Preservation and compensation: The functional neuroanatomy of insight and working memory in schizophrenia

SCHIZOPHRENIA RESEARCH

卷:152

Article

Sapara, Adegboyega¹  Ffytche, Dominic H.^2,4  Birchwood, Max³  Cooke, Michael A.¹  Fannon, Dominic¹  Williams, Steven C. R.⁴  Kuipers, Elizabeth^1,5  Kumari, Veena^1,5 

[1] Kings Coll London, Inst Psychiat, Dept Psychol, London SE5 8AF, England

[2] Kings Coll London, Inst Psychiat, Dept Old Age Psychiat, London SE5 8AF, England

[3] Univ Birmingham, Sch Psychol, Birmingham B15 2TT, W Midlands, England

[4] Kings Coll London, Inst Psychiat, Dept Neuroimaging, London SE5 8AF, England

[5] South London & Maudsley NHS Fdn Trust, NIHR Biomed Res Ctr Mental Hlth, London, England

关键词: Psychosis;    fMRI;    Working memory capacity;    Cerebellum;    Precuneus;    Frontal cortex;   

DOI  :  10.1016/j.schres.2013.11.026

来源: Elsevier

【 摘 要 】

Background: Poor insight in schizophrenia has been theorised to reflect a cognitive deficit that is secondary to brain abnormalities, localized in the brain regions that are implicated in higher order cognitive functions, including working memory (WM). This study investigated WM-related neural substrates of preserved and poor insight in schizophrenia. Method: Forty stable schizophrenia outpatients, 20 with preserved and 20 with poor insight (usable data obtained from 18 preserved and 14 poor insight patients), and 20 healthy participants underwent functional magnetic resonance imaging (fMRI) during a parametric 'n-back' task. The three groups were preselected to match on age, education and predicted IQ, and the two patient groups to have distinct insight levels. Performance and fMRI data were analysed to determine how groups of patients with preserved and poor insight differed from each other, and from healthy participants. Results: Poor insight patients showed lower performance accuracy, relative to healthy participants (p = 0.01) and preserved insight patients (p = 0.08); the two patient groups were comparable on symptoms and medication. Preserved insight patients, relative to poor insight patients, showed greater activity most consistently in the precuneus and cerebellum (both bilateral) during WM; they also showed greater activity than healthy participants in the inferior-superior frontal gyrus and cerebellum (bilateral). Group differences in brain activity did not co-vary significantly with performance accuracy. Conclusions: The precuneus and cerebellum function contribute to preserved insight in schizophrenia. Preserved insight as well as normal-range WM capacity in schizophrenia sub-groups may be achieved via compensatory neural activity in the frontal cortex and cerebellum. (C) 2013 The Authors. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free