, Theodoridou Anastasia, Hell Daniel
Psychiatric University Hospital Zürich, Lenggstrasse 31, 8032 Zürich, Switzerland.
BMC Psychiatry. 2006 May 24;6:25. doi: 10.1186/1471-244X-6-25.
Schizophrenia is a severe mental disorder involving impairments in executive functioning, which are important cognitive processes that can be assessed by planning tasks such as the Stockings of Cambridge (SOC), and tasks of rule learning/abstraction such as the Wisconsin Card Sorting Test (WCST). We undertook this study to investigate the association between performance during separate phases of SOC and WCST, including mean cerebral blood flow velocity (MFV) measurements in chronic schizophrenia.
Functional transcranial Doppler sonography (fTCD) was used to assess bilateral MFV changes in the middle (MCA) and anterior (ACA) cerebral arteries. Twenty-two patients with chronic schizophrenia and 20 healthy subjects with similar sociodemographic characteristics performed SOC and WCST during fTCD measurements of the MCA and the ACA. The SOC was varied in terms of easy and difficult problems, and also in terms of separate phases, namely mental planning and movement execution. The WCST performance was assessed separately for maintaining set and set shifting. This allowed us to examine the impact of problem difficulty and the impact of separate phases of a planning task on distinct intervals of WCST. Simultaneous registration of MFV was carried out to investigate the linkage of brain perfusion during the tasks.
In patients, slowing of movement execution during easy problems (SOC) was associated with slowing during maintaining set (WCST) (P < 0.01). In healthy subjects, faster planning and movement execution during predominantly difficult problems were associated with increased performance of WCST during set shifting (P < 0.01). In the MCA, patients showed a significant and positive correlation of MFV between movement execution and WCST (P < 0.01).
The results of this study demonstrate performance and brain perfusion abnormalities in the association pattern of two different tasks of executive functioning in schizophrenia, and they support the notion that executive functions have a pathological functional correlate predominantly in the lateral hemispheres of the brain. This study also underpins the scientific potential of fTCD in assessing brain perfusion in patients with schizophrenia.
精神分裂症是一种严重的精神障碍，涉及执行功能受损，执行功能是重要的认知过程，可通过诸如剑桥长袜（SOC）之类的计划任务以及诸如威斯康星卡片分类测试（WCST）之类的规则学习/抽象任务进行评估。我们开展这项研究以调查慢性精神分裂症患者在SOC和WCST不同阶段的表现之间的关联，包括平均脑血流速度（MFV）测量。
使用功能性经颅多普勒超声（fTCD）评估大脑中动脉（MCA）和前动脉（ACA）的双侧MFV变化。22例慢性精神分裂症患者和20例具有相似社会人口统计学特征的健康受试者在MCA和ACA的fTCD测量期间进行了SOC和WCST测试。SOC在简单和困难问题方面有所不同，并且在不同阶段也有所不同，即心理计划和动作执行。WCST表现分别在保持定势和转换定势方面进行评估。这使我们能够检查问题难度的影响以及计划任务不同阶段对WCST不同区间的影响。同时记录MFV以研究任务期间脑灌注的联系。
在患者中，简单问题（SOC）期间动作执行减慢与保持定势（WCST）期间减慢相关（P < 0.01）。在健康受试者中，主要在困难问题期间更快的计划和动作执行与转换定势期间WCST表现增加相关（P < 0.01）。在MCA中，患者在动作执行和WCST之间显示出MFV的显著正相关（P < 0.01）。
本研究结果表明精神分裂症患者在两种不同执行功能任务的关联模式中存在表现和脑灌注异常，并且支持执行功能在大脑外侧半球主要具有病理功能相关性的观点。本研究还强调了fTCD在评估精神分裂症患者脑灌注方面的科学潜力。
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