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Impairments in Perceptual Competency and Maintenance on a Visual Delayed Match-to-Sample Test in First-Episode Schizophrenia
Todd Lencz, PhD;
Robert M. Bilder, PhD;
Elihu Turkel, PsyD;
Robert S. Goldman, PhD;
Delbert Robinson, MD;
John M. Kane, MD;
Jeffrey A. Lieberman, MD
Arch Gen Psychiatry. 2003;60:238-243.
Background Deficits in working memory (WM) have been reported in patients with schizophrenia, but WM is a complex construct dependent on several subprocesses, including input representation (perceptual competency) and holding stimuli on-line (maintenance). A visual delayed match-to-sample task (DMST) was developed to isolate perceptual competency from maintenance during delays. It was hypothesized that patients in the first episode of schizophrenia would exhibit dissociable deficits in both WM domains.
Methods Performance on the DMST was assessed in 57 patients in the first episode of schizophrenia or schizoaffective disorder and 22 healthy comparison subjects. In phase 1 of the DMST, a complex visual stimulus (target) was followed immediately by a forced choice between 2 test stimuli, and item difficulty (differences between the test stimuli) was titrated until each subject achieved a consistent accuracy (80%-90%) in this no-delay condition. In phase 2, a delay of 4 or 8 seconds with a mask of randomly illuminated pixels was introduced between target and test stimuli; test stimuli were fixed in difficulty level based on phase 1 titration. Main outcome measures were mean item difficulty attained in the no-delay condition and mean accuracy in matching after delay.
Results Compared with controls, patients attained a lower level of difficulty in the no-delay condition (P = .001) and significantly lower accuracy with delay (P = .002).
Conclusions Deficits in both domains of WM suggest abnormality in the posterior and prefrontal cortexes. These deficits can be observed in a task involving complex visual pattern stimuli using only a brief delay and are present even in unmedicated patients in the first episode of illness.
From the Department of Psychiatry, the Zucker Hillside Hospital, North Shore–Long Island Jewish Health System, Glen Oaks, NY (Drs Lencz, Bilder, Turkel, Robinson, and Kane); the Center for Advanced Brain Imaging, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY (Dr Bilder); the Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY (Drs Lencz, Bilder, Turkel, Robinson, and Kane); Pfizer, Inc, New York, NY (Dr Goldman); and the University of North Carolina School of Medicine, Chapel Hill (Dr Lieberman). Dr Bilder is now with the Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles.
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