Inlern. I , Nriiiorriencc. 1983, Vol. 21. pp. 129-136 0 1983 Gordon and Breach Science Publishers, Inc.

0020.7454 (8312102-0I29 S I 8.5010 Printed in the United Kingdom

SCHIZOPHRENIC SUBGROUPS WITH

NORMAL AND ABNORMAL COGNITIVE
FUNCTIONING ON THE LURIA-NEBRASKA
NEUROPSYCHOLOGICAL BATTERY
JAMES A. MOSES, Jr.
Veterans Administration Medical Center, Palo Alto, Calijornia
Int J Neurosci Downloaded from informahealthcare.com by York University Libraries on 01/01/15

(Received April 5 , 1983)

A new set of decision rules for identification of brain dysfunction among schizophrenic or schizoaffec-
tive disorder patients were tested with the Luria-Nebraska Neuropsychological Battery. In a sample
of 100 patients from these categories with normal neurological examination findings, three groups
of patients were identified. These patients respectively were identified as cognitively normal, border-
line, or abnormal. These groups were subjected to a series of multivariate and univariate analyses
that showed them to be associated with significantlydifferent profiles on the Luria-Nebraska Neuro-
psychological Battery. Different functional systems were postulated to account for the differences in
impaired scores across normal, borderline, and abnormal cognitive functioning groups. Further re-
search with external validation criteria was encouraged.
For personal use only.

In recent years there has been much renewal of interest in identification of a biological
basis for cognitive abnormality in schizophrenic persons. Recent work in this area
has employed computerized tomographic measurements with planimetric or volu-
metric indices of structural change in the brain’s ventricular and sulcal areas (cf.
Golden, Moses, Zelazowski, Graber, Zatz, Horvath, & Berger, 1980; Jernigan, Zatz,
Moses, & Berger, 1982) as well as changes in brain density measurements (Golden,
Graber, Coffman, Berg, Newlin, & Bloch, 1981) as criterion measures to validate
inferences of cerebral dysfunction or their lack in schizophrenics. Patients with
schizoaffective disorder have been included in some of the studies. Lewis, Golden,
Hammeke, and Purisch (1 979) found psychometric evidence of cognitive functioning
differences among subgroups of chronic schizophrenics who were defined by their
performances on the Luria-Nebraska Neuropsychological Battery (LNNB). They
suggested the existence of a schizophrenic subgroup with cognitive functioning that
was clearly within normal limits and another subgroup with clearly abnormal cogni-
tive functioning. These findings were reconfirmed in independent studies that were
reported in the LNNB manual by Golden, Hammeke, and Purisch (1980). Golden,
Graber, Moses, and Zatz (1980) showed that the LNNB was capable of predicting the
presence of ventricular enlargement or sulcal widening as detected by computerized
tomographic scanning of the brain.
The literature in this area has been reviewed most recently by Moses, Golden,
Ariel, and Gustavson (1983), who recommended use of a tripartite set of rules similar
to those advanced by Golden, Hammeke, and Purisch (1980). These rules are based
on the prediction of abnormal findings on the computerized tomographic scan and
regional cerebral blood flow measures from scores on the LNNB. Such measures
provide anatomical and physiological indices of dysfunction, respectively. An attempt
to validate the existence of such schizophrenic subgroups on the basis of their psycho-
metric performance in new samples of patients not used in the derivation of the
decision rules is necessary further to justify recommendations for their clinical use.
129
 130 J . A . MOSES, Jr.

METHOD

Subjects
The subjects in the current study were 38 chronic paranoid schizophrenics, 41 chronic
undifferentiated schizophrenics, 2 residual schizophrenics, and 19 chronic schizoaf-
fcctive disorder patients. All patients met DSM-111 diagnostic criteria (American
Psychiatric Association, 1980), and diagnoses were made independently by two ex-
pert raters. All patients in the study presented with normal findings on the neuro-
logical examination and without a history of alcoholism, drug abuse, head trauma,
or neurological disorder.
Int J Neurosci Downloaded from informahealthcare.com by York University Libraries on 01/01/15

Method
The Luria-Nebraska Neuropsychological Battery (LNNB) was administered accord-
ing to the standardized procedures which are detailed in the test manual (Golden,
Hammeke, & Purisch, 1980). LNNB profiles for all subjects were grouped according
to classification rules reported in Moses, Golden, Ariel, and Gustavson (1983). Pro-
files with 0-2 scores that exceeded the critical level were designated as within normal
limits (Group I ) . Profiles with 3-4 scores that exceeded the critical level were classi-
fied as borderline (Group 2). Profiles with 5 or more scores that exceeded the critical
level were classified as abnormal (Group 3).
For personal use only.

One way analyses of variance were calculated across the three schizophrenic groups
for the following demographic variables : age, educational level, days hospitalized at
time of testing, age at onset of disorder, duration of disorder (months), and number
of previous psychiatric hospitalizations. A multivariate analysis of variance
(MANOVA) was calculated for the three critical level groups across the 14 LNNB
scales. The overall results were evaluated thereafter for each LNNB scale across
groups by means of a series of one way analyses of variance. The three critical level
elevation groups within each LNNB scale were compared by means of Tukey’s HSD
(honestly significant difference) test at the 0.05 level of statistical significance. This
measure provides a conservative estimate of the significance level of group differences.

RESULTS

Results of one way analyses of variance for all demographi2. variables across diag-
nostic groups are presented in Table I.
No significant intergroup differences were found for any of these variables. In the
analysis of the number of days that patients were hospitalized at the time of testing,
17 patients were excluded from the analysis since they were outpatients. It is of inter-
est that all of these cases came from the first group, with normal LNNB profile find-
ings.
The MANOVA results were significant at the 0.001 level for the overall multivariate
significance test (Hotelling’s trace: F = 7.35, df = 28/166, p < 0.001). Scalewise
univariate analyses of variance for the three critical level groups across the 14 LNNB
scales were uniformly significant as well. Results of these analyses are summarized
in Table 11. Scalewise comparisons of the critical level elevation groups were com-
pared by means of Tukey’s HSD test. Results of these comparisons are summarized
in Table 111.
 SCHIZOPHRENIC SUBGROUP ANALYSIS 131

TABLE I
Demographic variable means, standard deviations, one way analysis of variance F-ratios, and
significance levels for three schizophrenic subgroups

Variable/group N Mean SD F P
Age
Group 1 69 35.10 11.22
Group 2 16 37.00 12.28
Group 3 15 33.27 9.54
Overal 100 35.13 11.10 0.433 NS
Education
Group I 69 12.87 1.81
Int J Neurosci Downloaded from informahealthcare.com by York University Libraries on 01/01/15

Group 2 16 13.38 2.25

Group 3 15 13.40 1.30
Overall 100 13.03 1.82 0.861 NS
Days Hospitalizedn
Group 1 52 25.13 25.10
Group 2 16 114.63 359.13
Group 3 15 40.80 53.73
Overall 83 45.22 169.24 1.960 NS
Age at disorder onset
Group 1 69 24.32 6.01
Group 2 16 21.94 4.65
Group 3 15 23.53 5.40
For personal use only.

Overall 100 23.82 5.74 1.141 NS

Disorder duration
Group I 69 124.32 102.42
Group 2 16 172.69 139.10
Group 3 15 1 13.93 69.15
Overall 100 130.50 105.68 I .596 NS
Previous hospitalizations
Group 1 69 6.03 6.98
Group 2 16 4.63 4.98
Group 3 15 3.93 4.25
Overall 100 5.49 6.36 0.842 NS
~~~~~~~ ~

a 17 patients in Group 1 were outpatients, and were excluded from this analysis.

Comparison of the normal (first) and abnormal (third) groups produced significant
differences on each of the L N N B scales. The comparisons of the normal and border-
line (second) groups produced significant differences on the sensorimotor indices
(Motor, Rhythm, Tactile, Visual, Left Hemisphere, Right Hemisphere Scales), the
registration and problem-solving measures (Memory, Intellectual Processes Scales),
and the Pathognomonic Scale. The borderline group significantly differed from the
abnormal group on the language-related scales (Receptive Speech, Expressive Speech,
Writing, and Reading Scales) and on the Right Hemisphere sensorimotor Scale.

DISCUSSION

Current findings support the claims for existence of schizophrenic subgroups, and
suggest that differential patterns of cognitive deficit may exist among them. Use of
the profile classification rules of Moses, Golden, Ariel, and Gustavson (1983) appears
 I32 J. A. MOSES, Jr.

TABLE II
Means, standard deviations, one way analysis of variance
F-ratios and significance levels for three schizophrenic subgroups

L N N B scale/group N Mean SD F P

Motor
Group 1 69 42.30 1.14
Group 2 16 52.94 7.62
Group 3 15 59.73 11.17
Overall 100 46.62 10.64 32.61 O.oo00

Rhythm
Int J Neurosci Downloaded from informahealthcare.com by York University Libraries on 01/01/15

Group 1 69 45.61 9.99

Group 2 16 59.94 18.95
Group 3 15 70.93 16.98
Overall 100 5 I .70 16.02 27.50 O.oo00

Toctile
Group 1 69 41.84 6.28
Group 2 16 47.06 9.54
Group 3 15 48.80 9.32
Overall 100 43.72 7.83 7.46 0.0010

Visurrl
Group 1 69 46.78 7.00
For personal use only.

Group 2 16 52.75 9.48

Group 3 15 57.60 8.20
Overall 100 49.36 8.58 14.33 O.oo00

Hecrptioe speech
Group 1 69 41.96 6.30
Group 2 16 46.50 8.25
Group 3 I5 59.40 11.54
Overall 100 45.30 9.13 32.79 O.oo00

Eipressive speech
Group 1 69 42.04 6.46
Group 2 16 46.63 6.39
Group 3 15 55.47 9.93
Overall 100 44.79 8.48 22.92 O.oo00

Writing
Group 1 69 54.14 7.66
Group 2 16 54.63 7.18
Group 3 I5 65.13 10.66
Overall 100 55.87 8.92 1 1.57 O.oo00

Reading
Group 1 69 45.10 5.91
Group 2 16 46.63 6.21
Group 3 I5 54.93 9.15
Overall 100 46.82 7.33 14.02 O.oo00

Arithmetic
Group 1 69 51.29 10.28
Group 2 16 57.25 12.81
Group 3 15 62.27 15.35
Overall 100 53.89 12.16 6.37 0.0025
 SCHIZOPHRENIC SUBGROUP ANALYSIS 133

TABLE I1 continued

LNNB scale/group N Mean SD F P

Memory
Group 1 69 49.78 10.60
Group 2 16 60.50 7.14
Group 3 15 68.73 9.45
Overall 100 54.34 12.23 25.86 O.oo00

Intellectual
Group I 69 52.04 10.28
Group 2 16 65.19 12.07
Int J Neurosci Downloaded from informahealthcare.com by York University Libraries on 01/01/15

Group 3 15 71.27 10.69

Overall 100 57.03 13.02 25.72 O.oo00

Pathognomonic
Group 1 69 43.91 6.46
Group 2 16 53.75 6.98
Group 3 IS 57.40 7.98
Overall 100 47.5 1 8.67 32.41 O.oo00

Right hemisphere
Group 1 69 40.35 5.32
Group 2 16 45.19 8.1 1
Group 3 15 51.20 11.09
Overall 100 42.75 7.92 16.38 O.oo00
For personal use only.

Left hemisphere
Group 1 69 39.90 5.25
Group 2 16 48.00 9.61
Group 3 IS 49.47 8.68
Overall 100 42.63 7.78 18.87 O.oo00

TABLE 111
Tukey’s HSD test significance levels for three schizophrenic subgroup mean contrasts
-~
Group contrast

LNNB scale 1 vs 2 1 vs 3 2 vs 3

Motor 0.05 0.05 NS

Rhythm 0.05 0.05 NS
Tactile 0.05 0.05 NS
Visual 0.05 0.05 NS
Receptive speech NS 0.05 0.05
Expressive speech NS 0.05 0.05
Writing NS 0.05 0.05
Reading NS 0.05 0.05
Arithmetic NS 0.05 NS
Memory 0.05 0.05 NS
Intellectual processes 0.05 0.05 NS
Pathognomonic 0.05 0.05 NS
Right hemisphere 0.05 0.05 0.05
Left hemisphere 0.05 0.05 NS
 I34 J . A. MOSES. Jr.

to provide a useful means of schizophrenic subgroup identification for further exper-

imental work in this area. As expected, the most widely separated (normal and ab-
normal) groups in the sample produced consistently different LNNB profiles across
scales. This level of performance consistency supports the assertion that these are
clearly differentiable groups. Evaluation of the reliability of this differentiation awaits
replication with new samples.
Differentiation of the normal and borderline groups is based on sensorimotor and
perceptual measures as well as three of the four measures which are particularly sensi-
tive to forebrain dysfunction when they are elevated in combination: Rhythm, Memory,
and Intellectual Processes. From early work with the LNNB, it was noted that
schizophrenic and schizoaffective disorder patients tended to show elevations on
Int J Neurosci Downloaded from informahealthcare.com by York University Libraries on 01/01/15

these scales in combination with the Receptive Speech Scale (Purisch, Golden &
Hammeke, 1978; Moses & Golden, 1980).
In addition to the level of performance differences between the normal and abnormal
groups, differentiable functional systems may be involved in the deficit patterns noted
between the LNNB profile groups. Differences between the borderline and abnormal
groups suggest dysfunction of frontotemporal systems (elevated Rhythm, Memory,
Intellectual Processes) with relatively widespread sensorimotor (Motor, Tactile) and
audiovisual (Rhythm, Visual) deficit that is uncompensated (Pathognomonic).
Elevation of the Right and Left Hemisphere Scales is not sufficient to infer laterality
of dysfunction on the basis of these group data, but elevation of both indices in
higher-ranging profiles is associated with left hemispheric or bilateral dysfunction.
For personal use only.

Perisylvian language-related skills are not significantly different across these groups.
The latter linguistic scales, however, are the key to differentiation of the borderline
and abnormal groups from each other. This suggests that there is more of a left
hemispheric component to the syndrome in the patients with clearly abnoimal LNNB
profile findings, relative to the other two groups. Such an inference is consistent with
many reports in the literature (cf. Golden, Moses, Ariel & Gustavson, 1983; Newlin,
Carpenter, & Golden, 1981). Further validation of these rules requires use of the
rules to classify groups who then would be compared on external validation criteria
such as regional cerebral blood flow, planimetric computerized tomographic measure-
ments of cerebral ventricular structures, and positron emission tomographic scan
measurements of cerebral metabolism. Cross-validation of group differentiation by
the LNNB profile rules also provides a promising method of grouping the psycho-
metric findings among subgroups, but their relevance for anatomical and physio-
logical change in these diagnostic groups remains to be proven.

.-
REFERENCES

American Psychiatric Association. Diagnostic arid statistical manual of rnentrl disorders, 3rd ed.
(DSM-111). Washington, D.C., Author, 1980.
Golden, C. J., Graber, B., Coffman, J., Berg, R. A., Newlin, C. B., & Bloch, S. Structural brain
deficits in schizophrenia: identification by computed tomographic scan density measurements.
Archives of General Psychiatry, 1981, 38, 1014-1017.
Golden, C. J., Graber, B., Moses, J. A. Jr., & Zatz, L. M. Differentiation of chronic schizophrenics
with and without ventricular enlargement by the Luria-Nebraska Neuropsychological Battery.
International Journal of Neuroscience, 1980, 11, 13 I -I 38.
Golden, C. J., Hammeke, G. A., & Purisch, A. D. The Luria-Nebraska Neuropsychological Batrery:
niariual. Los Angeles : Western Psychological Services, 1980.
 SCHIZOPHRENIC SUBGROUP ANALYSIS 135

Golden, C. J., Moses, J. A. Jr., Zelazowski, R., Graber, B., Zatz, L. M., Horvath, T. B., & Berger,
P. A. Cerebral ventricular size and neuropsychological impairment in young chronic schizo-
phrenics: measurement by the Standardized Luria-Nebraska Neuropsychological Battery.
Archives of General Psychiatry, 1980, 31, 619-623.
Jernigan, T. L., Zatz, L. M., Moses, J. A. Jr., & Berger, P. A. Computed tomography in schizo-
phrenics and normal volunteers. I : Fluid volume. Archives of General Psychiatry, 1982, 39,
765-710.
Lewis, G., Golden, C. J., Purisch, A. D., & Hammeke, T. A. The effects of chronicity of disorder and
length of hospitalization on the standardized version of Luria's Neuropsychological Battery in a
schizophrenic population. Clinical Neuropsychology, 1919, 1, 13-1 8.
Moses, J. A. Jr., Golden, C. J., Ariel, R., & Gustavson, J. L. Interpretation of the Luriu-Nebraska
neuropsychological battery (Vol. I). New York: Grune and Stratton, 1983.
Newlin, D. B., Carpenter, B., & Golden, C. J. Hemispheric asymmetries in schizophrenia. Biological
Psychiatry, 1981, 16, 561-582.
Int J Neurosci Downloaded from informahealthcare.com by York University Libraries on 01/01/15
For personal use only.