Kognitive Defizite in der Schizophrenie

Zusammenfassung

Erkrankungen aus dem schizophrenen Formenkreis und insbesondere die Schizophrenie sind oft mit Einbußen kognitiver Leistungen assoziiert. Aufmerksamkeit und Vigilanz sowie ‚höhere‘ geistige Funktionen wie etwa das Arbeitsgedächtnis, exekutive Funktionen, episodisches und semantisches Gedächtnis und Sprachleistungen sind bei schizophrenen Patienten gestört und gelten zum Teil als reliable Verlaufsprädiktoren. Defizite im Arbeitsgedächtnis sowie im Bereich exekutiver Leistungen werden seit nunmehr dreißig Jahren mit einem empirisch nachweisbaren funktionellen Korrelat im präfrontalen Kortex in Verbindung gebracht. Mit zunehmendem Einsatz funktionell bildgebender Verfahren traten in den letzten Jahren auch gehäuft Zweifel am früher postulierten ‚Hypofrontalitätskonzept‘ auf. Neuere Untersuchungen weisen derzeit darauf hin, dass kognitive Defizite in der Schizophrenie weniger eine Folge einer isolierten, funktionell lokalisierbaren präfrontalen Dysfunktion sind sondern vielmehr als funktionelle Entkopplung eines frontotemporalen Netzwerks zu verstehen sind. Dieser Befund ist möglicherweise spezifisch für schizophrene Störungen und könnte sich in Zukunft als wertvoll für eine weiterführende Zusatzdiagnostik erweisen.

Summary

Disorders from the schizophrenia spectrum – particularly schizophrenia – are often associated with cognitive deficits. Attention, vigilance and higher cognitive functions such as working memory, executive functions, episodic and semantic memory as well as language are impaired in patients with schizophrenia. Moreover, these impaired domains are thought to be reliable predictors throughout the course of the disease. For three decades, impaired working memory and executive functions have been empirically associated with abnormalities of the prefrontal cortex. However, the advent of functional imaging techniques using cognitive activation paradigms has challenged the concept of ‘hypofrontality’ in schizophrenia. Recent work suggests that the cognitive deficits seen in schizophrenic patients maybe not the result of an isolated dysfunction of the prefrontal cortex, but rather a consequence from a functionally decoupled frontotemporal network. This finding maybe specific for schizophrenia and may prove to be useful for additional diagnostic application.

Schlüsselwörter

Schizophrenie - fMRT - frontaler Kortex - Dyskonnektivität

Key words

Schizophrenia - fMRI - frontal cortex - dysconnectivity

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