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Objectives:To evaluate whether cerebrospinal fluid biomarkers, apolipoprotein e4, neuroimaging abnormalities, and neuropsychological data differentially predict progression from mild cognitive impairment (MCI) to dementia for men and women.Methods:Participants who were diagnosed with MCI at baseline (n = 449) were classified as either progressing to Alzheimer’s dementia at follow-up or as not progressing. Men and women were first compared using bivariate analyses. Sex-stratified Cox proportional hazard regressions were performed examining the relationship between baseline data and the likelihood of progressing to dementia. Sex interactions were subsequently examined.Results:Cox proportional hazard regression controlling for age and education indicated that all variables significantly predicted subsequent progression to dementia for men and women. Sex interactions indicated that only Rey Auditory Verbal Learning Test (RAVLT) delayed recall and Functional Activities Questionnaire (FAQ) were significantly stronger risk factors for women. When all variables were entered into a fully adjusted model, significant risk factors for women were Aβ42, hippocampal volume, RAVLT delayed recall, Boston Naming Test, and FAQ. In contrast, for men, Aβ42, p-tau181, p-tau181/Aβ42, hippocampal volume, category fluency and FAQ were significant risk factors. Interactions with sex were only significant for p-tau181/Aβ42 and RAVLT delayed recall for the fully adjusted model.Conclusions:Men and women with MCI may to differ for which factors predict subsequent dementia although future analyses with greater power are needed to evaluate sex differences. We hypothesize that brain and cognitive reserve theories may partially explain these findings.

Background Although radiation (RT) is standard treatment for many brain tumors, it may contribute to neurocognitive decline. The objective of this study was to investigate associations between RT dose to circumscribed brain regions and specific neurocognitive domains in patients with meningioma. Methods We undertook a retrospective study of 40 patients with meningioma who received RT and underwent an in-depth clinical neurocognitive assessment. Radiation dosimetry characteristics were delineated based on treatment planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Principal components analysis was applied to organize neurocognitive test scores into factors, and multivariate multiple linear regression models were undertaken to examine if RT dose to circumscribed brain regions is associated with specific neurocognitive outcomes. Results Radiation dose to brain regions was associated with neurocognitive functions across a number of domains. High dose to the parietal-occipital region was associated with slower visuomotor processing speed (mean dose, β = −1.100, P = .017; dose to 50% of the region [D50], β = −0.697, P = .049). In contrast, high dose to the dorsal frontal region was associated with faster visuomotor processing speed (mean dose, β = 0.001, P = .036). Conclusions These findings suggest that RT delivered to brain regions (ie, parietal-occipital areas) may contribute to poor neurocognitive outcomes. Given that modern radiotherapy techniques allow for precise targeting of dose delivered to brain regions, prospective trials examining relations between dose and neurocognitive functions are warranted to confirm these preliminary results.

To synthesize quantitatively the mild cognitive impairment (MCI) literature with respect to the relationship between cognitive reserve and neuropsychological and functional outcomes.Participants with a diagnosis of MCI (total n = 7,871; 53% female) were included in this random-effects meta-analysis. Neuropsychological measures were combined into composite scores (e.g., overall cognitive functioning, screening measures, memory, language, visuospatial, attention/processing speed/working memory, executive functioning, and motor functioning). Measures assessing real-world abilities were combined into an activities of daily living (ADL) composite.Nearly all neuropsychological composite values were significantly correlated with education, with effect sizes ranging from small to moderate. The effect between overall neuropsychological functioning and occupation was weak and varied by cognitive domain. For cognitively stimulating leisure activity, only overall neuropsychological functioning demonstrated a significant relationship, with a weak effect size (r = .16). In contrast, ADLs were most strongly associated with leisure experience (r = .27), with a negligible relationship with education (r = 0.08) and occupation (r = 0.09).Of the cognitive reserve proxies examined in this study, participation in leisure activity had the largest magnitude of effect size with ADL functioning. This was in stark contrast to the negligible relationship found for education and occupation. Although education has been widely considered the most important cognitive reserve proxy with respect to cognition, this work questions whether other lifestyle factors may play a more important role in preserving real world functioning.

Intrinsic motivation deficits are a prominent feature of schizophrenia that substantially impacts functional outcome. This study used cluster analysis of innate real-world behaviours captured during two open-field tasks to dimensionally examine heterogeneity in intrinsic motivation in schizophrenia patients (SZ) and healthy controls (HC). Wireless motion capture quantified participants’ behaviours aligning with distinct aspects of intrinsic motivation: exploratory behaviour and effortful activity in the absence of external incentive. Cluster analysis of task-derived measures identified behaviourally differentiable subgroups, which were compared across standard clinical measures of general amotivation, cognition, and community functioning. Among 45 SZ and 47 HC participants, three clusters with characteristically different behavioural phenotypes emerged: low exploration (20 SZ, 19 HC), low activity (15 SZ, 8 HC), and high exploration/activity (10 SZ, 20 HC). Low performance in either dimension corresponded with similar increased amotivation. Within-cluster discrepancies emerged for amotivation (SZ > HC) within the low exploration and high performance clusters, and for functioning (SZ

In this study, we sought to explore if linguistic factors impact the diagnosis of mild traumatic brain injury (mTBI). More specifically, we examined if the meaning of acute injury characteristics that determine whether an mTBI was sustained systematically differed across linguistically diverse populations. A total of 296 participants (68% female; 33% of South Asian descent; 42% second generation Canadian) were administered an mTBI Criterion Questionnaire where they were asked to define the diagnostic terms “dazed,” “disoriented,” and “confused.” These words were analyzed and placed into an appropriate validated word category scale (i.e., self-reference, social, positive emotion, negative emotion, and cognitive) using the Linguistic Inquiry and Word Count software program. There were no significant differences between native-English and limited English proficiency (i.e., non-native-English) speaker groups for the diagnostic terms “dazed” and “confused.” However, there were significant differences between these language groups for the diagnostic term “disoriented.” Our findings suggest that individuals that have limited English proficiency may be subject to additional distortions in symptom reporting. Clinicians should be particularly mindful of linguistic differences in patient interpretation of acute injury characteristics in the context of establishing a diagnosis of mTBI.

In this pilot study, intraindividual variability in neurocognitive test performance was examined in 24 healthy individuals with high levels of education and average full-scale IQ of 121.9 on a short neuropsychological battery across multiple cognitive domains. Marked variability was found across all domains. Intraindividual differences between the highest and lowest z-scores ranged from 2.05 to 6.92 (M = 3.89, SD = 1.25). Based on the definitions of abnormality proposed by Lezak, Wechsler and Heaton, 46% of our sample participants had at least one score that was more than 2 standard deviations below the population mean; 50% had at least one score that was less than the 5th percentile (z 1.0 SD) across our sample. Our findings suggest the need for caution when inferring the presence of cerebral dysfunction in high academic achievers, particularly in a medical legal setting where false-positive diagnoses may be of particular consequence.

We sought to determine whether the diagnostic terms 'mild traumatic brain injury (mTBI)' and 'concussion' result in differences in perceived cognitive, emotional, and post-concussive sequelae.A total of 81 healthy university students (79% female; 69% of Asian descent) were randomly assigned to one of two conditions: mTBI (There were no significant group differences between expected cognitive, emotional, or post-concussive consequences. However, both groups received poorer scores than the normative data.These results suggest that diagnostic terminology does not appear to influence anticipated recovery following mild brain injury. However, the presentation of information about the injury itself may impact recovery outcomes. This study provides preliminary support for the potential negative effects that may arise as a result of providing participants with non-evidence based information about mild brain injuries.

This study aimed to investigate long-term neurocognitive, psychological, and return to work (RTW) outcomes in meningioma patients, and to explore whether neurocognitive and psychological factors influence RTW outcomes in this population.In this retrospective study, 61 meningioma patients completed in-depth clinical neuropsychological assessments. Of these participants, 42 were of working-age and had RTW information available following neuropsychological assessment. Seventy-one percent and 80% of patients received radiation and surgery, respectively, with 49% receiving both radiation and surgery. Associations between demographic, medical, neurocognitive, psychological, and RTW data were analyzed using multivariable logistic regression analyses.In our sample, 68% of patients exhibited global neurocognitive impairment, with the largest effect sizes found on tests of visual memory (d = 0.73), executive function (d = 0.61), and attention (d = 0.54). Twenty-seven percent exhibited moderate to severe levels of depressive symptoms. In addition, 23% and 30% exhibited clinically significant state and trait anxiety, respectively. Forty-eight percent of patients were unable to RTW. Younger age, faster visuomotor processing speed, and, unexpectedly, higher trait anxiety scores were associated with an increased likelihood of returning to work.Meningioma patients are at risk of experiencing neurocognitive deficits, psychological symptoms, and difficulties returning to work. Our results suggest that neurocognitive and psychological factors contribute to RTW status in meningioma patients. Prospective research studies are necessary to increase our understanding of the complexity of functional disability in this growing population.

The Personality Assessment Inventory (PAI) is a reliable multidimensional psychometric inventory that is increasingly being used in the medical–legal context. To date, 18 language adaptations of the PAI exist, yet only the Spanish, Greek and German language versions have been examined psychometrically. This study evaluated the psychometric properties of the French-Canadian version of the PAI by comparing mean scale and subscale scores between the French-Canadian and English language versions, and analyzing the internal consistency and mean item inter-correlations (MICs) of each version in a sample of 50 bilingual university students. Cronbach’s alphas ranged from −.57 to .80 in the French-Canadian version and from −1.10 to .83 in the English version, with most scales being below .70, indicating inadequate internal consistency. In addition, most of the MICs were below .20, indicating a lack of item homogeneity. Caution is given to this adaptation of the PAI in the medical–legal context.

Traumatic brain injury (TBI) is a craniocerebral trauma associated with decreased level of consciousness, amnesia, and potential abnormalities on neuroimaging. Apathy is a common symptom after TBI with a wide prevalence range (11–71%), which may be due to assessment, overlapping symptoms with depression, time since injury, and severity of injury. There is a dearth of studies exploring the neurobiology of apathy after TBI but patterns indicate the involvement of the prefrontal cortex, anterior cingulate cortex, and insula. These areas are also commonly disrupted after a TBI. Little is known regarding the neuropsychology of apathy and TBI with some evidence of executive dysfunction and acquisition memory deficits. Similarly, there is limited evidence for treatment of apathy after TBI. Many interventions implemented to date were based on empirically based interventions for neurodegenerative disorders. This review is intended to raise clinicians’ awareness of apathy after TBI and encourage researchers to explore this emerging phenomenon.

Research suggests decreased cortical dopamine is a neural correlate of cognitive deficits in schizophrenia. Evidence of impaired cognitive task-induced cortical dopamine release was demonstrated in patients with psychosis. However, whether cortical dopamine release in response to a cognitive task in clinical high risk for psychosis (CHR) is also impaired, is currently unknown. We aimed to test dopamine release in the dorsolateral prefrontal cortex (DLPFC) and the anterior cingulate cortex (ACC) in antipsychotic-free CHR participants and healthy controls (HC) performing the Wisconsin Card Sorting Task (WCST). Two [11C]FLB457 PET scans were conducted for 13 CHR and 15 HC while performing the WCST and the sensorimotor control task (SMCT), respectively. A magnetic resonance image was acquired for anatomical delineation. Percentage change in binding potential (ΔBPND) in ACC and DLPFC in WCST were compared with the SMCT between CHR and HC. Mixed model analysis revealed no statistically significant differences in the cognitive task induced ΔBPND in any ROIs. There were no main effect of group (F(1, 26) = 0.348; p = 0.560) or ROI (F(1, 26) = 1.080; p = 0.308) and no significant Group x ROI interaction (F(1, 26) = 0.049; p = 0.826). Our findings suggest no statistically significant difference between CHR and HC in cognitive task-induced cortical dopamine release. This is the first in vivo study to illustrate that the cortical hypodopaminergic state observed in schizophrenia may not be present in its putative high-risk state.

The ability to use feedback to guide optimal decision-making is essential for goal-directed behaviour. While impairments in feedback-driven decision-making have been associated with schizophrenia and depression, this has been examined primarily in the context of binary probabilistic choice paradigms. In real-world decision-making, however, individuals must make choices when there are more than two competing options that vary in the frequency and magnitude of potential rewards and losses. Thus, the current study examined win-stay/lose-shift (WSLS) behaviour on the Iowa Gambling Task (IGT) in order to evaluate the influence of immediate rewards and losses in guiding real-world decision-making in patients with schizophrenia and major depressive disorder. Fifty-one patients with schizophrenia, 43 patients with major depressive disorder, and 51 healthy controls completed the IGT, as well as a series of clinical and cognitive measures. WSLS was assessed by quantifying trial-by-trial behaviour following rewards and losses on the IGT. Multivariate analyses of variance revealed that patients with schizophrenia demonstrated intact lose-shift behaviour, but significantly reduced win-stay rates compared to healthy controls. In contrast, no WSLS impairments emerged in the depressed group. Win-stay impairments in the schizophrenia group were significantly related to deficits in motivation and cognition. Patients with schizophrenia exhibit impaired reward-driven decision-making in the context of multiple choices with concurrent rewards and losses, and this appears to be driven by a reduced propensity for advantageous win-stay behaviour. With the importance of reward learning and decision-making in generating goal-directed behaviour, these findings suggest a potential mechanism contributing to the motivation deficits seen in schizophrenia.

Traumatic brain injury (TBI) is a leading cause of death and disability, with injuries classified as mild in severity being the most frequently sustained. While the majority of patients recover within 3 months post-injury, many individuals continue to experience debilitating emotional sequelae several months after the injury. While spiritual well-being has been shown to carry protective benefits against both depression and anxiety in the general population, it has not been investigated as a protective factor in this population. The aim of this study was to investigate whether spiritual well-being leads to a reduction in anxious and depressive symptomatology following mild TBI (mTBI). The Beck Anxiety Inventory, Beck Depression Inventory-II, and Spiritual Well-Being Scale were administered to a sample of 83 litigating examinees who had undergone neuropsychological testing to assess their present functioning secondary to mTBI. The existential well-being (EWB) subscale significantly predicted depressive symptomatology. These findings support the role of EWB as contributory factor related to depressive symptomatology following mTBI. Rehabilitation practitioners should consider treatment paradigms that address EWB as a primary contributor to reduce depressive symptomatology, which may ultimately lead to improved functional ability.

The present study set out to examine the ecological validity of the Neuropsychological Assessment Battery-Screening Module (NAB-S) and to examine more specifically, whether performance on this test battery is related to real-world disability status in patients who have sustained a mild traumatic brain injury (mTBI) as a consequence of a motor vehicle collision (MVC). Seventy-nine patients were recruited from a random sample of litigating patients who incurred an mTBI and were referred for a neuropsychological examination due to subjective complaints of cognitive function. Of the total sample, 54 patients were categorized into the non-disabled group and 25 patients were categorized into the disabled group using the 4th edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (AMA; 1993). A multivariate analysis of variance revealed that performance on the NAB-S significantly differed between the two groups, and that memory and attention domains provided a more discriminative index of disability than general neuropsychological functions. In addition, discriminant function analyses revealed that the NAB-S correctly classified 73% of patients according to their group membership. The current findings provide evidence for the ecological validity of the NAB-S as a reliable index of real-world disability status as defined by the AMA Guides.

Confabulations, or false memories, are observed in various disorders, including schizophrenia. In forensic psychiatric assessment, this is problematic, particularly when garnering a clinical history and detailed account of the index offense(s) from the individual being charged. This study sought to quantitatively synthesize the existing literature regarding the frequency of confabulations in schizophrenia and its neurocognitive correlates. The keywords “schizophrenia” and “psychosis” were systematically canvassed in combination with “confabulation,” “false memory,” and “false memories” on PsycINFO, PubMed, and Scopus. Inclusion criteria included the following: (1) Participant samples that included the patients with schizophrenia and healthy controls; (2) commercially available neuropsychological test measures were employed (i.e., no experimental paradigms were considered); (3) quantitative data (i.e., means and standard deviations) was available so that an effect size could be computed; (4) published findings in peer-reviewed academic journals and written in English. Studies examining high-risk or first-episode psychosis groups were excluded. Five studies were included in the final analysis. Effect sizes in terms of Cohen’s d were calculated for number of confabulations made. When available, the correlations between confabulation and neurocognitive variables were recorded. The findings suggest that patients with schizophrenia confabulated more than healthy controls for new information if it was related to old information. The relationship between confabulations and neurocognitive variables was inconsistent. Together, the results from this quantitative review has important implications for interviewing techniques in forensic psychiatric assessment. Specifically, the assessor should take great care not to ask leading questions or introduce unverified, contextual information into the interview, as it may result in a confabulation, rather than a more accurate account of the event.

Using meta-analytic methods, we sought to synthesize the research literature on memory impairment in schizophrenia. Additionally, we compared performances across memory measures to determine if task difficulty (e.g., effortful encoding and retrieval vs non-effortful encoding and retrieval) could account for variance across studies. Our primary measures of interest included the California Verbal Learning Test, Wechsler Memory Scale, Rey Auditory Verbal Learning Test, Hopkins Verbal Learning Test, Rey-Osterrieth Complex Figure Test, and the Benton Visual Retention Test. We searched for all studies that met inclusion criteria using PubMed, PsycINFO, Scholars Portal Search, and Google Scholar. Studies were included if: (i) they were published after 1980; (ii) healthy controls were compared to patients with schizophrenia; (iii) at least one of the noted measures of interest was employed in the primary study; and (iv) the primary study included data that could be transformed to point estimate effect sizes (i.e., Cohen's d). Cohen's d was calculated between patients and healthy controls, along with overall 95% confidence intervals. A two-tailed independent samples t-test was conducted to assess if performance differed on various paired subtests of the same domain. Large effect sizes were found for all memory tests. No significant differences were found between subtests. In conclusion, patients with schizophrenia experience significant verbal and visual memory impairments, which are not explained by task difficulty. Patients were unable to learn or retrieve more reliably despite repetition and cuing strategies, suggesting that memory impairment in the illness is not a function of task difficulty.

BACKGROUND Gender differences in instrumental activities of daily living (IADLs) in mild cognitive impairment (MCI) and Alzheimer's disease may be explained by gender differences in IADL involvement. OBJECTIVE We introduce a novel theoretical construct, termed functional reserve, and empirically examine gender differences in IADL experience as a proxy of this reserve. METHODS We cross-sectionally examined men (n = 502) and women (n = 340) with MCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Demographic factors, depressive symptoms, neuropsychological scores, and IADL experience were included as independent variables and total Functional Activities Questionnaire (FAQ) scores as the dependent variable. Regression analyses were performed on the full cohort and stratified by gender to identify differential predictive relationships for men and women. RESULTS Gender was associated with total FAQ (p

Background In recent decades, research in the treatment of schizophrenia has shifted to early detection and intervention. Unfortunately, the development of psychosis is still poorly understood, making such an endeavour more challenging. Cognitive models of psychosis suggest that neurocognitive deficits place an individual at greater risk of developing metacognitive deficits. Such deficits in metacognition have been shown to contribute to the development of positive symptomatology. A large body of literature supports that patients with schizophrenia exhibit impairments across nearly all domains of neurocognition, as well as metacognition. Theory of mind (ToM) is one of the most widely studied components of metacognition, which includes both cognitive (i.e., understanding what another person is thinking) and affective (i.e., understanding what another person is feeling) processes. Research indicates patients with schizophrenia demonstrate deficits in cognitive and affective ToM, and these deficits are associated with delusional symptomatology. If ToM is involved in the development of positive symptoms, it is expected that this deficit would be present prior to the onset of a first episode psychosis. It is unclear from current research findings if this is the case, however. Additionally, research examining the role of neurocognition as it relates to ToM is lacking. While some research has examined these variables in clinically-high-risk (CHR) groups, little research has examined nonclinical samples at risk for psychosis. Thus, this study sought to examine the relationship between ToM and neurocognition in a nonclinical sample with schizotypal traits, as research suggests these individuals may be at risk of developing a psychotic illness. It was hypothesized that lower performance in working memory and executive functioning would be related to poorer performance in cognitive and affective ToM, which would subsequently be associated with subsyndromal delusions. It was further predicted that schizotypal traits would moderate the relationship between neurocognitive performance and ToM abilities. Methods Undergraduate students (N = 99) completed self-report measures of personality and psychosocial functioning, including the Schizotypal Personality Questionnaire, Beck Depression Inventory-II, Launay-Slade Hallucination Scale-Revised, and 21-Item Peters Delusions Inventory. Participants also completed the Neuropsychological Assessment Battery Screening Module, which is a screening measure for neurocognitive dysfunction. Finally, they completed the Recognition of Faux Pas Test, a task-based measure that evaluates cognitive and affective ToM. Results Data collection is complete, and the data will be analysed using partial least squares structural equation modeling. This is a regression-based path analysis designed for exploratory models. This statistical method is better able to handle non-normally distributed data and smaller sample sizes when compared to covariance-based structural equation modeling. Discussion Study findings will be discussed in the context of cognitive models for the development of psychosis. The ways in which these findings, and cognitive models more broadly, can facilitate early detection of schizophrenia will be discussed, along with how such models can be used to inform psychosocial interventions for the illness.

Background Intrinsic motivation (IM) deficits are a prominent feature of schizophrenia that substantially impacts functional outcome. Previous investigations have primarily assessed IM as a general construct or towards specific activities, but multifaceted examination of IM using objective and ecologically valid means has been lacking. The current study aimed to determine whether IM-driven real-world behaviours of individuals with and without schizophrenia reveal distinct behavioural phenotypes that predict differential clinical and functional profiles. Methods Forty-five stable adult outpatients with schizophrenia or schizoaffective disorder (SZ) and 47 healthy controls (HC), group-matched for age and sex, completed the study. Wireless motion capture was used to quantify participants’ behaviour (during two previously validated 15-minute open-field tasks) aligning with distinct aspects of IM: exploratory behaviour (in an unfamiliar setting that contained common and uncommon objects) and unincentivized activity engagement (under provision of explicit choice between active versus passive engagement options). Sparse k-means clustering was applied to task-derived indices of locomotion and object exploration, and activity duration, intensity, and persistence to identify behaviourally differentiable subgroups. Clusters were compared across standard clinical measures of general amotivation, cognition, and community functioning. Diagnostic group by cluster assignment interaction effects were evaluated to identify potential discrepancies in within-cluster SZ versus HC differences across clusters. Results Three clusters emerged: medium activity and low exploration (20 SZ and 19 HC), low activity and medium exploration (15 SZ and 8 HC), and high activity and exploration (10 SZ and 20 HC). Cluster assignment did not significantly predict diagnostic group (Fisher’s exact p=0.067) but indicated increased odds of diminished exploration or activity in SZ (odds ratio=2.57, p=0.047). General amotivation differed across clusters (F(2,89)=6.31, p=0.003) due to significantly elevated scores in the low exploration and low activity clusters versus the high performance cluster. Evaluation of the diagnostic group by cluster assignment interaction effect for amotivation (F(2,86)=3.12, p=0.062) revealed significantly higher scores in SZ versus HC within the low exploration and high performance clusters, but not the low activity cluster. Evaluation of the interaction effect for community functioning (F(2,86)=4.86, p=0.007) revealed significantly lower scores in SZ versus HC within all clusters, with the discrepancy increasing from high performance to low activity to low exploration. Discussion Multidimensional characterization of IM stands to provide valuable insights into motivation and functioning deficits in schizophrenia that behaviourally manifest differently across individuals. Impairment in IM-driven behaviour may be substantially detrimental particularly for individuals with schizophrenia, as SZ participants demonstrated clinically observable deficits even compared to within-cluster HC counterparts. The current lack of objective standards to measure IM underscores the benefit of behaviour-based characterization. Further, as IM has been deemed a valuable psychosocial intervention target in schizophrenia, multidimensional behavioural phenotyping may help guide personalized therapy by differentiating between IM impairments demanding amelioration versus unimpaired tendencies that may be leveraged to facilitate remediation.

Cognitive impairments in depression contribute to disability. According to prevailing cognitive theories, one's perception related to cognitive ability can cause and maintain depression, and related outcomes. Here, we investigate the degree to which perceived cognitive impairment predicts functional impairment above and beyond objective neurocognition. A sample of young adults (n = 123) completed a battery of tests measuring objective cognitive ability, perceived cognitive function (e.g., Perceived Deficits Questionnaire), disability (e.g., World Health Organization Disability Assessment Schedule) and depressive symptoms (Beck Depression Inventory-2). Hierarchical multiple regression analyses tested the incremental variance that perceived cognitive impairment accounts for above and beyond neuropsychological test measures and disability related to depression. Results show that perceived cognitive impairment accounts for significant incremental variance in depressive symptoms beyond neuropsychological test scores; disability measures were significantly associated with depressive symptoms, as was perceived cognitive impairment. Individuals with depression and related disorders are more likely to report cognitive impairments and experience diminished cognitive ability - relative to healthy controls - regardless of objective impairments, highlighting the importance of considering, measuring, and treating this perceived cognitive impairment, that is, Cognitive Impairment Bias ( Dhillon and Zakzanis, 2019 ).

While it is well established that individuals with schizophrenia exhibit a wide range of neurocognitive deficits, there is significant heterogeneity in this regard. Impairments in verbal fluency appear to present consistently across most individuals with the illness. The present study examined the stability of verbal fluency abilities in chronic schizophrenia longitudinally. It was hypothesized that semantic but not phonemic verbal fluency performance would be stable over one year. Data was extracted from a larger study that followed 53 outpatients (70% male; mean age = 39.2 years) diagnosed with schizophrenia or schizoaffective disorder. At each testing interval (baseline, 6, and 12 months), the Brief Assessment of Cognition in Schizophrenia was administered, which included phonemic (i.e., F, S) and semantic (i.e., animals) verbal fluency tasks. No significant differences were found across time points for semantic and phonemic verbal fluency with respect to mean number of words generated, clustering, and switching. The findings provide evidence of stability in semantic and phonemic verbal fluency abilities in chronic schizophrenia. Moving forward, it would be valuable to examine verbal fluency performance longitudinally across multiple stages of illness (i.e., clinically high-risk to chronic schizophrenia).

BACKGROUND: Motivation deficits have been linked to poor functional outcomes in schizophrenia (SZ) and major depressive disorder (MDD) and represent an unmet therapeutic need. Recent conceptualizations of the motivation system have outlined five inter-related reward processes, whereby (1) reward responsiveness (i.e. “liking”) and (2) reward prediction (i.e. “wanting”, established through appropriate reward learning) converge to inform both (3) reward valuation and (4) effort valuation which is associated with a cost-benefit analysis, followed by (5) the development and execution of an action plan to achieve the desired outcome. The inclusion of approach motivation within the RDoC Positive Valence System further underscores its importance as a pervasive symptom that cuts across traditional diagnostic boundaries. Previous investigations, however, have typically only focused on isolated reward processes, often within single diagnostic groups. Thus, in line with emerging dimensional approaches to examining psychopathology, the present study sought to utilize a cluster-analytic approach to objectively evaluate the multiple facets of the motivation system concurrently across SZ, MDD, and healthy control (HC) participants. METHODS: The study sample consisted of 39 SZ, 38 MDD, and 39 HC participants. Participants were administered a series of assessments to evaluate symptom severity and cognitive functioning. Discrete facets of the motivation system were measured using an extensive battery of objective computerized tasks. Variables of interest were extracted from each task and entered into a principal components analysis in order to explore the factor structure of the motivation framework. Factor scores were subsequently applied to K-means cluster analysis to identify subgroups of individuals with similar motivation profiles. RESULTS: Principal components analysis revealed five distinct motivation factors: hedonic capacity, reward expectancy and learning, cost-benefit decision-making, goal-directed decision-making, and effort expenditure. K-means clustering identified two distinct subgroups of individuals based on their motivation task performance. The first cluster demonstrated impaired hedonic capacity (t(114)=-3.7, p

Research suggests decreased cortical dopamine is a neural correlate of cognitive deficits in schizophrenia. Evidence of impaired cognitive task-induced cortical dopamine release was demonstrated in patients with psychosis. However, whether cortical dopamine release in response to a cognitive task in clinical high risk for psychosis (CHR) is also impaired, is currently unknown. We aimed to test dopamine release in the dorsolateral prefrontal cortex (DLPFC) and the anterior cingulate cortex (ACC) in antipsychotic-free CHR participants and healthy controls (HC) performing the Wisconsin Card Sorting Task (WCST). Two [

It is well established that most people recover soon after a mild traumatic brain injury (mTBI), yet protracted neuropsychological impairment is evident in many individuals. We sought to elucidate the relationship between apathy and neuropsychological impairment and disability as it pertains to real-world function in patients who sustained a mTBI reporting and demonstrating protracted neuropsychological impaired (i.e., more than three months post-injury). We employed a battery of neuropsychological and psychological measures, along with a measure of apathy in 104 patients who sustained a mTBI reporting neuropsychological complaints (38 in the not disabled group and 66 in the disabled group). Their ability to return to work was used as proxy for real-world disability. Specific deficits in verbal fluency, memory, and information processing predicted real-world disability but apathy did not, suggesting that psychological factors may play less of a mediating role than specific neuropsychological factors in the relationship between impairment and real world disability. Our research furthers our understanding of the cognitive and psychological differences that exist in patients with mTBI who have real-world disability compared to those who do not.

Prospection is the ability to plan ahead by creating a series of intentions and sequential steps to achieve a particular goal. The current study examined whether prospection was compromised in patients who had sustained a mild traumatic brain injury (mTBI) and who claimed to be disabled because of their chronic cognitive impairment, as operationalized by an inability to achieve goals (e.g. return to work) well after their expected recovery.This study employed the Tower of London (TOL) to measure prospection and compared two groups of patients who sustained a mTBI who both presented with cognitive impairment, but were or were not disabled in terms of their real world functioning (as defined by their instrumental activities of daily living, IADLs).The results revealed that the TOL could reliably discriminate between these two groups. In subsequent structural equation modelling, TOL scores were used to create a prospection model that was able to predict IADLs functioning.This study demonstrates that prospection is a critical component of one's ability to function independently following the onset of a mTBI when chronic cognitive impairment is evident and that clinicians should routinely investigate prospection in this context.

OBJECTIVE: The American Psychological Association (APA) celebrated its 125th anniversary in 2017. As part of this celebration, the APA journal Neuropsychology has published in its November 2017 issue 11 papers describing some of the advances in the field of neuropsychology over the past 25 years. METHOD: The papers address three broad topics: assessment and intervention, brain imaging, and theory and methods. RESULTS: The papers describe the rise of new assessment and intervention technologies, the impact of evidence for neuroplasticity on neurorehabilitation. Examples of the use of mathematical models of cognition to investigate latent neurobehavioral processes, the development of the field of neuropsychology in select international countries, the increasing sophistication of brain imaging methods, the recent evidence for localizationist and connectionist accounts of neurobehavioral functioning, the advances in neurobehavioral genomics, and descriptions of newly developed statistical models of longitudinal change. CONCLUSION: Together the papers convey evidence of the vibrant growth in the field of neuropsychology over the quarter century since APA's 100th anniversary in 1992. (PsycINFO Database Record

Purpose: To investigate the prevalence of post-traumatic growth (PTG) following mild traumatic brain injury (mTBI) and to examine whether PTG is associated with vocational status. Materials and methods: Archival data from a random sample of 74 individuals who sustained mTBI (mean age: 43.23; male, 55%) were obtained from a larger sample of litigating patients who were referred for a neuropsychological examination. Factors associated with return to work were ascertained using a multiple regression analysis. The demographic variables age, sex, and education were added to the first block, whilst relating to others, new possibilities, personal strength, spiritual change, and appreciation of life, as measured by the Posttraumatic Growth Inventory (PTGI), were added in the second block. Results: Approximately 31% of the sample exhibited moderate levels of PTG, as defined by endorsing a 3 or more on each item of the PTGI, with the most common aspects of PTG being appreciation of life, relating to others, and personal strength. The multiple regression analysis revealed that new possibilities and personal strength were independently associated with return to work. Conclusions: Results of this study suggest that there is evidence for the development of PTG among individuals with mTBI. These findings have important implications for rehabilitation planning, individual and family adjustment, and the prediction of long-term outcome as it pertains to return to work in particular. Implications for Rehabilitation Return to work is an integral component of rehabilitation following mild traumatic brain injury (mTBI) and should not be overlooked. Results of this study indicate that post-traumatic growth (PTG) can be used to inform intervention approaches that seek to promote growth and resiliency post-injury. Informing patients about the prospects of a positive post-injury recovery trajectory could help manage the individual's expectations of recovery.

BACKGROUND: Motivation deficits and reduced goal-directed behaviour are prominent in schizophrenia (SZ), and significantly contribute to poor functional and treatment outcomes. One of the critical components of the multi-faceted motivation system is effort valuation, which refers to the mental processes involved in computing how much effort one is willing to exert in order to obtain a desired outcome. These effort-cost computations are typically measured using effort-based decision-making (EBDM) paradigms, where individuals must choose between performing low- or high-effort tasks for varying reward magnitudes. Rather than demonstrating an overall unwillingness to expend effort, however, studies have shown that individuals with SZ inefficiently allocate effort across different probability and reward conditions. Thus, in order to better understand the underlying computations involved in effort-based decision-making, the present study sought to model the predictors of choice behaviour in SZ and healthy control (HC) participants. METHODS: Fifty-one SZ patients and 51 demographically-matched HC participants completed the Effort Expenditure for Rewards Task (EEfRT) as a measure of EBDM. In addition, all participants underwent characterization of clinical amotivation severity and cognitive functioning using the Apathy Evaluation Scale (AES) and Brief Assessment of Cognition in Schizophrenia (BACS), respectively. Generalized Estimating Equations (GEE) were subsequently applied to the EEfRT data with a binary logistic distribution used to model the likelihood of choosing hard tasks. A number of models were tested with independent variables including reward magnitude, probability, expected value (EV), diagnostic group, AES, and BACS. RESULTS: GEE models revealed significant main effects for reward magnitude (b = .54, p < .001), probability (b = .02, p < .001), and EV (b = .46, p < .001), but no main effect of group. However, significant interaction terms were found between group and reward (b = -.33, p < .001), group and probability (b = -.01, p = .007), and group and EV (b = -.58, p = .001). While there were no AES or BACS main effects, there were significant AES x reward (b = -.02, p < .001) and AES x EV (b = -.02, p = .01) interactions, as well as BACS x reward (b = .11, p < .001), BACS x probability (b = .01, p < .001), and BACS x EV (b = .31, p < .001) interactions. DISCUSSION: While SZ and HC participants are similarly willing to exert effort in pursuit of a reward, patients with SZ are less likely to utilize important information regarding the magnitude, probability, and expected value associated with that reward in driving their effort-based decision-making. Moreover, reward magnitude and EV are less predictive of effortful choices for individuals with greater motivation and cognitive impairments, regardless of their diagnostic status. Taken together, these findings suggest a direct link between amotivation, cognition, and inefficient utilization of reward and probability information in the context of choice behaviour and effort-cost computations.

Parkinson's disease (PD) is a progressive disorder characterized by the emergence of motor deficits. In light of the voluminous and conflicting findings in the literature, the aim of the present quantitative review was to examine the effects of repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex (M1) in the treatment of motor signs in PD. Studies meeting inclusion criteria were analyzed using meta-analytic techniques and the Unified Parkinson's Disease Rating Scale (UPDRS) sections II and III were used as outcome measures. In order to determine the treatment effects of rTMS, the UPDRS II and III scores obtained at baseline, same day, to 1 day post rTMS treatment (short-term follow-up) and 1-month post stimulation (long-term follow-up) were compared between the active and sham rTMS groups. Additionally, the placebo effect was evaluated as the changes in UPDRS III scores in the sham rTMS groups. A placebo effect was not demonstrated, because sham rTMS did not improve motor signs as measured by UPDRS III. Compared with sham rTMS, active rTMS targeting the M1 significantly improved UPDRS III scores at the short-term follow-up (Cohen's d of 0.27, UPDRS III score improvement of 3.8 points). When the long-term follow-up UPDRS III scores were compared with baseline scores, the standardized effect size between active and sham rTMS did not reach significance. However, this translated into a significant nonstandardized 6.3-point improvement on the UPDRS III. No significant improvement in the UPDRS II was found. rTMS over the M1 may improve motor signs. Further studies are needed to provide a definite conclusion.

Amotivation and reduced goal-directed activity engagement are prominent features of schizophrenia. Previous investigations of patients' activities have relied on accounts of daily living activities, rather than objective measures. This study used wireless motion capture to objectively evaluate activity preference when individuals are provided an explicit choice between an active versus passive engagement option. Twenty outpatients with schizophrenia and twenty matched healthy controls completed the Activity Preference Task, in which participants play a motion-based game (active) or watch a film (passive), and were administered clinical and cognitive assessments. Schizophrenia participants' duration, intensity, and persistence of active engagement were associated with apathy and community functioning. No group differences emerged from comparisons of task measures; however, exploratory cluster analysis identified a distinct subgroup of schizophrenia patients with reduced engagement and increased apathy compared to other patients and controls. The Task provides a means of quantifying activity engagement, which may be particularly valuable given the lack of objective measures for intrinsically motivated behaviours. Our initial findings suggest that schizophrenia patients as a group are equally inclined as healthy individuals towards actively engaging activities when presented an explicit choice, but such provision may be insufficient for initiation and maintenance of functional behaviours among amotivated patients.

Despite the prevalence of executive dysfunction across multiple neurological and psychiatric conditions, there have been few validated rehabilitative interventions targeting it. One intervention holding promise for patients with executive dysfunc­tion is Robertson’s Goal Management Training (GMT; Robertson, 1996). GMT is based on Duncan’s (1986) theory of goal neglect (or failure to execute intentions), in which disorganized behavior is attributed to impaired construction and use of “goal lists,” considered to direct behavior by controlling actions that promote or oppose task completion. GMT attempts to ameliorate goal neglect through verbally mediated, metacognitive strategies that systematically target planning abilities by teach­ing individuals to structure their intentions. Through presentations, discussions, exercises, and homework assignments, GMT trains participants to use strategies like stopping and orienting to relevant information, partitioning goals into more easily managed subgoals, encoding and retaining goals, and monitoring performance. Investigations into the efficacy of GMT have been promising in both normal older adults and in patients with acquired brain injury (ABI). In order to investigate the efficacy of GMT for older adults with cognitive complaints, van Hooren and colleagues (2007) randomly assigned 69 normal, community-dwelling adults age 55 years or older to a six-week GMT program or to a waitlist control group. After the intervention, participants from the GMT group reported significantly fewer anxiety symptoms, were significantly less annoyed by their cognitive failures, and reported improved ability to manage their executive failures as com­pared to control participants. Though this study reported positive results for subjective outcome measures, the intervention showed no effect on the Stroop Colour Word Test (Houx, Jolles, & Vreeling, 1993; Stroop, 1935). Levine and colleagues (2000) reported on 30 traumatic brain injury (TBI) patients who were randomly assigned to receive a brief trial (1-hour session) of GMT or motor skills training. Upon completion of the intervention, the GMT group, but not the motor skills group, showed significant improvement on paper-and-pencil tasks designed to mimic everyday executive tasks that are problematic for patients with goal neglect.

Objective Previous research suggests that overall experience participating in instrumental activities of daily living (IADLs) is associated with reduced IADL impairment in individuals with mild cognitive impairment, possibly because of an increased functional reserve. Given that difficulties managing finances tend to occur with mild cognitive impairment, this study explores whether experience managing one's finances is associated with independence across various IADLs. Methods Participants with a screen or baseline diagnosis of mild cognitive impairment (n = 862) were taken from the Alzheimer's Disease Neuroimaging Initiative study. Functional dependence and experience were quantified from the Functional Activities Questionnaire. Results No group differences between those with and without financial management experience existed in Mini-Mental State Examination scores, age, and years of education, although women were more likely to have experience managing finances (P

Background: Anhedonia has long been associated with schizophrenia (SZ); however, the true nature of this deficit remains elusive. Given the role of hedonic capacity within the larger motivational framework, we sought to examine reward responsiveness (RR) and reward expectancy (RE) across a spectrum of motivation deficits in SZ (Study 1). Further, we sought to better understand the relationship between hedonic capacity and specific facets of the motivational system (Study 2).

Background: Evidence from probabilistic reinforcement learning tasks have revealed impaired reward-driven learning in schizophrenia. This has been examined exclusively in the context of binary probabilistic choice paradigms. In real-world decision-making, however, individuals must also make choices when there are more than 2 competing options that vary in the frequency and magnitude of potential rewards and losses. To advance our understanding of decision-making in schizophrenia, it is important to examine how patients manage choices in the face of concurrent rewards and losses—especially when the immediately rewarding choice is not necessarily the advantageous option in the long run. Thus, the current study examined Win-Stay/Lose-Shift (WSLS) behavior on the Iowa Gambling Task (IGT) in order to examine the influence of immediate rewards and losses in guiding real-world decision-making in schizophrenia.

Negative schizotypal traits may be related to anhedonia and/or amotivation; however it is unclear which of these symptoms is related to negative schizotypy to a greater extent. Moreover, the impact of schizotypal traits on overall subjective well-being remains uncertain. The present study examined these two questions in a non-clinical sample assessed for schizotypal traits ( n = 138). Schizotypal traits were measured using the Schizotypal Personality Questionnaire, amotivation was assessed using Marin’s Apathy Evaluation Scale, anhedonia was assessed using the Snaith–Hamilton Pleasure Scale, and happiness was assessed using both the Satisfaction with Life Scale and a single-item happiness measure. Greater schizotypal traits were individually associated with both greater anhedonia and amotivation. Amotivation was a key predictor of negative schizotypy, with no independent predictive value offered by hedonic capacity. Furthermore, schizotypal traits, particularly negative schizotypal traits, were significantly associated with lower levels of happiness. This relationship between negative schizotypy and happiness remained even after controlling for the influence of amotivation. Our findings affirm that negative schizotypal traits are more closely related to symptoms of amotivation rather than anhedonia. Potential mechanisms mediating the relationship between negative schizotypy and happiness are discussed; nonetheless, future research exploring such mechanisms underlying lower well-being in schizotypy is needed.

Impairments in cognitive flexibility have been used to characterize the neuropsychological presentation of persons with autism spectrum disorders (ASDs). Previous studies have yielded mixed results. Our objective was to systematically review the sensitivity of cognitive flexibility measures in ASD using quantitative methods employed by meta-analytic statistical techniques. Seventy-two studies met inclusion criteria for analysis and included a total of 2,137 individuals with ASD and 2,185 healthy controls. Our findings demonstrate that while the shift sub-scale of the self-report version of the Behavioral Rating Inventory of Executive Function (BRIEF) showed approximate absolute discriminability, of all the performance measures that were systematically reviewed and evaluated, none could reliably differentiate between individuals with ASD and controls; this is not surprising given that cognitive flexibility is not a core deficit of ASD. Our findings suggest that while the shift sub-scale of the self-report version of the BRIEF is a promising clinical marker, clinical performance measures of cognitive flexibility may lack ecological validity and lastly, reinforces that impairments in cognitive flexibility do not uniformly characterize all persons with ASD.

Background Undiagnosed major depressive disorder (MDD) is associated with increased morbidity in children and adolescents. This study evaluated features of sleep macro- and microarchitecture assessed by polysomnography (PSG) as diagnostic markers for MDD in children and adolescents. Methods MEDLINE, PSYCINFO, EMBASE and PUBMED were searched from their availability dates to March 1st, 2013. The literature search identified 932 abstracts of which 51 studies were retrieved and 28 were included in the analysis. Study design, features of sleep macro- and microarchitecture, demographic and clinical characteristics of study groups were extracted for each study. Results There were modest differences on sleep macroarchitecture between children and adolescents with MDD and healthy controls. The most robust difference was found in sleep latency, 31% of adolescents with MDD had increased sleep latency. Age, suicidal ideation, suicidal behavior, and psychiatric comorbidities were significant predictors of sleep macroarchitecture. Modest differences were found for sleep microarchitecture, intrahemispheric and interhemispheric temporal coherence was decreased in a third of patients with MDD. Age was a significant predictor of sleep microarchitecture. Limitations This meta-analysis is limited by the small number of studies on sleep macroarchitecture in children with MDD and studies on sleep microarchitecture overall and by the heterogeneity in methodology between studies. Conclusions This synthetic review of the existing literature is among the largest to quantitatively assess impaired sleep as a diagnostic marker for MDD in children and adolescents. Knowledge of sleep macro- and microarchitecture in early-onset MDD may aid the clinician in developing a treatment strategy for MDD-related sleep symptoms in a subset of patients.

Obsessive-Compulsive Disorder (OCD) is characterized by persistent and unwanted obsessions generally accompanied by ritualistic behaviors or compulsions. Previous research proposed specific disgust facial emotion recognition deficits in patients with OCD. This research however, remains largely inconsistent. Therefore, the results of 10 studies contrasting facial emotion recognition accuracy in patients with OCD (n=221) and non-psychiatric controls (n=224) were quantitatively reviewed and synthesized using meta-analytic techniques. Patients with OCD were less accurate than controls in recognizing emotional facial expressions. Patients were also less accurate in recognizing negative emotions as a whole; however, this was largely due to significant differences in disgust and anger recognition specifically. The results of this study suggest that patients with OCD have difficulty recognizing specific negative emotions in faces and may misclassify emotional expressions due to symptom characteristics within the disorder. The contribution of state-related emotion perception biases to these findings requires further clarification.

The most common cause of vascular cognitive impairment not demented (VCIND) is cerebral small vessel disease leading to diffuse subcortical white matter lesions. While many studies indicate that the core cognitive features of VCIND are executive dysfunction and impaired processing speed, this finding is not always consistent, and may be partially dependent on the comparison group applied. Hence, we undertook two systematic meta-analytic reviews on neuropsychological test performance across eight cognitive domains: between VCIND and healthy controls (data from 27 studies), and between VCIND and non-vascular mild cognitive impairment (nv-MCI; data from 20 studies). Our quantitative synthesis of the research literature demonstrates that individuals with VCIND show weaknesses across all cognitive domains relative to healthy controls, with the greatest impairment in the domain of processing speed (Md = -1.36), and the least affected being working memory (Md = -.48) and visuospatial construction (Md = -.63). When compared directly with nv-MCI, individuals with VCIND had significantly greater deficits in processing speed (Md = -.55) and executive functioning (Md = -.40), while those with nv-MCI exhibited a greater relative deficit in delayed memory (Md = .41). Our analyses indicate that disruption to subcortical white matter tracts impairs more cognitive processes than is typically thought to be directly related to the fronto-subcortical network. The data also suggest that differing brain aetiologies can be responsible for similar cognitive profiles. Although the findings do not evince diagnostic value, they allude to the interconnectivity of disparate cognitive processes and call for further research on the behavioural outcome of network disruption.

Background Rates of cannabis use among patients with schizophrenia are high, however little is understood about clinical effects of continued cannabis use and cessation after illness onset. Therefore, we investigated the effects of 28-days of cannabis abstinence on psychotic and depressive symptomatology in cannabis dependent patients with schizophrenia. Method Males with cannabis dependence and co-morbid schizophrenia (n = 19) and non-psychiatric controls (n = 20) underwent 28-days of monitored cannabis abstinence. Clinical symptoms were assessed at baseline and then weekly. Abstinence was encouraged using weekly therapy sessions and contingency reinforcement, confirmed by twice-weekly urine assays. Results Forty-two percent (8/19) of patients and 55% (11/20) of controls achieved 28-days of sustained cannabis abstinence. In patients, PANSS subscores did not change over time irrespective of abstinence status. In contrast, patient abstainers demonstrated a more pronounced reduction in depression scores compared to non-abstainers, however, the Abstinence Status x Time interaction was non-significant. Discussion Short-term (28-days) cannabis abstinence is not associated with improvement in psychotic symptoms, but may be associated with improvement in depressive symptomatology in patients with schizophrenia. Future studies employing larger samples as well as a continuous cannabis-using group may help to better characterize the causal effects of cannabis on symptom outcomes in this disorder.

Anhedonia has traditionally been considered a characteristic feature of schizophrenia, but the true nature of this deficit remains elusive. This study sought to investigate consummatory and anticipatory pleasure as it relates to motivation deficits. Eighty-four outpatients with schizophrenia and 81 healthy controls were administered the Temporal Experience of Pleasure Scale (TEPS), as well as a battery of clinical and cognitive assessments. Multivariate analyses of variance were used to examine the experience of pleasure as a function of diagnosis, and across levels of motivation deficits (i.e. low vs. moderate. vs. high) in schizophrenia. Hierarchical regression analyses were also conducted to evaluate the predictive value of amotivation in relation to the TEPS. There were no significant differences between schizophrenia and healthy control groups for either consummatory or anticipatory pleasure. Within the schizophrenia patients, only those with high levels of amotivation were significantly impaired in consummatory and anticipatory pleasure compared to low and moderate groups, and compared to healthy controls. Further, our results revealed that amotivation significantly predicts both consummatory and anticipatory pleasure, with no independent contribution of group. Utilizing study samples with a wide range of motivation deficits and incorporating objective paradigms may provide a more comprehensive understanding of hedonic deficits.

Background Amotivation and reduced engagement in goal-directed activities are prominent features of schizophrenia. Previous investigations of patients’ engagement in activities have largely relied on accounts of daily living activities rather than objective task-based measures. The current study used wireless motion capture in an open-field setting to evaluate activity preference when individuals are provided an explicit choice between an active engagement option versus a passive engagement option. Methods Twenty stable adult outpatients with schizophrenia and twenty matched healthy controls completed the Activity Preference Task, in which participants play a physical motion-based video game (active engagement) or watch a film (passive engagement) for fifteen minutes. No incentive was associated with either activity, and participants could engage in either activity at any time. Duration of engagement on the active option and number of switches between activity options were computed as the primary task outcome measures using objective motion data. Participants’ behaviour during active engagement was further quantified by computation of physical intensity (average hand speed) and persistence (tendency for sustained continuous engagement). Clinical assessments of positive and negative symptoms, apathy, cognition, depression, medication side-effects, motor ability, and community functioning were also administered. Results Schizophrenia participants’ duration, intensity, and persistence of active engagement were correlated with apathy (|ρ|=0.72–0.79, p

Background Motivational impairments are a core feature of schizophrenia and although there are numerous reports studying this feature using clinical rating scales, objective behavioural assessments are lacking. Here, we use a translational paradigm to measure incentive motivation in individuals with schizophrenia. Methods Sixteen stable outpatients with schizophrenia and sixteen matched healthy controls completed a modified version of the Effort Expenditure for Rewards Task that accounts for differences in motoric ability. Briefly, subjects were presented with a series of trials where they may choose to expend a greater amount of effort for a larger monetary reward versus less effort for a smaller reward. Additionally, the probability of receiving money for a given trial was varied at 12%, 50% and 88%. Clinical and other reward-related variables were also evaluated. Results Patients opted to expend greater effort significantly less than controls for trials of high, but uncertain (i.e. 50% and 88% probability) incentive value, which was related to amotivation and neurocognitive deficits. Other abnormalities were also noted but were related to different clinical variables such as impulsivity (low reward and 12% probability). These motivational deficits were not due to group differences in reward learning, reward valuation or hedonic capacity. Conclusions Our findings offer novel support for incentive motivation deficits in schizophrenia. Clinical amotivation is associated with impairments in the computation of effort during cost-benefit decision-making. This objective translational paradigm may guide future investigations of the neural circuitry underlying these motivational impairments.