Brain Behavior Laboratory, Sha'ar Menashe Mental Health Center, Mobile Post Hefer 38814, Israel; Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
Psychiatry Res. 2013 Dec 30;210(3):694-701. doi: 10.1016/j.psychres.2013.07.031. Epub 2013 Aug 21.
Executive impairment is prominent in schizophrenia, in conditions such as Parkinson's disease and dementia and in healthy aging. Identifying processes that critically constrain executive function can advance investigation of their biological basis and treatment planning. Recent findings that elderly healthy individuals showed similar impairment on conditional exclusion task as schizophrenia patients raised the question whether similar processes are impaired. To test this we compared 56 schizophrenia patients, 57 elderly and 77 young healthy individuals on three executive tests: conditional exclusion, abstraction and inhibition and tests of working memory and psychomotor speed. Schizophrenia patients performed worse than elderly healthy on abstraction, inhibition and verbal working memory. They were similarly impaired on Penn Conditional Exclusion Test (PCET) outcome measures but differed in performance characteristics. Schizophrenia patients needed relatively more trials to learn the first PCET category than the second or the third. This correlated with other cognitive impairments, particularly in working memory. Elderly healthy individuals found it most difficult to learn the last category. The two groups showed different error patterns. We propose that schizophrenia patients have particular difficulty in early (probabilistic) learning ("what to do") while aging individuals have selective impairment in executive integration. These constitute distinct targets for customized treatment in the two conditions.
执行功能障碍在精神分裂症、帕金森病、痴呆和健康老龄化等疾病中表现突出。确定严重限制执行功能的过程可以促进对其生物学基础和治疗计划的研究。最近的研究发现，老年健康个体在条件排除任务上与精神分裂症患者表现出相似的损伤，这引发了一个问题，即是否存在类似的损伤过程。为了验证这一点，我们比较了 56 名精神分裂症患者、57 名老年健康个体和 77 名年轻健康个体在三个执行功能测试上的表现：条件排除、抽象和抑制以及工作记忆和心理运动速度测试。精神分裂症患者在抽象、抑制和言语工作记忆方面的表现逊于老年健康个体。他们在宾夕法尼亚条件排除测试（PCET）的结果测量上表现相似，但在表现特征上存在差异。精神分裂症患者需要相对更多的尝试来学习第一个 PCET 类别，而不是第二个或第三个。这与其他认知障碍有关，尤其是工作记忆。老年健康个体发现最难学习最后一个类别。这两个群体表现出不同的错误模式。我们提出，精神分裂症患者在早期（概率）学习（“做什么”）方面存在特殊困难，而老年个体在执行整合方面存在选择性损伤。这构成了这两种情况下个性化治疗的不同目标。
