The Puzzle of Processing Speed, Memory, and Executive Function Impairments in Schizophrenia: Fitting the Pieces Together
Open accessAbstract
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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If cognitive speed is excessively slow, then performance of "non-speeded" tasks acquires an additional challenge and may lead to challenges in accessing correct strategies in a timely manner.
“If cognitive speed is excessively slow, then performance of “non-speeded” tasks acquire an additional challenge and may lead to challenges in access correct strategies in a timely manner. 64”
From Domains of cognition and their assessment (2019) · cites this paper as [64]
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- Authors
- Knowles, E. E. M., Weiser, M., David, A. S., Glahn, D. C., Davidson, M., & Reichenberg, A.
- Affiliations
- Hartford Hospital (US)
- Sheba Medical Center (IL)
- King's College London (GB)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Knowles, Emma E.M.
- ORCID
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 78
- Issue
- 11
- Pages
- 786-793
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC4547909
- OpenAlex
- W2029450128
- Cited by
- 77
- References
- 43
- Citations by year
- 2025: 4 · 2024: 6 · 2023: 6 · 2022: 3 · 2021: 5 · 2020: 8 · 2019: 12 · 2018: 12 · 2017: 10 · 2016: 7 · 2015: 4
- FWCI
- 8.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- NIMH (MH066105)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- schizophrenia, processing speed, working memory, executive function, cognitive impairment, verbal fluency, cognitive processing models, neuropsychological assessment
- MeSH terms
- Adolescent, Adult, Aged, Cognition Disorders, Factor Analysis, Statistical, Female, Humans, Male, Memory Disorders, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Psychomotor Disorders, Schizophrenia, Schizophrenic Psychology, Logistic Models, Young Adult, Executive Function
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