Journal of Abnormal Psychology Copyright 2002 by the American Psychological Association, Inc.

2002, Vol. 111, No. 2, 211–224 0021-843X/02/$5.00 DOI: 10.1037//0021-843X.111.2.211

Cognitive Impairments Associated With Formal Thought

Disorder in People With Schizophrenia
John G. Kerns and Howard Berenbaum
University of Illinois at Urbana–Champaign

Formal thought disorder (FTD), or disorganized speech, is one of the central signs of schizophrenia.
Despite extensive research, the cognitive processes associated with FTD are still unclear. However, the
authors’ review of FTD theories and research indicates that considerable progress has been made in
identifying possible cognitive impairments associated with FTD. Specifically, FTD is strongly associated
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with impaired executive functioning and with impaired processing of semantic information. Their review
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indicates that previous research has not yet supported an association between FTD and either an increase
in spreading activation or an impairment within the language production system.

People with schizophrenia often produce speech that is disor-
ganized or incoherent (Andreasen, 1979; Rochester & Martin,
1979). Examples include switching topics disjointedly, responding
to questions in an oblique manner, using made-up words, and
being completely incomprehensible (Andreasen, 1979). Collec-
tively, different signs of disorganized speech are referred to as
formal thought disorder (FTD; Andreasen, 1982).1 The goal of this
article is to understand what cognitive impairments have been
consistently associated with FTD in individuals with schizophre-
nia. We examine which of the following four posited cognitive
impairments of FTD have been supported by previous research: (a)
impaired executive functioning, (b) increased spreading activation,
(c) impaired semantic memory, and (d) impaired language produc-
tion (i.e., a circumscribed disturbance within the language produc-
tion system). We begin by discussing the importance of FTD in
understanding schizophrenia, as well as problems interpreting pre-
vious FTD research. We then describe and present a meta-analysis
of the four posited cognitive impairments of FTD. Finally, we
provide recommendations for future research.
Importance of FTD in Understanding Schizophrenia and
Problems in Interpreting Previous FTD Research
Historically, FTD has figured prominently in descriptions (e.g.,
Fish, 1964) and conceptualizations of schizophrenia (e.g., Bleuler,
1911/1950). Despite the diagnostic and conceptual emphasis on
FTD, and despite a fair amount of previous research, psychopa-
John G. Kerns, Department of Psychology, University of Illinois at
Urbana–Champaign; Howard Berenbaum, Departments of Psychology and
Psychiatry, University of Illinois at Urbana–Champaign.
Work on this article was supported by National Institute of Mental
Health Grants MH 50531 and MH 12166. We thank Deanna Barch, Gary
Dell, Greg Miller, and Marie Banich for comments on drafts of this article.
We also thank Neal Cohen and Wendy Heller for making executive
function task ratings.
Correspondence concerning this article should be addressed to Howard
Berenbaum, Department of Psychology, University of Illinois at Urbana–
Champaign, 603 East Daniel Street, Champaign, Illinois 61820. E-mail:
hberenba@uiuc.edu
thologists have lamented the lack of progress in understanding
which cognitive impairments are associated with FTD (Maher,
1991), and research on FTD has been described as a “graveyard”
(Rochester & Martin, 1979). Furthermore, it has been some time
since the last comprehensive reviews of FTD models and research
(Rochester, 1980; Schwartz, 1978; recent reviews have focused on
specific research programs, e.g., Maher, 1996; M. Spitzer, 1997).
Thus, it seems that a review that can draw clear conclusions in
summarizing previous FTD research and provide directions for
future research is warranted.
We attempt to draw conclusions about previous FTD research
by using the organizing principle that research tests theories.
Therefore, we examine previous FTD research to decide which if
any theories of FTD have been supported. We contend that four
cognitive impairments effectively summarize the major common-
alities and contrasts among existing cognitive models of FTD.
Many previous models have suggested that FTD is associated with
impaired executive functioning (e.g., Barch & Berenbaum, 1997;
Harrow, Lanin-Kettering, & Miller, 1989; Holzman, 1978;
McGrath, 1991). Other models have suggested that FTD is asso-
ciated with increased spreading activation (e.g., Harrow et al.,
1989; M. Spitzer, 1997). Some models have suggested that FTD is
associated with impaired semantic memory (Hoffman, 1987;
Nestor et al., 1993), whereas others have explicitly argued that
semantic memory is not impaired in people with FTD (Maher,
1983; M. Spitzer, 1997). Some models have also suggested that
FTD is associated with impaired language production (Berenbaum
& Barch, 1995; Chaika, 1990), whereas others have explicitly
argued that language production is not impaired in people with
FTD (Harrow et al., 1989; Holzman, 1978). Hence, our goal was
to decide which of these four cognitive impairments have been
consistently associated with FTD in previous research. Ideally, our
1
In addition to disorganized speech, FTD has sometimes also included
“negative” signs of language disturbance, such as a paucity in the amount
or in the content of speech (Andreasen, 1979). However, researchers have
consistently found that disorganized speech is distinct from negative
speech signs (e.g., Berenbaum, Oltmanns, & Gottesman, 1985; Harvey et
al., 1992). In this article, we use FTD to refer to disorganized and not to
negative types of language disturbance.

211
 212 KERNS AND BERENBAUM
review allows conclusions to be drawn about previous research
that can lead to the development and testing of even more precise
models of FTD.
Four Posited Cognitive Impairments of FTD
Impaired Executive Functioning
Executive functioning refers to the supervision of complex
thought, such as planning, decision making, and self-monitoring
(e.g., Banich, 1997; Smith & Jonides, 1998; Stuss, Eskes, &
Foster, 1994; Tranel, Anderson, & Benton, 1994). Executive func-
tioning is associated with the supervision of many types of pro-
cesses and is not restricted to a particular domain, such as percep-
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tion, language, or memory. Moreover, executive functioning is
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closely associated with the prefrontal cortex; however, other brain
regions also are involved (e.g., Tranel et al., 1994). An impairment
in executive functioning could conceivably contribute to FTD by
impairing the monitoring, organization, and planning of discourse.
Increased Spreading Activation
In neural network models, activation spreads between nodes that
share connections (i.e., the automatic spread of activation between
two related concepts, such as dog and cat; Dell & O’Seaghdha,
1991). The end state of an “epoch” of spreading activation is
analogous to the completion of a cognitive process or computation,
such as word reading (Rumelhart & McClelland, 1986) or lan-
guage production (Dell & O’Seaghdha, 1991). A potentially im-
portant issue in evaluating models positing increased spreading
activation in people with FTD is that the total amount of activation
and the distance that activation spreads might be somewhat inde-
pendent. For example, in neural network simulations of lexical
processing, Dell and O’Seaghdha (1991) found that an increase in
the overall amount of spreading activation in a network resulted in
increased activation only for those words that were strongly related
to an already activated word. An increase in the overall amount of
spreading activation had a much smaller effect on the amount of
activation that spread to distantly related words. Thus, if people
with FTD have an increase in the overall amount of spreading
activation, then they should exhibit increased semantic priming,
especially in tasks involving strongly related words. In contrast, if
people with FTD have an increase in the distance that activation
spreads (and not in the overall amount of activation), then they
should exhibit increased priming only for distantly related infor-
mation. An increase in either the amount or distance of spreading
activation could potentially contribute to FTD by making word and
topic selection in discourse susceptible to extraneous cognitive
associations.
Impaired Semantic Memory
Semantic memory refers to the storage of factual knowledge
(e.g., “a dog is an animal and has fur”; Kounios, 1996). Intact
semantic processing requires that information is stored in memory
and that it can be retrieved from memory (e.g., Rapp & Cara-
mazza, 1993). People with impaired semantic memory have been
found to exhibit decreased or absent semantic priming (e.g., Moss,
Tyler, Hodges, & Patterson, 1995). An impairment in semantic
memory might conceivably contribute to FTD by impairing the
formation of conceptual messages that guide discourse.
Impaired Language Production
By language production impairment, we mean a deficit within
a circumscribed language production system (e.g., Bock & Levelt,
1994). For example, this might be an impairment with retrieving
lexical or syntactic information or with encoding phonological
information. An impairment in language production might con-
ceivably contribute to FTD by impairing the ability to select
appropriate words during discourse.
Previous FTD Research
We conducted meta-analyses to examine the four posited cog-
nitive impairments of FTD. Initially, we conducted a literature
search with the target being any article in which FTD was mea-
sured and its association with a cognitive task was examined. The
complete PsycINFO computer database was searched (through
November 2000) using the following subject terms: formal thought
disorder, thought disorder, language and schizophrenia, schizo-
phrenia symptoms, and disorganization. In addition, the reference
sections of any examined articles or book chapters were searched
to find additional references in which it seemed remotely possible
that FTD was measured. Furthermore, we examined all issues in
the following journals between 1990 to November 2000 for arti-
cles measuring FTD: Archives of General Psychiatry, American
Journal of Psychiatry, Psychological Medicine, Psychiatry Re-
search, Journal of Abnormal Psychology, and Schizophrenia
Bulletin.
For each of the four cognitive processes, we computed a single
meta-analysis that (a) was weighted by sample size (specifically,
the inverse of the variance of each study, n – 3; Hedges, 1994;
Rosenthal, 1991), (b) used r as the measure of effect size, with
both z and 95% confidence intervals (CI) as the measures of
statistical significance (for computational procedures in obtaining
effect sizes from published results, see Rosenthal, 1991, 1993;
Shadish & Haddock, 1994), and (c) included only one effect size
from each study.2 As an estimate of the effect of unpublished
nonsignificant results, for meta-analyses with overall significance
levels of less than .05, we calculated the number of unreported
studies with z ⫽ 0.00 that would result in a significance level of
.05 (Rosenthal, 1991). In addition, we also conducted moderator
variable analyses, using regression analyses (Hedges, 1994) with
each regression weighted by the inverse of the variance of each
study; regressions included multiple effect sizes from a single
study (i.e., the shifting units of analysis approach; see Cooper,
1998). Moderator variable analysis examined whether any vari-
ables moderated the association between FTD and a particular
cognitive process.
One moderator variable we examined was task difficulty. FTD
might be associated with poor performance on difficult tasks
(Chapman & Chapman, 1973, 1978, 1989). Thus, FTD might be
associated with a particular cognitive process (e.g., executive
functioning) only because tasks that involve that process are dif-
ficult. To test this possibility, we examined whether task difficulty
moderated the relationship between FTD and cognitive processes.
2
If more than one effect size was reported by a single study, then a
single composite effect size was calculated from the average of the Fisher’s
transformed correlations of all effect sizes from that single study, as
recommended by Rosenthal (1991).
 COGNITIVE CORRELATES OF FTD
As a measure of task difficulty, we used the effect size of the
difference in performance between control participants and people
with schizophrenia on each task; we assumed that this effect size
would be larger for more difficult tasks. This assumption is based
on previous findings that individuals with schizophrenia tend to do
more poorly as a group on most cognitive tasks (e.g., Blanchard &
Neale, 1994). Given that people with schizophrenia tend to do
more poorly than control participants on most tasks, then it seems
plausible to assume that this between-group difference varies in
part as a function of task difficulty (i.e., larger between-group
differences for more difficult tasks). For studies that did not
include control participants, we used an effect size from other
published studies. If the association between FTD and a cognitive
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process is not the result of task difficulty, then task difficulty
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should not moderate the association between FTD and the cogni-
tive process. Although this moderator analysis is not a replacement
for an assessment of task difficulty within each study (Chapman &
Chapman, 1973, 1978, 1989), it does provide useful information
that constrains some explanations for how task difficulty could
explain the results of the meta-analyses.
In addition to task difficulty, we examined several other possible
moderators. We examined whether the level of involvement of
specific executive functions moderated the association between
FTD and executive functioning. We examined two components of
executive functioning: context memory (the maintenance of goal-
relevant information in memory; e.g., Cohen, Braver, & O’Reilly,
1996; Goldman-Rakic, 1995) and inhibition of information and
responses (Smith & Jonides, 1998; West, 1996). These two over-
lapping executive function components are widely held to be
important and central aspects of executive functioning (e.g., Smith
& Jonides, 1998; Stuss et al., 1994; West, 1996), and we also
thought they were likely to be involved in the cognitive tasks used
in previous FTD research. Executive functioning tasks involve
psychological processes other than executive functioning (e.g.,
Banich, 1997; Stuss et al., 1994; Tranel et al., 1994). Therefore, we
also assessed effortful or sustained attention in the various exec-
utive function tasks, which (although possibly not an aspect of
executive functioning) we thought was likely to be involved in the
executive function tasks used in previous FTD research.
To assess the level of involvement of these component pro-
cesses, we obtained continuous ratings (1 ⫽ little involvement; 7 ⫽
great involvement) of the likely level of involvement of these three
components in each of the executive function tasks. Raters were
given precise details of each task. The following definitions were
provided to raters: context memory ⫽ maintenance of goal-
relevant information in performing the task; inhibition ⫽ suppres-
sion of inappropriate thoughts and/or behaviors; sustained atten-
tion ⫽ vigilant and effortful attention. Ratings were provided by
one of the authors (Kerns) and by two cognitive neuroscientists.
Interrater reliabilities, measured using intraclass correlations
(Shrout & Fleiss, 1979) and treating the raters as random effects
and the mean of the raters as the unit of reliability, were .48 for
context memory, .65 for inhibition, and .78 for sustained attention.
Interrater reliability was lowest for context memory; however, this
is only problematic for null results. In addition to conducting
moderator analyses using the mean executive function ratings, we
also conducted separate moderator analyses using each individual
rater’s ratings. The results of these analyses were identical to those
obtained using the mean ratings.
213
Hence, we used these continuous ratings of context memory,
inhibition, and sustained attention as moderator variables to ex-
amine whether the level of each component moderated the asso-
ciation between FTD and executive task performance. We thought
this moderator analysis would be particularly important because
executive functioning tasks are likely to involve a number of
processing components (Miyake, Friedman, Emerson, Witzki, &
Howerter, 2000). Thus, if context memory or inhibition (which are
central executive functioning component processes) moderate the
association between FTD and executive functioning, then this
further supports the association between FTD and executive func-
tioning impairment.
Semantic priming tasks also probably involve multiple cognitive
processes, such as automatic spreading activation and strategic
factors such as expectancy and semantic matching (Neely, 1991).
To more precisely test the spreading activation hypothesis, we
accounted for the role of strategic factors in priming tasks in two
ways. First, when possible, we limited our review to prime con-
ditions that involved stimulus onset asynchronies (SOAs) of less
than 500 ms because expectancy effects are not likely to be
operative at SOAs shorter than 500 ms (Neely, 1991). Second, we
conducted moderator analyses to examine the contribution of
semantic matching to priming in people with FTD. Semantic
matching is the use of relatedness between primes and targets to
make a word–nonword decision in lexical decision tasks (Neely,
1991). Several studies have found evidence for semantic matching
at short SOAs (Chwilla, Hagoort, & Brown, 1998; de Groot, 1985;
Koivisto, 1998); this makes intuitive sense given that semantic
matching occurs after lexical access. The occurrence of semantic
matching does vary according to the particular priming task. Se-
mantic matching is thought to be possible only in lexical decision
tasks but not in word naming tasks (Neely, 1991). In lexical
decision tasks, semantic matching is thought to be likely to occur
if there is both (a) a high proportion of related primes and targets
(a high relatedness proportion) and (b) a high proportion of pairs
of word primes and nonword targets (a high nonword ratio; Kahan,
Neely, & Forsythe, 1999; Neely, 1991; Neely & Keefe, 1989;
Neely, Keefe, & Ross, 1989). Hence, to examine the role of
semantic matching in priming, we examined whether relatedness
proportions and nonword ratios were moderators of the association
between FTD and semantic priming in studies that used a lexical
decision task. If people with FTD exhibit increased priming be-
cause of an increase in the amount of automatic spreading activa-
tion, then the size of the association between FTD and semantic
priming should either not vary by the presence or absence of
semantic matching or at least the association should be evident
when semantic matching is not likely to be occurring.
Research Examining Executive Functioning and FTD
As can be seen in Table 1 and in Figure 1, the association
between executive functioning task performance and FTD has
been examined in 26 studies. The overall effect size of the 26
studies is .36, a medium effect.3 The lower and upper bound limits
3
Unfortunately, two relevant studies could not be included. In one study
(Manschreck, Maher, Redmond, Miller, & Beaudette, 1966), results were
simply reported as nonsignificant; in the second study (Kuperberg,
McGuire, & David, 1998), reported results were based on regression
 214 KERNS AND BERENBAUM
of the 95% CI were .30 and .42. The overall level of significance
is z ⫽ 9.46, p ⬍ .00001, and the number of unpublished nonsig-
nificant studies that would increase the significance level to .05 is
930.4 The effect sizes across the 26 studies were statistically
heterogeneous ( p ⬍ .05; see Rosenthal, 1993, for computational
procedures), suggesting the possibility of moderating variables.
Task difficulty was not a significant moderator of the size of the
association between FTD and executive function task performance
(␤ ⫽ .11, z ⫽ 0.80, p ⬎ .20).5 Thus, previous research has
demonstrated a sizable and robust association between impaired
executive functioning and FTD. Additionally, this association does
not appear to be due to a generalized performance deficit.
Next we examined whether the level of involvement of context
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memory, inhibition, and sustained attention moderated the associ-
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ation between FTD and task performance. Both executive function
components, inhibition (␤ ⫽ .11, z ⫽ 4.33, p ⬍ .0001) and context
memory (␤ ⫽ .07, z ⫽ 2.67, p ⬍ .01) were significant, positive
moderators of the association between FTD and executive func-
tioning. Thus, it appears that the association between FTD and
executive function tasks increases as the level of involvement of
inhibition and context memory in those tasks increases. Addition-
ally, sustained attention was a significant positive moderator of the
association between FTD and executive function task performance
(␤ ⫽ .04, z ⫽ 1.76, p ⬍ .05). Both inhibition (␤ ⫽ .10, z ⫽ 4.19,
p ⬍ .0001) and context memory (␤ ⫽ .06, z ⫽ 2.03, p ⬍ .05)
continued to be significant predictors of FTD when sustained
attention was entered into the regression equation along with them
(in the same step); in contrast, however, when either inhibition or
context memory was entered into the regression equation along
with sustained attention, sustained attention was no longer a sig-
nificant predictor (if context memory, ␤ ⫽ .003, z ⫽ .12, p ⬎ .40;
if inhibition, ␤ ⫽ .02, z ⫽ 1.06, p ⬎ .14). Overall, the results of the
moderator analysis suggest that impairments of two facets of
executive functioning, inhibition and context memory, might be
particularly associated with FTD. In fact, the moderator analysis
suggests that the overall effect size estimate of .36 between FTD
and executive functioning might be an underestimate of the asso-
ciation. When tasks are used that most heavily emphasize inhibi-
tion and context memory, the association between FTD and those
tasks is even larger.
Executive functioning is involved in the supervision of complex
thought. Therefore, it appears that FTD, in part, might be associ-
ated with impaired guidance of discourse. For example, FTD
might be associated with difficulty maintaining a discourse topic,
planning upcoming speech, or inhibiting irrelevant speech. Previ-
ously, executive functioning has been most often conjectured to be
associated with the negative signs and symptoms of schizophrenia
(e.g., decreased speech output, avolition, and decreased emotional
expression; Chua & McKenna, 1995). Our review strongly indi-
cates that FTD, a positive sign, is also associated with impaired
executive functioning.
analyses, which do not yield a usable effect size statistic for meta-analyses
(Rosenthal, 1993). It should be noted that inclusion of the Manschreck et
al. study with an effect size estimate of .00 would leave all results
unchanged. The results of the Kuperberg et al. study were very consistent
with both the overall executive functioning meta-analysis as well as with
the results of the executive functioning moderator analysis.
In summary, there is a sizable and robust association between
FTD and impaired executive functioning. The association has been
found across a broad array of executive functioning tasks and in a
sizable number of studies. In addition, current evidence suggests
that this cannot be explained by either task difficulty or unpub-
lished null results. Finally, the association between FTD and
impaired executive functioning is especially evident when execu-
tive function tasks are likely to involve high context memory and
inhibition demands.
Research Examining Spreading Activation and FTD
We examined the results of semantic and phonemic priming
studies to assess whether people with FTD have an increase in
spreading activation. As previously mentioned, if people with FTD
have an increase in the amount of spreading activation, then they
should exhibit increased semantic priming of related words (hy-
perpriming). Alternatively, if people with FTD have an increase in
the distance that activation spreads, then they should exhibit in-
creased priming for distantly related primes. On the other hand, if
people with FTD have impaired semantic memory, then they
should exhibit decreased semantic priming (hypopriming). To min-
imize the influence of expectancy effects, in all cases except one
(in which results were not presented separately for different
SOAs), we used only results for conditions with SOAs less than
500 ms. Additionally, given that most studies reported difference
scores, where possible we only used difference scores in our
meta-analysis (although difference scores, as we discuss below,
could increase the association between FTD and priming). As can
be seen in Table 2 and Figure 1, eight studies have examined
priming and FTD; six used lexical decision and two used naming
tasks.6 The overall effect size is –.07, lower and upper bound limits
of the 95% CI were –.18 and .03, z ⫽ ⫺1.06, p ⬎ .75, a weak
4
The large number of executive functioning studies allowed us to
examine a normal quantile plot, as recommended by Wang and Bushman
(1998), to assess any effect of publication bias (i.e., a large number of
unpublished null results). The plot looked like an approximate straight line
with no breaks in the distribution, which suggests a lack of a publication
bias.
5
An estimate of task difficulty could not be obtained for the planning
task used by Barch and Berenbaum (1996) because the study did not
involve a control group and the task has not been used in other research.
However, assuming that the effect size for task difficulty for this task was
either as small or as large as any other estimate did not change the results
of the moderator analysis.
6
Manschreck et al. (1988) also examined priming and FTD. However,
an effect size could not be computed from the reported reuslts in this study
for two reasons: (a) Standard deviations for priming effects were not
reported, and (b) the result of a comparison between people with schizo-
phrenia with FTD and without FTD was not reported. This study did
provide some evidence for hyperpriming in FTD, because people with FTD
had numerically larger mean priming effects than people without FTD
(with FTD ⫽ 83, without FTD ⫽ 36). In any event, when we included an
estimated effect size for Manschreck et al., which we computed using the
smallest standard deviations reported in any priming study (Besche et al.,
1997; note that effect sizes increase as standard deviations decrease), the
meta-analysis for spreading activation and the results for moderator anal-
ysis of lexical decision studies were identical.
 COGNITIVE CORRELATES OF FTD 215

Table 1
Studies Included in Executive Functioning Meta-Analysis

Study n FTD scale Cognitive tasks r CM INH SA

Allen et al., 1993 20 MSI Category fluency errors .39 2.7 4.3 3.0
Barch & Berenbaum, 1996 39 TLC, IR Composite .13
Reality monitoring report say errors .09 4.0 4.0 3.3
Speech planning .17 3.0 3.7 2.0
Barch et al., 1992 25 SAPS Letter fluency total ⴚ.02 3.0 3.0 3.3
Berenbaum & Barch, 1995 21 TLC, TDI, BIT Auditory distraction digit span .18 6.3 6.3 6.3
Docherty & Gordiner, 1999 55 CDI, BPRS, SAPS Auditory distraction digit span .46 6.3 6.3 6.3
Docherty et al., 1994; Docherty,
Hawkins, et al., 1996a 48 IR Composite .26
Letter fluency total ⫺.16 3.0 3.0 3.3
Letter fluency errors .37 3.3 5.0 3.7
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Trails B .48 3.0 5.3 3.3

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Auditory CPT .29 5.0 3.7 6.3

Fukushima et al., 1988 12 BPRS Antisaccade errors .61 3.7 6.7 4.3
Fukushima et al., 1990 32 BPRS Antisaccade errors .39 3.7 6.7 4.3
Goldberg et al., 1998b 23 TLC Composite .19
Letter–number sequence .08 6.3 2.3 6.3
WCST category number .29 4.3 4.7 3.3
Harvey, 1985 20 TLC Composite .55
Reality monitoring report say errors .74 4.0 4.0 3.3
Reality monitoring total correct .28 4.3 4.0 3.7
Harvey, Earle-Boyer, & Levinson, 1986 23 IR Auditory distraction digit span .79 6.3 6.3 6.3
Harvey, Earle-Boyer, Wielgus,
& Levinson, 1986 24 TLC Recall of integrated text ⴚ.09 4.3 3.7 3.7
Harvey & Pedley, 1989 36c TLC Composite .24
Auditory distraction digit span .51 6.3 6.3 6.3
Visual distraction digit span ⫺.07 5.7 5.3 6.0
Harvey & Serper, 1990 38 TLC, IR Composite .51
Reality monitoring total correct .35 4.3 4.0 3.7
Auditory distraction digit span .64 6.3 6.3 6.3
Landre & Taylor, 1995 37 SAPS, BIT CPT A-X d⬘ .31 5.0 4.7 6.3
Maher et al., 1980 17 SADS Recall of integrated text .68 4.3 3.7 3.7
Manschreck et al., 1991 20 TTR Primacy portion of recall .54 3.0 3.0 4.3
Nathaniel-James & Frith, 1996 12 MSI Confabulation .50 5.7 5.3 4.3
Nelson et al., 1998 15 SAPS CPT degraded stimulus d⬘ .66 5.0 3.7 7.0
Nuechterlein et al., 1986 40d TDI CPT A-X d⬘ .09 5.0 4.7 6.3
Oltmanns et al., 1978 21 CRRS Auditory distraction digit span .55 6.3 6.3 6.3
Pandurangi et al., 1994 41 CASH, TLC CPT A-X commission errors .47 5.3 6.0 6.3
Ragland et al., 1996 30 SAPS Composite .23
WCST category number .14 4.3 4.7 3.3
WCST perseveration .32 5.0 6.0 4.3
Serper, 1993 20 TLC Line monitoring reaction time and errors .25 1.7 2.3 6.3
Strauss et al., 1993 45 TLC CPT degraded stimulus d⬘ .35 5.0 3.7 7.0
Van der Does et al., 1993 60 BPRS Card sort perseveration .39 5.0 6.0 4.3

Note. Values in the meta-analysis are presented in bold. The following formal thought disorder (FTD) scales were used: Bizarre-Idiosyncratice Thinking
(BIT; Marengo et al., 1985); Brief Psychiatric Rating Scale (BPRS; Overall & Gorham, 1962); Comprehensive Assessment of Symptoms and History
(CASH: Andreasen, Flaum, & Arndt, 1992); Communication Disturbances Index (CDI; Docherty, De Rosa, & Andreasen, 1996); Case Record Rating Scale
(CRRS; Strauss, 1974); Incompetent References (IR; Rochester & Martin, 1979); Manchester Scale, Incoherence item (MSI; Krawiecka, Goldberg, &
Vaughn, 1977); Schedule for Affective Disorders and Schizophrenia (SADS; R. L. Spitzer & Endicott, 1978); Schedule for the Assessment of Positive
Symptoms (SAPS; Andreasen, 1984); Thought Disorder Index (TDI; Johnston & Holzman, 1979); Thought, Language, and Communication (TLC;
Andreasen, 1979); Type-Token Ratio (TTR; Manschreck, Maher, & Ader, 1981). WCST ⫽ Wisconsin Card Sorting Task; CPT A-X ⫽ Continuous
Performance Task, A-X version; CM ⫽ context memory; INH ⫽ inhibition; SA ⫽ sustained attention.
a
Correlations with individual cognitive tasks are from Docherty et al. (1994); correlations with composite cognitive scores were reported in Docherty,
Hawkins, et al. (1996). b Goldberg et al. (1998) involved largely the same participants as Aloia et al. (1998). c Half of the participants were
unmedicated. d Participants were tested as both inpatients and outpatients.

effect that is in the opposite direction predicted by the increased
spreading activation hypothesis.
In three of the eight priming studies, people with FTD exhibited
hyperpriming, whereas in five other studies, people with FTD
exhibited hypopriming. Statistically, these eight studies are heter-
ogeneous ( p ⬍ .01), suggesting the presence of moderating fac-
tors. We performed moderator analyses to examine whether the
likely presence of semantic matching (which should occur in
lexical decision tasks with high relatedness proportions and high
nonword ratios) moderated the association between FTD and se-
mantic matching. Both relatedness proportion and nonword ratio
were significant moderators: for relatedness proportion, ␤ ⫽ 2.30,
z ⫽ 4.59, p ⬍ .0001; for nonword ratio, ␤ ⫽ 2.20, z ⫽ 4.62, p ⬍
.0001; for the summed average of relatedness proportion and
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216
KERNS AND BERENBAUM

Figure 1. Dot plot of effect sizes and 95% confidence intervals (CI). The asterisks represent the effect sizes.
 COGNITIVE CORRELATES OF FTD 217

Table 2
Studies in Spreading Activation, Semantic Memory, and Language Production Meta-Analyses

Study n FTD scale Cognitive tasks r

Spreading activation
Aloia et al., 1998 a
20 TLC Naming semantic priming ⫺.41
Barch, Cohen, et al., 1996 100 BPRS Naming semantic priming ⫺.31
Besche et al., 1997 34 TLC LDT semantic priming ⫺.59
Blum & Freides, 1995 18 TLC LDT semantic priming ⫺.12
Passerieux et al., 1997 22 TLC LDT semantic priming ⫺.52
Spitzer et al., 1993 50 BPRS LDT semantic priming .29
Spitzer et al., 1994 70 BPRS LDT semantic & phonemic .30
priming
Weisbrod et al., 1998 40 BPRS LDT semantic priming .31
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Semantic memory
Allen et al., 1993 20 MSI Semantic clustering .55
Andrews et al., 1993 19 SAPS N400 .53
Chen et al., 1994 39 CASH Categorization judgment RT .29
Goldberg et al., 1998a 23 SAPS Peabody Vocabulary; text .40
processing errors; difference
category & letter fluency
Kerns et al., 1999 26 SAPS Verbal fluency clustering .34

Language production
Barch & Berenbaum, 1996 39 TLC, IR Induced nonword errors .14
Docherty et al., 1994, 1996b 48 IR Boston Naming .03
Faber & Reichstein, 1981 24 Derailmentc Boston Diagnostic Aphasia .14
Exam, picture naming, token test
Goldberg et al., 1998a 23 SAPS Boston Naming .24
Landre & Taylor, 1995 37 SAPS, BIT Porch Aphasia Exam .18

Note. The following formal thought disorder (FTD) scales were used: Bizarre-Idiosyncratic Thinking (BIT;
Marengo et al., 1985); Brief Psychiatric Rating Scale (BPRS; Overall & Gorham, 1962); Comprehensive
Assessment of Symptoms and History (CASH; Andreasen, Flaum, & Arndt, 1992); Incompetent References (IR;
Rochester & Martin, 1979); Manchester Scale, Incoherence item (MSI; Krawiecka, Goldberg, & Vaughn, 1977);
Schedule for the Assessment of Positive Symptoms (SAPS; Andreasen, 1984); Thought, Language, and
Communication (TLC; Andreasen, 1979). LDT ⫽ lexical decision task; RT ⫽ reaction time.
a
The Aloia et al. (1998) and Goldberg et al. (1998) studies involved largely the same participants. b Corre-
lations with individual cognitive tasks are presented in Docherty et al. (1994). c Derailment and loose
associations were rated by clinicians.

nonword ratio, ␤ ⫽ 2.82, z ⫽ 5.20, p ⬍ .0001. As can be seen in
Table 3, the three studies with the highest relatedness proportions
and nonword ratios, which would likely involve semantic match-
ing, reported hyperpriming. In contrast, the three studies with the
lowest relatedness proportions and nonword ratios, which would
likely not involve semantic matching, reported hypopriming.7
Similarly, the two studies that used naming tasks, which do not
involve semantic matching, found that people with FTD exhibited
hypopriming (Aloia et al., 1998; Barch et al., 1996). Thus, the
results of the moderator analysis suggest that when semantic
matching is involved, people with FTD exhibit hyperpriming.
Conversely, when semantic matching is minimized, and when the
effects of spreading activation should be most evident, people with
FTD exhibit hypopriming.
The results of the moderator analysis are not easily reconciled
with the hypothesis that FTD is associated with an increase in the
amount of spreading activation. As mentioned previously, an in-
crease in the amount of automatic spreading activation should
produce hyperpriming in all tasks, especially those that minimize
the influence of other cognitive processes such as semantic match-
ing. However, the opposite pattern was found, with hyperpriming
only in those instances in which semantic matching was likely to
be taking place. Thus, previous priming studies do not support an
association between amount of spreading activation and FTD.
We think there are at least three explanations for hyperpriming
in previous studies. First, use of semantic matching might have a
greater compensatory benefit for people with FTD than for people
without FTD. This is analogous to the hyperpriming exhibited by
nonpsychiatric participants when target words are visually de-
graded (Neely, 1991). Hence, priming effects should be larger for
7
As can be seen in Table 3, although Besche et al. (1997) and Blum and
Freides (1995) have similar relatedness proportions and nonword ratios,
there is a sizable difference in the effect size for the association between
FTD and amount of priming in these two studies. However, as can also be
seen in Table 3, these two studies actually found identical effect sizes for
the amount of semantic priming exhibited by people with FTD. Therefore,
these two studies do not differ in the amount of priming exhibited by
people with FTD, but they do differ in the amount of priming exhibited by
people without FTD (possibly because of the high proportion of lateralized,
i.e., only left or right visual field, stimulus presentation trials in the study
by Blum & Freides).
 218 KERNS AND BERENBAUM
Table 3
Nonword Ratio (NR), Relatedness Proportion (RP),
and Priming Effect Sizes
NR and RP
Study ra NR RP average rb
Weisbrod et al., 1998 .31 .75 .67 .71 .51
Spitzer et al., 1994 .30 .62 .61 .62 .61
Spitzer et al., 1993 .29 .75 .67 .71 .59
Blum & Freides, 1995 ⫺.12 .33 .50 .42 .30
Passerieux et al., 1997 ⫺.52 .55 .17 .36 ⫺.12
Besche et al., 1997 ⫺.59 .39 .50 .45 .30
a
Effect size for association between formal thought disorder and amount of
semantic priming. b Effect size for amount of semantic priming in a
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group of people with a high level of formal thought disorder.
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all individuals to the extent that they (a) have more room to
improve their performance and (b) are able to use prime-target
relatedness to improve their performance. Individuals with FTD,
who typically have slower baseline reaction times on these tasks
than people without FTD, are likely to have more room to improve
their performance, and they might only be able to improve their
performance when they can use semantic matching. A second
reason for hyperpriming is the use of difference scores rather than
proportion scores (Chapman, Chapman, Curran, & Miller, 1994).
Difference scores might be artifactually larger if baseline reaction
times are slower. Hence, given that people with FTD have slower
baseline reaction times, then difference scores probably overesti-
mate the amount of priming in people with FTD.
We think the results of previous studies suggest a third reason
that explains why people with FTD sometimes exhibit hyperprim-
ing: People with FTD might have an increase in the distance that
activation spreads. As mentioned previously, if people with FTD
have an increase in the distance that activation spreads, this might
result in the priming of distantly related information. The results of
two studies provide compelling evidence of priming of distantly
related information in people with FTD. These two studies found
effects that were qualitatively unique to people with FTD and,
thus, cannot be explained as a quantitative artifact of the use of
difference scores. First, Weisbrod, Maier, Harig, Himmelsbach,
and Spitzer (1998) found that only people with FTD exhibited
mediated priming with a right visual field–left hemisphere target
presentation (other participants actually exhibited inhibition). It is
interesting that the left hemisphere is ordinarily thought to process
semantic-lexical information in a narrow and focused manner
(Beeman & Chiarello, 1998). People with FTD apparently lacked
a narrow, focused spread of activation and exhibited priming for
distantly related targets. Similarly, at an SOA of 200 ms, M.
Spitzer et al. (1994) found inhibited phonological priming in
nonpsychiatric control participants and people without FTD,
whereas people with FTD exhibited no phonological inhibition at
a 200 ms SOA and phonological facilitation at longer SOAs. These
findings of greater priming for distantly related targets might
reflect, in part, a more diffuse spread of activation over a greater
distance in people with FTD. As suggested by M. Spitzer (1997),
a greater distance in the spread of activation might occur concom-
itantly with impaired semantic-lexical processing. We think im-
paired semantic-lexical processing and increased distance of
spreading activation could be related, with either one causing the
other. For example, impaired semantic-lexical processing could
result in a diffuse and unfocused spreading of activation.
In summary, in the five semantic priming studies that should
have most directly assessed automatic spreading activation, people
with FTD have consistently exhibited hypopriming. Thus, previ-
ous researchers have not found an association between FTD and
increased amount of spreading activation. People with FTD appar-
ently exhibit hyperpriming in conditions that allow for semantic
matching. Additionally, there is some supportive evidence (albeit
from only two studies) for an increase in the distance of automatic
spreading activation in people with FTD.
Research Examining Semantic Memory and FTD
As just discussed, evidence of increased distance of spreading
activation is consistent with a semantic memory impairment. Ad-
ditionally, hypopriming in semantic priming tasks is consistent
with semantic memory impairment. Previous reports of hypoprim-
ing in people with FTD may be the result of impaired semantic
memory for the following reasons. First, hypopriming was found
on those tasks that emphasized spreading activation and the integ-
rity of the information within semantic networks. Second, as
previously mentioned, other people with semantic memory impair-
ment have been found to exhibit decreased priming (e.g., Moss et
al., 1995). Finally, Aloia et al. (1998) found an association be-
tween hypopriming and poor performance on semantic memory
tasks in people with FTD. Thus, we think these results are con-
sistent with impaired semantic-lexical processing in people with
FTD.
In this section, we further explore whether FTD is associated
with an impairment of semantic memory by examining the asso-
ciation between FTD and performance on nonpriming tasks that
likely involve semantic memory. There have been five studies that
have measured the association between FTD and nonpriming
semantic memory tasks.8 The effect size for the five studies is .42,
a large effect. The lower and upper bound limits of the 95% CI
were .25 and .56. The overall significance level was z ⫽ 4.29, p ⬍
.0001, and the number of unpublished nonsignificant studies that
would increase the significance level to .05 is 35. The effect sizes
across the five studies were statistically homogeneous ( p ⬎ .05).
Additionally, greater task difficulty was not a significant moder-
ator of the association between FTD and semantic memory task
performance (␤ ⫽ .04, z ⫽ 0.45, p ⬎ .30).9 Thus, these five studies
have found a large and consistent association between FTD and
measures of impaired processing of semantic information. Hence,
8
In calculating an effect size from the study by Allen, Liddle, and Frith
(1993), we did not include their measure of estimated word pool size
because the estimate for FTD seemed unrealistically high (i.e., participants
with FTD were estimated to have word pools three times larger than those
of nonpsychiatric control participants). The much larger estimate of word
pool size in people with FTD makes the valid precision of these estimates
questionable. In any event, when we included the effect size for word pool
and FTD, –.54, in the meta-analysis for semantic memory, the effect size
was still sizable, .33, a medium effect.
9
An estimate of task difficulty could not be obtained for the study by
Kerns, Berenbaum, Barch, Banich, and Stolar (1999) because this study did
not include a control group (however, see Kerns et al., 1999, for arguments
against a task difficulty explanation in this study).
 COGNITIVE CORRELATES OF FTD
nonpriming studies of semantic memory are consistent with prim-
ing studies in finding evidence of impaired processing of semantic
information in people with FTD.
In general, there are two plausible explanations for poor perfor-
mance in semantic memory tasks: a loss of stored information or
impaired retrieval (Rapp & Carammazza, 1993). Disentangling
these two explanations can be difficult, and previous research on
semantic memory and FTD has not been extensive enough, both in
terms of the number of studies and in terms of the type of semantic
memory measures used (e.g., no research examining association
between FTD and performance on a battery of semantic memory
tasks), to adequately settle the issue. Impaired retrieval could be
due to impaired executive functioning, and the semantic memory
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tasks used in previous research also probably involved executive
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functioning. Thus, future research must still address the integrity
of semantic information in people with FTD separate from an
executive functioning deficit. However, regardless of the cause of
impaired semantic processing of people with FTD, we think that
the association between FTD and impaired semantic processing
could still be important in understanding the occurrence of FTD.
In summary, previous research consistently supports an associ-
ation between FTD and impaired processing of semantic informa-
tion. Hypopriming results in some priming studies in people with
FTD are consistent with impaired semantic memory processing.
Furthermore, people with FTD also are impaired in nonpriming
semantic memory tasks. Although the association between seman-
tic processing and FTD seems consistent (albeit the total number
of studies is small), it is unclear whether this is due to a loss of
semantic information or to impaired access to and processing of
semantic information (maybe as a result of impaired executive
functioning).
Studies Examining Language Production and FTD
Five studies have examined associations between language pro-
duction performance and FTD. The overall effect size was .14, a
small effect. The lower and upper bound limits of the 95% CI were
–.02 and .30. The overall level of significance was Z ⫽ 1.56, p ⫽
.06. Thus, overall, previous research has not supported a general
association between impaired language production and FTD. How-
ever, previous research does suggest that some particular facets of
FTD might be associated with impaired language production.
Berenbaum and Barch (1995) posited that only certain facets of
FTD (what they called disturbances in fluency [p. 358], such as
neologisms, word approximation, and incoherence), exhibited by
only a minority of people with schizophrenia, are associated with
impaired language production.
In a test of the association of a language production impairment
with particular FTD facets, Barch and Berenbaum (1996) exam-
ined the number of nonword speech errors produced in a speech
error induction task. In this task, as in regular conversation, non-
word errors are rare and an increase in nonword speech errors
could indicate a language production impairment. Barch and Be-
renbaum found that only people with neologisms and word ap-
proximations produced a much higher number of nonword speech
errors. In contrast, several other facets of FTD were not associated
(or were only weakly associated) with nonword speech errors.
Therefore, some facets of FTD (e.g., neologisms and word approx-
219
imations) might be associated with impaired language production,
whereas other facets of FTD (e.g., derailments) might not.
If only a minority of people with FTD have a language
production-specific impairment, then composite measures of FTD
should exhibit only modest associations with language production
measures. The composite effect size of the study by Barch and
Berenbaum (1996) was small, .14, identical to the overall effect
size of all five language production studies. Thus, the composite
FTD measure in Barch and Berenbaum’s study, taken by itself,
obscures the finding that specific facets of FTD were associated
with the language production task. There is a similar pattern in the
results of Landre and Taylor (1995). In that study, one measure of
FTD, the Schedule for the Assessment of Positive Symptoms
(Andreasen, 1984), was strongly associated with poor performance
on an aphasia battery; however, another measure of FTD, the
Bizarre-Idiosyncratic Thinking (Marengo, Harrow, Lanin-
Kettering, & Wilson, 1985), was modestly associated with better
performance. Thus, the composite effect size from this study was
small, .18, and comparable to the overall effect size of all five
language production studies. Along the same lines, two studies
have found that another facet of FTD, incompetent references
(Rochester & Martin, 1979), is not associated with language pro-
duction task performance (Barch & Berenbaum, 1996; Docherty et
al., 1996). Thus, although the effect size of the five language
production studies was small and argues against a general associ-
ation between FTD and language production, these studies do
provide some preliminary support to the hypothesis that some
facets of FTD, what Berenbaum and Barch (1995) referred to as
disturbances in fluency, might be associated with deficits within
the language production system.10
In summary, previous research has found (at best) a small
association between FTD and impaired language production. Thus,
current research does not support an association between a broad
language production impairment and FTD. However, the possibil-
ity of an association between FTD and a language production
impairment cannot yet be ruled out. First, to date only five studies
have tested this possibility. Second, not all possible language
production impairments have been examined, and many that have
been examined have each been examined in only one or two
studies. However, it is also possible that perhaps only a subset of
FTD facets is associated with impaired language production. Con-
sistent with this, there is some initial evidence that some aspects of
FTD (e.g., word approximations and neologisms) are associated
with impairments in some aspects of language production (e.g.,
lexical processing; Barch & Berenbaum, 1996).
10
Landre, Taylor, and Kearns (1992) reported additional evidence for an
association between FTD and impaired language production. They com-
pared 10 people with schizophrenia and FTD with 10 people with aphasia
on the following: Boston naming task, repetition of words and phrases,
token test, speech fluency, and amount of speech information. There were
no significant differences between people with FTD and people with
aphasia on these language measures. Similarly, Faber et al. (1983) reported
that on 9 of 14 language abnormalities assessed, people with FTD did not
differ significantly from people with aphasia. Therefore, this study also
found some similarities between people with FTD and people with aphasia.
These similarities between people with FTD and people with aphasia, who
likely have a language production impairment, suggest that some people
with FTD also might have a language production impairment.
 220 KERNS AND BERENBAUM
Comparison of Four Cognitive Processes as Predictors
of FTD
We conducted moderator analyses to examine whether effect
sizes differed across the four cognitive processes. All comparisons
were significantly different except that the effect sizes for execu-
tive functioning and semantic memory did not differ significantly
from each other ( p ⬎ .30; note that the results were identical if we
used focused contrasts, e.g., Rosenthal, 1991).
Summary of Meta-Analysis
Overall, of the four cognitive impairments, two have been
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consistently associated with FTD in previous research. First, there
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is consistent evidence for a sizable association between FTD and
impaired executive functioning. Second, there is evidence for an
association between FTD and impaired processing of semantic
information. In contrast, the two other cognitive impairments have
not been consistently associated with FTD in previous research.
Previous research has not consistently found an association be-
tween FTD and increased amount of spreading activation. Some
studies, however, have found some support for increased distance
of spreading activation in people with FTD. Previous research has
not consistently found an association between FTD and a language
production impairment. Instead, previous research suggests that
only a subset of FTD facets (i.e., disturbances in fluency) might be
associated with impaired language production.
Meta-analysis allows for a principled and quantitative review of
previous research. However, meta-analysis is not a flawless
method (for criticisms of meta-analysis, see Cooper & Hedges,
1994; Rosenthal, 1991, chapter 7). One potential criticism of all
meta-analyses, including the ones we have conducted, is that the
quality of any meta-analysis is a function of the studies included.
For example, although differences between FTD measures (Beren-
baum & Barch, 1995) and FTD facets (Barch & Berenbaum, 1996)
might exist, previous research has not often examined whether
cognitive deficits are differentially associated with different FTD
scales or facets. In addition, our conclusions are dependent in part
on how we have divided tasks into different categories in conduct-
ing the four different meta-analyses (as well as on the quality of
our ratings of the involvement of different executive function
component processes). We would not be surprised if some inves-
tigators disagreed with our grouping of studies. In part, this is
because some tasks could reasonably be included in more than one
category (e.g., the sentence verification task used by Chen,
Wilkins, and McKenna, 1994, probably involves both semantic
memory processes and executive functioning). However, given the
nature of the results—the robust association with executive func-
tioning, the inconsistent priming results, the consistent size of all
associations with semantic memory and language production, re-
spectively—we are confident that the overall conclusions of our
review regarding the four possible cognitive impairments would
not change very much even if some changes were made to which
task was included in which meta-analysis. Another limitation of
meta-analyses is that, like individual correlation studies, the results
of meta-analyses of correlations are limited in what they can tell us
about causation. For example, although the meta-analysis provided
clear evidence that inhibition deficits are associated with FTD, it is
plausible that it is not the inhibition deficits themselves, but rather
something else associated with inhibition deficits, that contribute
causally to FTD.
Recommendations for Future FTD Research
Previous research has found a sizable and robust association
between executive functioning and FTD. FTD researchers should
attempt to develop and test more precise theories of executive
functioning impairment. For example, Cohen, Barch, Carter, and
Servan-Schreiber (1999) found evidence that disorganization
symptoms (of which FTD is the most prevalent sign) are associ-
ated with deficits in the processing of contextual information.
Thus, researchers should directly examine whether FTD is partic-
ularly associated with impaired processing of context (Cohen et
al., 1996).
Previous research has found a large association between inhibi-
tion and FTD. It is important to examine the range of inhibitory
deficits in people with FTD. Our review addressed only whether
FTD is associated with executive inhibition. If FTD is only asso-
ciated with executive inhibition, then FTD should not be associ-
ated with inhibition in nonexecutive inhibition tasks, such as
negative priming (Kramer, Humphrey, Larish, & Logan, 1994).
Consistent with this, FTD has not been found to be associated with
prepulse inhibition (e.g., Perry & Braff, 1994). Furthermore, re-
searchers should examine whether FTD is associated with all types
of executive inhibition. In a review of the cognitive processes
associated with the prefrontal cortex, West (1996) concluded that
two different types of inhibition have been associated with it. One
type of inhibition, interference control, is thought to be involved in
managing information within working memory, such as clearing
inappropriate information in a proactive interference task or a
paired associate learning task (e.g., Shimamura, Jurica, Mangels,
Gershberg, & Knight, 1995). The second type of inhibition, pre-
potent inhibition, would be involved in withholding a strongly
activated response, such as in perseverative errors in the Wisconsin
Card Sorting Task or errors in the antisaccade task (West, 1996).
FTD might be associated with impairments in only one of these
two types of executive inhibition. Furthermore, given that context
memory deficits probably can produce deficits in inhibition (per-
haps especially prepotent inhibition), it is important to examine
whether people with FTD have a deficit in inhibition separate from
a deficit in context memory.
Future research should also examine whether FTD is associated
with additional components of executive functioning. There might
be other executive function components not yet adequately exam-
ined that are associated with FTD. For example, task switching
might be an elementary and important aspect of executive control
(e.g., Smith & Jonides, 1998) that has not been adequately exam-
ined in previous FTD research. Also, monitoring and manipulation
of information (Petrides, 1996) might be an important component
of executive functioning that is impaired in FTD.
Previous research has demonstrated a large association between
FTD and semantic memory. Although this association was found
across a range of tasks, future research must more adequately
demonstrate a semantic memory deficit in people with FTD. For
example, research has yet to examine associations between FTD
and performance on semantic memory batteries (McKay et al.,
1996). Use of semantic memory batteries would also be relevant
for further addressing whether people with FTD exhibit a loss of
 COGNITIVE CORRELATES OF FTD
semantic information or a retrieval deficit, an issue most ade-
quately addressed by examining the pattern of performance across
a range of semantic memory tasks (e.g., Rapp & Caramazza,
1993). In addition, given the role of executive functioning pro-
cesses in semantic memory tasks (e.g., Thompson-Schill,
D’Esposito, & Kan, 1999), it is important to examine the relation-
ship between executive functioning and semantic memory task
performance in people with FTD.
Explanations for hypopriming and hyperpriming in people with
FTD should continue to be explored. For example, research using
the same sample of participants and the same stimuli can manip-
ulate relatedness proportions and nonword ratios and test directly
whether the relation between FTD and priming effects on lexical
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decision tasks depends on semantic matching. To provide addi-
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tional converging evidence for an impaired lexical-semantic pro-
cessing explanation of hypopriming, research examining the rela-
tion between semantic priming and FTD should also include other
semantic memory measures, such as semantic memory batteries
(Moss et al., 1995) and N400 event-related potentials (Kounios &
Holcomb, 1992).
Researchers can use several other methodological tools to fur-
ther examine semantic memory, spreading activation, and seman-
tic matching in people with FTD. First, they could use modified
priming tasks that discourage semantic matching, such as go/no-go
tasks and tasks that require the matching of targets with a probe
stimulus (Neely, 1991). Second, researchers could examine sum-
mation of activation across a series of related primes and targets as
a means of testing the activation levels of different words (Balota
& Paul, 1996). Third, spreading activation hypotheses could be
tested and refined through computational modeling (e.g., Dell &
O’Seaghdha, 1991; Hoffman, 1987).
Researchers have found qualified support for an association
between some facets of FTD and impaired language production.
This might be best further examined by the use of standard
language production research methods. For example, impaired
lexical access could be examined using picture naming and word
and phrase repetition tasks (Bock & Levelt, 1994). Deficits in
lexical access could also be examined in spreading activation and
connectionist models (Dell & O’Seaghdha, 1991). Finally, we
think it is critical for future research to test predictions concerning
which specific facets of FTD are associated with language pro-
duction impairments. We predict that language production system
impairments are associated with the FTD facets categorized as
deficits in fluency by Berenbaum and Barch (1995), such as
incoherence, clanging, neologisms, and word approximations.
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Received December 26, 2000
Revision received July 20, 2001
Accepted September 1, 2001 䡲