SynopsisTwenty-five schizophrenic patients currently experiencing Schneiderian symptoms performed a series of tasks in which drawings had to be made in the absence of immediate visual feedback. In comparison to 10 normal controls and to 30 patients not experiencing Schneiderian symptoms, the target group had great difficulty in keeping track of their performance and remembering what actions they had made. These results are consistent with the hypothesis that Schneiderian symptoms (such as delusions of alien control) are associated with impairments in the central monitoring of action.
Background/Aim: The Clock Drawing Test (CDT) is a valid alternative screening tool to the Mini-Mental State Examination (MMSE) and, crucially, it may be completed faster. The aim of our study was to standardize and simplify the CDT scoring system for screening in three common conditions: mild cognitive impairment (MCI), Alzheimer’s disease (AD) and mixed dementia (MD). Methods: We included 188 subjects (43 healthy volunteers, 49 patients with MCI, 54 patients with AD, and 42 patients with MD), who performed the MMSE and CDT. The CDT was evaluated using a modified 4-point scoring system. Results: The healthy subjects had the highest median values for the MMSE and CDT, followed by patients with MCI, AD and MD. The optimal cut-off for all patients and each patient group separately was 3 out of 4 points. Sensitivity was 89% for AD, 93% for MD and 83% for all patients, while specificity was 91%. The MMSE produced similar results. In comparison to the MMSE, sensitivity for MCI was significantly higher using the CDT (20 vs. 69%, respectively). Conclusion: A simple, 4-point scoring system may be used as a screening method for fast and accurate detection of cognitive impairment in patients with MCI, AD and MD.
Schizophrenic disorganisation syndrome is usually considered to be associated with poor performance on frontal lobe tasks, specifically those that require suppression of dominant responses. Two cases are presented who do not fulfil this expectation Despite severe disorganisation of speech and behaviour these patients performed well on several executive tasks in which dominant responses had to be suppressed. One of the patients showed significantly less interference on the Stroop task than normal controls. In contrast, both patients performed badly on a sentence completion task in which production of the dominant response was appropriate. These observations imply that these patients were able to exert ''top-down'' supervisory control in situations where it was necessary to inhibit dominant response tendencies. We propose that, although many patients with schizophrenia and intellectual deficits do show disorganised behaviour associated with a defective supervisory system, there are others in whom this behaviour is a consequence of the failure of ''bottom-up'' control by context. Our cases indicate that disorganisation in schizophrenia may be associated with different underlying cognitive deficits.
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