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A Comparison of Patients Matched for Performance on a Prefrontal-Type Task

Terry E. Goldberg, PhD; Karen Faith Berman, MD; Erich Mohr, PhD; Daniel R. Weinberger, MD

Arch Neurol. 1990;47(4):418-422.

Abstract
• Matching patients with etiologically distinct but clinically overlapping cognitive disorders on performance of a regionally specific neuropsychological task is a novel and potentially powerful approach to highlighting differences in the pathophysiological mechanisms of impaired cognition. We used this strategy to compare patients with Huntington's disease (HD) and schizophrenia (SC), disorders that share similarities in cognitive impairment. Patients were matched on the basis of performance on the Wisconsin Card Sorting test of "prefrontal" function, after which neuropsychological test data and regional cerebral blood flow data were determined while patients who performed the Wisconsin Card Sorting test were examined. Patients with HD performed worse on visuospatial tasks and recall memory than did patients with SC, although Wechsler Adult Intelligence Scales-Revised IQ and Wechsler Memory Scale memory quotients were equivalent. These differences could not be attributed to differences on the index task, the Wisconsin Card Sorting Test. Patients with HD and SC exhibited a double dissociation in regional cerebral blood flow. The patients with SC had relatively low frontal and high parietal flows, while patients with HD exhibited the reverse of this pattern. Thus, the regional cerebral blood flow and neuropsychological findings in this study appeared to demonstrate that the single final common cognitive impairment of executive function in HD and SC is associated with two markedly dissimilar pathophysiological states.

Author Affiliations
From the Clinical Brain Disorders Branch, Intramural Research Program, National Institute of Mental Health (Drs Goldberg, Berman, and Weinberger), Washington, DC; and the Medical Neurology Branch, National Institute of Neurological Diseases and Stroke (Dr Mohr), Bethesda, Md.

Footnotes
Accepted for publication August 2, 1989.

Reprint requests to National Institute of Mental Health Neurosciences Center at St Elizabeths, WAW Bldg, Room 500, 2700 Martin Luther King Jr Ave SE, Washington, DC 20032 (Dr Goldberg).

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