Neurokognition psychiatrischer Patienten

Matthias Brand; Hans J. Markowitsch

doi:10.1055/s-2004-828481

Psychiatrische Praxis, Table of Contents

Psychiatr Prax 2004; 31: 200-209
DOI: 10.1055/s-2004-828481

Originalarbeit

Neurokognition psychiatrischer Patienten

Neurocognition of Psychiatric PatientsMatthias Brand¹ , Hans J. Markowitsch¹

¹Physiologische Psychologie, Universität Bielefeld

Abstract

Zusammenfassung

Kognitive, mnestische und emotionale Funktionen können bei psychiatrischen Patienten beeinträchtigt sein. In diesem Beitrag werden zunächst verschiedene neuropsychologische Funktionen vorgestellt, schwerpunktmäßig Lernen und Gedächtnis sowie exekutive Funktionen. Anschließend werden Einbußen dieser Bereiche und deren neurale Korrelate bei schizophrenen, depressiven und alkoholabhängigen Patienten sowie Personen mit Korsakow-Syndrom beschrieben. Auf Hirnebene lassen sich für neuropsychologische Änderungen sowohl neurochemische als auch strukturelle Abweichungen demonstrieren, die zumeist Teile des Stirnhirns sowie limbische und dienzephale Strukturen einbeziehen.

Abstract

Cognitive, mnestic, and emotional disturbances can occur in a wide range of psychiatric patients. Both neurochemical alterations as well as structural brain abnormalities can be neural correlates of neuropsychological dysfunctions in these patients. In this paper, we give an introduction to neuropsychological domains with a focus on different kinds of memory and executive functions. Thereafter, we describe neurocognitive deteriorations in patients with schizophrenia, depression, alcohol addiction, and Korsakoff's syndrome. Brain alterations affect primarily parts of the frontal lobe, especially the dorsolateral prefrontal and the orbitofrontal cortex. This can be seen in volume reduction, glucose hypometabolism, or dysfunctions of dopaminergic fronto-striatal loops. Furthermore, structural or functional changes of hippocampal formation, anterior cingulate gyrus, amygdala, and different thalamic nuclei are also involved in neurocognitive disturbances of psychiatric patients.

Full Text

References

Literatur

1 Thöne-Otto A, Markowitsch H J. Gedächtnisstörungen nach Hirnschäden. Göttingen; Hogrefe 2004
2 Atkinson R C, Shiffrin R M. Human memory: a proposed system and its control processes. In: Spence KW, Spence JT The Psychology of Learning and Motivation: Advances in Research and Theory. New York; Academic Press 1968: 89-195
3 Baddeley A D. Working memory. Science. 1992; 255 556-559
4 Baddeley A D. The episodic buffer: A new component of working memory?. Trends Cogn Sci. 2000; 4 417-423
5 Brand M, Markowitsch H J. Amnesia: Neuroanatomic and clinical issues. In: Feinberg T, Farah T Behavioral Neurology and Neuropsychology. New York; McGraw-Hill 2003: 431-443
6 Markowitsch H J. Memory and amnesia. In: Mesulam M-M Principles of behavioral and cognitive Neurology. New York; Oxford University Press 2000: 257-293
7 Squire L R. Memory and the Brain. New York; Oxford University Press 1987
8 Tulving E. Organization of memory: Quo vadis?. In: Gazzaniga MS The cognitive Neurosciences. Cambridge; MIT Press 1995: 839-847
9 Markowitsch H J. Psychogenic amnesia. Neuroimage. 2003; 20 S132-S138
10 Markowitsch H J. The anatomical bases of memory. In: Gazzaniga MS The new cognitive Neurosciences. 2^nd ed. Cambridge; The MIT Press 2000: 781-795
11 Markowitsch H J. Which brain regions are critically involved in the retrieval of old episodic memory?. Brain Res Rev. 1995; 21 117-127
12 Brand M, Markowitsch H J. The principle of bottleneck structures. In: Kluwe RH, Lüer G, Rösler F Principles of Learning and Memory. Basel; Birkhäuser 2003: 171-184
13 Nauta W JH. Expanding borders of the limbic system concept. In: Rasmussen T, Marino R Functional Neurosurgery. New York; Raven Press 1979: 7-23
14 Nieuwenhuys R. The greater limbic system, the emotional motor system and the brain. In: Holstege G, Bandler R, Saper CB The emotional motor System (Progress in Brain Research, Vol. 107). Amsterdam; Elsevier 1996: 551-580
15 Fletcher P C, Henson R NA. Frontal lobes and human memory: Insights from functional neuroimaging. Brain. 2001; 124 849-881
16 Markowitsch H J. Dem Gedächtnis auf der Spur: Vom Erinnern und Vergessen. Darmstadt; PRIMUS-Verlag 2002
17 Markowitsch H J. Memory: disturbances and therapy. In: Brandt T, Caplan L, Dichgans J, Diener HC, Kennard C Neurological Disorders; Course and Treatment. 2^nd ed. San Diego; Academic Press 2003: 287-302
18 Calabrese P, Markowitsch H J. Gedächtnis und Gehirn - neurobiologische Korrelate von Gedächtnisstörungen. Fortschr Neurol Psychiatr. 2003; 71 211-219
19 Smith E E, Jonides J. Storage and executive processes in the frontal lobe. Science. 1999; 283 1657-1661
20 Markela-Lerenc J, Ille N, Kaiser S, Fiedler P, Mundt C, Weisbrod M. Prefrontal-cingulate activation during executive control: which comes first?. Brain Res Cogn Brain Res. 2004; 18 278-287
21 Godefroy O. Frontal syndrome and disorders of executive functions. J Neurol. 2003; 250 1-6
22 Newman S D, Carpenter P A, Varma S, Just M A. Frontal and parietal participation in problem solving in the Tower of London: fMRI and computational modeling of planning and high-level perception. Neuropsychologia. 2003; 41 1668-1682
23 Brodmann K. Physiologie des Gehirns. In: von Bruns P Neue deutsche Chirurgie (Bd. 11, Tl.1). Stuttgart; Enke 1914: 85-426
24 Petrides M, Pandya D N. Comparative architectonic analysis of the human and the macaque frontal cortex. In: Boller F, Grafman J Handbook of Neuropsychology. Amsterdam; Elsevier 1994: 17-58
25 Camille N, Coricelli G, Sallet J, Pradat-Diehl P, Duhamel J-R, Sirigu A. The involvement of the orbitofrontal cortex in the experience of regret. Science. 2004; 304 1167-1170
26 Bolla K I, Eldreth D A, London E D, Kiehl K A, Mouratidis M, Contoreggi C, Matochik J A, Kurian V, Cadet J L, Kimes A S, Funderburk F R, Ernst M. Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task. Neuroimage. 2003; 19 1085-1094
27 Bechara A. Risky business: emotion, decision-making, and addiction. J Gambl Stud. 2003; 19 23-51
28 Tranel D, Bechara A, Denburg N L. Asymmetric functional roles of right and left ventromedial prefrontal cortices in social conduct, decision-making, and emotional processing. Cortex. 2002; 38 589-612
29 Damasio H, Grabowski T, Frank R, Galaburda A M, Damasio A R. The return of Phineas Gage: Clues about the brain from the skull of a famous patient. Science. 1994; 264 1102-1105
30 Brébion G, Smith M J, Gorman J M, Malaspina D, Sharif Z, Amador X. Memory and schizophrenia: differential link of processing speed and selective attention with two levels of encoding. J Psychiatr Res. 2000; 34 121-127
31 Volk D W, Lewis D A. Impaired prefrontal inhibition in schizophrenia: relevance for cognitive dysfunction. Physiol Behav. 2002; 77 501-505
32 Lysaker P H, Bell M D, Greig T C, Bryson G J. Emotional discomfort and impairments in verbal memory in schizophrenia. Psychiatry Res. 2000; 97 51-59
33 Nelson H E. A modified card sorting test sensitive to frontal lobe defects. Cortex. 1976; 12 313-324
34 Stratta P, Arduini L, Daneluzzo E, Rinaldi O, Genova A di, Rossi A. Relationship of good and poor Wisconsin Card Sorting Test performance to illness duration in schizophrenia: a cross-sectional analysis. Psychiatry Res. 2004; 121 219-227
35 Rossi A, Pollice R, Stratta P, Arduini L, Marinangeli M G, Daneluzzo E. Wisconsin Card-Sorting Test performance does not discriminate different patterns of premorbid behavioral abnormalities in schizophrenic patients. Psychiatry Clin Neurosci. 2002; 56 403-407
36 Bersani G, Clemente R, Gherardelli S, Pancheri P. Deficit of Executive Functions in Schizophrenia: Relationship to Neurological Soft Signs and Psychopathology. Psychopathology. 2004; 37 118-123
37 Kurtz M M, Wexler B E, Bell M D. The Penn Conditional Exclusion Test (PCET): relationship to the Wisconsin Card Sorting Test and work function in patients with schizophrenia. Schizophr Res. 2004; 68 95-102
38 Röhrenbach C, Markowitsch H J. Störungen im Bereich exekutiver und überwachender Funktionen - der Präfrontalbereich. In: Markowitsch HJ Enzyklopädie der Psychologie. Themenbereich C Theorie und Forschung, Serie I Biologische Psychologie, Band 2 Klinische Neuropsychologie. Göttingen; Hogrefe 1997: 329-493
39 Tallent K A, Gooding D C. Working memory and Wisconsin Card Sorting Test performance in schizotypic individuals: a replication and extension. Psychiatry Res. 1999; 89 161-170
40 Bustini M, Stratta P, Daneluzzo E, Pollice R, Prosperini P, Rossi A. Tower of Hanoi and WCST performance in schizophrenia: problem-solving capacity and clinical correlates. J Psychiatr Res. 1999; 33 285-290
41 Rushe T M, Morris R G, Miotto E C, Feigenbaum J D, Woodruff P W, Murray R M. Problem-solving and spatial working memory in patients with schizophrenia and with focal frontal and temporal lobe lesions. Schizophr Res. 1999; 37 21-33
42 Staal W G, Hulshoff Pol H E, Schnack H G, Hoogendoorn M L, Jellema K, Kahn R S. Structural brain abnormalities in patients with schizophrenia and their healthy siblings. Am J Psychiatry. 2000; 157 416-421
43 Liu Z, Tam W C, Xie Y, Zhao J. The relationship between regional cerebral blood flow and the Wisconsin Card Sorting Test in negative schizophrenia. Psychiatry Clin Neurosci. 2002; 56 3-7
44 Weinberger D R, Faith Berman K. Prefrontal function in schizophrenia: confounds and controversies. Philos Trans R Soc Lond B Biol Sci. 1996; 351 1495-1503
45 Heckers S, Weiss A P, Deckersbach T, Goff D C, Morecraft R J, Bush G. Anterior cingulate cortex activation during cognitive interference in schizophrenia. Am J Psychiatry. 2004; 161 707-715
46 Farde L. Brain imaging of schizophrenia - the dopamine hypothesis. Schizophr Res. 1997; 28 157-162
47 Bechara A, Damasio A R, Damasio H, Anderson S W. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition. 1994; 50 7-15
48 Whitney K A, Fastenau P S, Evans J D, Lysaker P H. Comparative neuropsychological function in obsessive-compulsive disorder and schizophrenia with and without obsessive-compulsive symptoms. Schizophr Res. 2004; 69 75-83
49 Ritter L M, Meador-Woodruff J H, Dalack G W. Neurocognitive measures of prefrontal cortical dysfunction in schizophrenia. Schizophr Res. 2004; 68 65-73
50 Bechara A, Damasio H, Damasio A R. Role of the amygdala in decision-making. Ann N Y Acad Sci. 2003; 985 356-369
51 Bechara A, Tranel D, Damasio H. Characterization of decision-making deficit of patients with ventromedial prefrontal cortex lesions. Brain. 2000; 123 2189-2202
52 Bechara A, Damasio H, Tranel D, Anderson S W. Dissociation of working memory from decision making within the human prefrontal cortex. J Neurosci. 1998; 18 428-437
53 Zald D H, Boileau I, El-Dearedy W, Gunn R, McGlone F, Dichter G S, Dagher A. Dopamine transmission in the human striatum during monetary reward tasks. J Neurosci. 2004; 24 4105-4112
54 Thiel A, Hilker R, Kessler J, Habedank B, Herholz K, Heiss W-D. Activation of basal ganglia loops in idiopathic Parkinson's disease: a PET study. J Neural Transm. 2003; 110 1303-1311
55 Kuperberg G R, Broome M R, McGuire P K, David A S, Eddy M, Ozawa F, Goff D, West W C, Williams S C, Kouwe A J van der, Salat D H, Dale A M, Fischl B. Regionally localized thinning of the cerebral cortex in schizophrenia. Arch Gen Psychiatry. 2003; 60 878-888
56 Aleman A, Hijman R, Haan E H de, Kahn R S. Memory impairment in schizophrenia: a meta-analysis. Am J Psychiatry. 1999; 156 1358-1366
57 Silver H, Feldman P, Bilker W, Gur R C. Working memory deficit as a core neuropsychological dysfunction in schizophrenia. Am J Psychiatry. 2003; 160 1809-1816
58 Gooding D C, Tallent K A. Nonverbal working memory deficits in schizophrenia patients: evidence of a supramodal executive processing deficit. Schizophr Res. 2004; 68 189-201
59 Cirillo M A, Seidman L J. Verbal declarative memory dysfunction in schizophrenia: from clinical assessment to genetics and brain mechanisms. Neuropsychol Rev. 2003; 13 43-77
60 Hill S K, Beers S R, Kmiec J A, Keshavan M S, Sweeney J A. Impairment of verbal memory and learning in antipsychotic-naive patients with first-episode schizophrenia. Schizophr Res. 2004; 68 127-136
61 Leiderman E A, Strejilevich S A. Visuospatial deficits in schizophrenia: central executive and memory subsystems impairments. Schizophr Res. 2004; 68 217-223
62 Holthausen E A, Wiersma D, Sitskoorn M M, Dingemans P M, Schene A H, Bosch R J van den. Long-term memory deficits in schizophrenia: primary or secondary dysfunction?. Neuropsychology. 2003; 17 539-547
63 Minzenberg M J, Ober B A, Vinogradov S. Semantic priming in schizophrenia: a review and synthesis. J Int Neuropsychol Soc. 2002; 8 699-720
64 Takano K, Ito M, Kobayashi K, Sonobe N, Kurosu S, Mori Y, Takeuchi S, Uchiyama M, Kanno M, Niwa S. Procedural memory in schizophrenia assessed using a mirror reading task. Psychiatry Res. 2002; 109 303-307
65 Salgado-Pineda P, Junque C, Vendrell P, Baeza I, Bargallo N, Falcon C, Bernardo M. Decreased cerebral activation during CPT performance: structural and functional deficits in schizophrenic patients. Neuroimage. 2004; 21 840-847
66 McCarley R W, Wible C G, Frumin M, Hirayasu Y, Levitt J J, Fischer I A, Shenton M E. MRI anatomy of schizophrenia. Biol Psychiatry. 1999; 45 1099-1119
67 Narr K L, Thompson P M, Szeszko P, Robinson D, Jang S, Woods R P, Kim S, Hayashi K M, Asunction D, Toga A W, Bilder R M. Regional specificity of hippocampal volume reductions in first-episode schizophrenia. Neuroimage. 2004; 21 1563-1575
68 Konick L C, Friedman L. Meta-analysis of thalamic size in schizophrenia. Biol Psychiatry. 2001; 49 28-38
69 Hassler R. Funktionelle Neuroanatomie und Psychiatrie. In: Gruhle HW, Jung R, Mayer-Gross W, Müller M Psychiatrie der Gegenwart. Forschung und Praxis: Grundlagenforschung der Psychiatrie. Berlin; Springer 1967: 152-285
70 Heyck H. Kritischer Beitrag zur Frage anatomischer Veränderungen im Thalamus bei Schizophrenie. Monatsschr Psychiatr Neurol. 1954; 128 106-128
71 Corcoran R, Frith C D. Autobiographical memory and theory of mind: evidence of a relationship in schizophrenia. Psychol Med. 2003; 33 897-905
72 Cohen A S, Docherty N M. Affective reactivity of speech and emotional experience in patients with schizophrenia. Schizophr Res. 2004; 69 7-14
73 Moberg P J, Arnold S E, Doty R L, Kohler C, Kanes S, Seigel S, Gur R E, Turetsky B I. Impairment of odor hedonics in men with schizophrenia. Am J Psychiatry. 2003; 160 1784-1789
74 Vogeley K, Bergmann A, Falkai P. Theory of mind und Selbstperspektive - neuronale Korrelate und Veränderungen bei der Schizophrenie. In: Schiepek G Neurobiologie der Psychotherapie. Stuttgart; Schattauer 2003: 423-435
75 Beblo T, Herrmann M. Neuropsychologische Defizite bei depressiven Störungen. Fortschr Neurol Psychiatr. 2000; 68 1-11
76 Brand A N, Jolles J, Gispen-de Wied C. Recall and recognition memory deficits in depression. J Affect Disord. 1992; 25 77-86
77 Bussmann C, Sauer M, Kessler J, Hautzinger M, Markowitsch H J. Wiedererkennensleistung und Funktionsrestitution bei abklingenden depressiven Erkrankungen. Eine Studie mit visueller unilateraler Exposition affektiv getönten Reizmaterials. Zeitschr klin Psychol. 1988; 17 307-318
78 Deijen J B, Orlebeke J F, Rijsdijk F V. Effect of depression on psychomotor skills, eye movements and recognition-memory. J Affect Disord. 1993; 29 33-40
79 Stordal K I, Lundervold A J, Egeland J, Mykletun A, Asbjornsen A, Landro N I, Roness A, Rund B R, Sundet K, Oedegaard K J, Lund A. Impairment across executive functions in recurrent major depression. Nord J Psychiatry. 2004; 58 41-47
80 Naismith S L, Hickie I B, Turner K, Little C L, Winter V, Ward P B, Wilhelm K, Mitchell P, Parker G. Neuropsychological performance in patients with depression is associated with clinical, etiological and genetic risk factors. J Clin Exp Neuropsychol. 2003; 25 866-877
81 Bremner J D, Vythilingam M, Vermetten E, Nazeer A, Adil J, Khan S, Staib L H, Charney D S. Reduced volume of orbitofrontal cortex in major depression. Biol Psychiatry. 2002; 51 273-279
82 Campbell S, Marriott M, Nahmias C, MacQueen G M. Lower hippocampal volume in patients suffering from depression: a meta-analysis. Am J Psychiatry. 2004; 161 598-607
83 Hastings R S, Parsey R V, Oquendo M A, Arango V, Mann J J. Volumetric analysis of the prefrontal cortex, amygdala, and hippocampus in major depression. Neuropsychology. 2004; 29 952-959
84 Liotti M, Mayberg H S. The role of functional neuroimaging in the neuropsychology of depression. J Clin Exp Neuropsychol. 2001; 23 121-136
85 Davidson R J, Pizzagalli D, Nitschke J B, Putnam K. Depression: perspectives from affective neuroscience. Ann Rev Psychol. 2002; 53 545-547
86 Drevets W C. Neuroimaging studies of mood disorders. Biol Psychiatry. 2000; 48 813-829
87 Driessen M, Beblo T, Mertens M, Piefke M, Rullkoetter N, Silva-Saavedra A, Reddemann L, Rau H, Markowitsch H J, Wulff H, Lange W, Woermann F G. Posttraumatic stress disorder and fMRI activation patterns of traumatic memory in patients with borderline personality disorder. Biol Psychiatry. 2004; 55 603-611
88 Moselhy H F, Georgiou G, Kahn A. Frontal lobe changes in alcoholism: a review of the literature. Alcohol Alcoholism. 2001; 36 357-368
89 Noel X, Linden M van der, Schmidt N, Sferrazza R, Hanak C, Bon O Le, Mol J de, Kornreich C, Pelc I, Verbanck P. Supervisory attentional system in nonamnesic alcoholic men. Arch Gen Psychiatry. 2001; 58 1152-1158
90 Lishman W A. Alcohol and the brain. Br J Psychiatry. 1990; 156 635-644
91 Bonhoeffer K. Der Korsakowsche Symptomenkomplex in seinen Beziehungen zu den verschiedenen Krankheitsformen. Allg Zeitschr Psychiatr. 1904; 61 744-752
92 Kopelman M D. The Korsakoff syndrome. Br J Psychiatry. 1995; 166 154-173
93 Oscar-Berman M, Kirkley S M, Gansler D A, Couture A. Comparisons of Korsakoff and non-Korsakoff alcoholics on neuropsychological tests of prefrontal brain functioning. Alcohol Clin Exp Res. 2004; 28 667-675
94 Brand M, Fujiwara E, Kalbe E, Steingass H-P, Kessler J, Markowitsch H J. Cognitive estimation and affective judgments in alcoholic Korsakoff patients. J Clin Exp Neuropsychol. 2003; 25 324-334
95 Markowitsch H J, Kessler J, Bast-Kessler C, Riess R. Different emotional tones significantly affect recognition performance in patients with Korsakoff psychosis. Int J Neurosci. 1984; 25 145-159
96 Brand M, Fujiwara E, Borsutzky S, Kalbe E, Kessler J, Markowitsch H J. Decision-making deficits of Korsakoff patients in a new gambling task with explicit rules - associations with executive functions. Neuropsychology 2004, im Druck
97 Victor M, Adams R D, Collins G H. The Wernicke-Korsakoff Syndrome. 2^nd ed. Philadelphia; F. A. Davis Company 1989
98 Mair W G, Warrington E K, Weiskrantz L. Memory disorder in Korsakoff's psychosis: a neuropathological and neuropsychological investigation of two cases. Brain. 1979; 102 749-783
99 Reed L J, Lasserson D, Marsden P, Stanhope N, Stevens T, Bello F, Kingsley D, Colchester A, Kopelman M D. FDG-PET findings in the Wernicke-Korsakoff syndrome. Cortex. 2003; 39 1027-1045
100 Förstl H. Klinische Neuro-Psychiatrie: Neurologie psychischer Störungen und Psychiatrie neurologischer Erkrankungen. Stuttgart; Thieme Verlag 2000
101 Calabrese P, Markowitsch H J. Neuropsychologie des Gedächtnisses. In: Förstl H Lehrbuch der Gerontopsychiatrie und -psychotherapie. 2^nd ed. Stuttgart; Thieme Verlag 2002: 75-86
102 Härting C, Markowitsch H J. Neuropsychologische Befunde der Zwangsstörung. Fortschr Neurol Psychiatr. 1997; 65 509-515
103 Fujiwara E, Markowitsch H J. Das mnestische Blockadesyndrom - hirnphysiologische Korrelate von Angst und Stress. In: Schiepek G Neurobiologie der Psychotherapie. Stuttgart; Schattauer 2003: 186-212
104 Förstl H. Frontalhirn - Funktionen und Erkrankungen. Berlin; Springer 2002

Dr. Matthias Brand

Physiologische Psychologie Universität Bielefeld

Postfach 100131

33501 Bielefeld

Email: m.brand@uni-bielefeld.de