Abstract
Reality monitoring impairment is often reported in schizophrenia but the neural basis of this deficit is poorly understood. Difficulties with reality monitoring could be attributable to the same pattern of neural dysfunction as other cognitive deficits that characterize schizophrenia, or might instead represent a separable and dissociable impairment. This question was addressed through direct comparison of behavioral performance and neural activity associated with reality monitoring and working memory in patients with schizophrenia and matched healthy controls. Participants performed a word-pair reality monitoring task and a Sternberg working memory task while undergoing fMRI scanning. Distinct behavioral deficits were observed in the patients during performance of each task, which were associated with separable task- and region-specific dysfunction in the medial anterior prefrontal cortex for reality monitoring and dorsolateral prefrontal cortex for working memory. The results suggest that reality monitoring impairment is a distinct neurocognitive deficit in schizophrenia. The findings are consistent with the presence of a range of dissociable cognitive deficits in schizophrenia which may be associated with variable functional and structural dysconnectivity in underlying processing networks.
Highlights
Reality monitoring is the ability to discriminate between internally and externally generated information (Johnson and Raye, 1981), typically tested using source memory paradigms involving the recollection of whether or not information was generated by participants themselves
There were no significant correlations between reality monitoring accuracy and working memory accuracy, for either the patients, r = 0.186, p = 0.432, or controls: r = −0.057, p = 0.812, suggesting that the reality monitoring and working memory tasks may have drawn on largely unrelated cognitive processes
Patients with schizophrenia exhibited performance deficits during reality monitoring and working memory tasks that were accompanied by distinct activity reductions in the medial anterior and dorsolateral prefrontal cortex (PFC), respectively
Summary
Reality monitoring is the ability to discriminate between internally and externally generated information (Johnson and Raye, 1981), typically tested using source memory paradigms involving the recollection of whether or not information was generated by participants themselves. In schizophrenia, reporting reductions in medial anterior PFC activity (BA 10) in patients compared with controls during source memory retrieval of self-generated (imagined) items compared with those that had been externally perceived (Subramaniam et al, 2012; Vinogradov et al, 2008) It is unclear whether the reality monitoring impairment observed in patients with schizophrenia is associated with the same pattern of underlying neural dysfunction as other cognitive deficits that characterize the disorder, or whether instead it represents a separable and dissociable deficiency. We predicted a finding of region and task specificity, based on previous between-study behavioral evidence (e.g. see Green et al, 2013), which would support a dissociation hypothesis that reality monitoring impairment in schizophrenia represents a distinct neurocognitive deficit
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