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924
CEREBRAL
VENTRICULIR
SIZE
AND
COGNITTYE
IMPAIRMENT
INCHRONICSCHIZOPHRENIA
EvB
C.
JouNsroNn
T.
J.CnowC.D.
Fmrn
J,rNrr
HusaeNo
L.
Knnnr
Dioisions
of
PsychiatryandRadiologjt,
Clinical
Research
Cenrre,
lVatlord
Road,
Harrow,
Middlesex
ItAI
3IJJ
SumnarSr
By
comparison
with
age-matchedcon-
trolsin
employment,
l7
institutionalised
schizophrenic
patientswereshown
by
computerised
axialtornography
ofthe
brain
to
have
intreasej
cerebral
in
the
group
of
schizophrenic
pa_
cular
sizewas
highly
significantly
gmuve
lmpalrment.
Introduction
be
unimpaired,T
Thereare
undoubredly
patientsin
whom
anillness
with
aschizophrenic
presintation
is
fol-
li:iil.
1
Methods:ai:r""'
i
THE
LANcET,
ocroBEl
30,L976
TABLE
II-PATIDNTS
nr
nvc
cUon
)re
"
3t)+5
27
T2
3679
33
64
TABLE
I-NORI\{AL
CONTROLS
5lJ
6l
6762565040
52
908088
o/r02
t02
109116
Technical
supervisor
Porter
Messenger
PorterMaintenance
engineer
Porter
Engineer
Maintenance
engineerCase
no.Age
'l'ime
in
hospital
(yr.)
I'revious
Ireatment
I
)revrous
(
)ccupa
t
lon
\-ognfrrnc
scol
eucotomyNo.
of
E.C.T.
No.
of
insulin
comas
PhenoI
2J
5
6
7
89
l0
ll
t2
l3
t4l5l6
l1
Itl
64426653666352476966546370
5l
6454463924
4l
3242392325384024423220
2828
29
27
+++
8
8
40
>40
J
o
8
28
8
l4
55
47+0
5568774858
++++++
+
WirelessengrneerWarehouseasslstant
LabourerNava!ratingClerkViolinist
Commercial
artlstLabourer
Clerk
Salesman
UpholstererDioing-carattendant
Busconductor
LabourerClerk
Coalman
ArmydriverR.A.F.
servrceman
3
64
2
4
8
4
2E
6(
r
l)hcrrothiazinesgivenat anytime
rHE
LANCET,
OCTOBER
30,
I976
Northwick
Park
Hospilaland
Clinical
Research
Centre
who
were matched
with
the
index
group
for
age,
and
as
closely
as
possible
for
premorbid occupationalattainment.
The
mental
stales
of
the
patienls and controls
were
assessed
in
termsofthe
rating
sca.le
devised
byKrawieckaet al.t0A
total
score
ofposi-
tive
features
of
schizophrenia(delusions,
hallucinations
and
thoughtdisorder)
and
negativefeatures
of
schizophrenia
(retardation,flattening
of
affect,and
muteness)was
derived
from
this
rating.
The cognitive
functioning
ofthepatients
and
controls
was
assessed
onthe
clinical
testsdevised
by
Withers
and
rou-
,erythro-
i.ri3'"'n'
8
schizo-
phrenics and
from
8 controls.Tomographic
sect;ons
throughrhe
brain
were
takenbeginning
a!,
and
continuingparallel
to,theorbitomeatal
line,
at
1
cmintervals
to
thevertex.
Two
im-
ages
at
comparablelevels were
selected
for
each
patient.
Oneshowed
the
body
ofthe
lateral
ventriclesand the other
showed
the
anterior
and
posterior horns
of
thelateral
ventricles
rogether
with the
third
ventricle.
The
images
were
photo-graphedandthe
area
ofthe
ventricles
in
each
photograph
was
measured
with
aplanimeter,
an
instrument which
measures
thearea contained
within
a
circumference.These
measure-ments
were
made
blindly
on
two
separate occasions
by
twoin-dependent
investigators,
giving
four
measurements
on
each
subject.
No attempt
was
made
in
rhis
study
to
assess
the
sizeTABLE
III-RELATIONSHIP
OF
CLINICAL
FEATURESTO
VENTRICULARSIZE
IN
SCHIZOPHRENICPATIENTS
(LEUcoroMlsED
cAsEs
oMlrrED)
r-------
N
o
=
C
S
ign ific
a
nce
o
=
teucotomised ootient
I
T
IrlttI
a
oo
!
to.
a
ao
aaa
o
a
70
18
t0t4
17
10
of
thesulci,
in
view
of
thedifficulties
of
findingan
obiectiveand reliable
means
of
measurement.
Results
There
wereno
oblious
discrepanciesbetween
the
ages
and
occupations
of
the
control
(table
r)
and
patient(table
rr)
groups.
Themental
states
of
the
control
group
showed
no
abnormality
on lhe
Krawiecka
scale'The
schizophrenicsperformed
significantly
less
wellthan
the
control
group on theWithers and
Hinton
tests
of
cogni-
tive
function
(n<0.001).
In
theEMI-scan
assessments
there
was
a
high
correla-
Normols
SchtzoPhrenics
Ventriculr
size
in
patients andcontrols.
Each
point
representsaverage
of
four
measurementsonphotographs,
tion
betweenthemeasurements
obtainedbythe two
sep
arare
observers
(cut1,
r:0'96,
e<<0'001;
cut
2,
r:0.94,
p<<0.001)
andapparently
this
is a
reliablemethod
of
measuring
ventricularsize'
The
correlation
between
the
measurements
at the
two
levels
in
the
same
1)
Cll
2'
r:
001)'
and
r
variation
ite
of
the
unlikely
s
to
alTect
r
slze.
fhe
figure
shows
the
mean
of
the
four
measurements
of
ventricular
size.Leucotomy
is
associated
wirh
in-
creased
ventricular
sizeand
in
some
cases
with
distor-
tion of
the
ventricles.
For this
reason
the
leucotomised
patients
were
omitted
fromall
calculations
except
those
concerning
the
effects
of
leucotomy.
Ventricular
size
in
the
schizophrenic
group,
with
leucotomised
patients
excluded,is
significantlygreaterthan
thatin
the
controlgroup
(r<0.01).
The
relationship
between
ventricular
size
and
clinical
features
within
theschizophrenicgroup
(leucotomised
patients
excluded)is shown
in
table
tIt.In
this
group there
is
a
significant
association
between
in-
creased
ventricular
size
andpoor
performance
on
theWithersand
Hinton
test
battery(p<0'01).
This
impair-
ment
emerges
principally
in
thoseitems
in
the
batter,T
-
that
place
greatest demands
on memory-e.g.,
serial
(,onrparrson
Correla tion
coelllcient
No.
of
paIlents
v
rcnLricular
size
Cognrtivctunctionrr
v
ventricular
size
l'osrtive
featuresv,
ventricular
size
Negatrvc fcatures
l
rcntricular
sizc
Irornr
of
t
rcatlrcDt
r:
021
r:-0.70
r-
0.2
4
r:
0.3
8
Wirh
lrca
Imenl
t2.3
s
o
0.70
9.9s.o.2.96
q.-1.D
1.76
8.i
s.o.1,45
N.S.
p
<
0.01
NS
!
N.s
I
fABL!t
IV--RgLArroNSHrp
Br..rwgtN
pREvrOUs
TREATMENT
AND
tvL.NTRICULAR
SIZEIN
SCHIZOPHRENICS
(LEUCOTOMISED
PATIIINTSEXCLUDEDFROM COMPARISONSEXCEPT
THAT
CONCERNINGLEUCOTOMY)
Mean
ventricular
size29
cm
Nr)
o[
cases
Without
trea
t
men
I
!(ithout
trcatmen
t
9.9
so.
9.97
s.o.
11.3
s
o
11.2
s.o
0.04
1.572.71
<0'05
(1tailed)
N.S,N.S,
<o.05
2057760IJ
7+
7
2.06
b
-'"'^'*-''
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