Oades, R. D., Röpcke, B., Henning, U., & Klimke, A., (2005) Neuropsychological measures of attention and memory function in schizophrenia: relationships with symptom dimensions and serum monoamine activity. Behavioral and Brain Functions, 1, 14 (view pdf).

Introduction:
Some clinical symptoms and some cognitive functions have been related to the overall state of monoamine activity measured in patients with schizophrenia, (e.g. inverse correlation of plasma/serum levels of the dopamine metabolite HVA with delusions or visual-masking performance). However, profiles (as presented here) of the relations of the activity of dopamine (DA), noradrenaline (NA) and serotonin (5-HT) to neuropsychologic (dys)functions in major patient sub-groups with their very different symptomatic and cognitive characteristics have not been reported.

Methods:
Serum measures of DA, NA and 5-HT turnover were examined by regression analyses for the prediction of performance on 10 neuropsychological measures reflecting left- and right-hemispheric and frontal-, parietal- and temporal-lobe function in 108 patients with schizophrenia and 63 matched controls. The neuropsychological battery included tests of verbal fluency, Stroop interference, trail-making, block-design, Mooney faces recognition, picture-completion, immediate and delayed visual and verbal recall. Paranoid and nonparanoid subgroups were based on ratings from the Positive and Negative Syndrome Scale (PANSS). Groups with high and low ratings of ideas-of-reference and thought-disorder were formed from a median split on the Scale for Assessment of Positive Symptoms (SAPS).

Fig (above). Monoamine, metabolite, turnover and inter metabolite ratios (separately for typical/atypical abtipsychotic treatments). .

Results:
1/ Verbal-fluency and Stroop-interference (left frontal and fronto-cingulate function) were negatively associated with NA turnover in nonparanoid and thought-disordered patients. Fig. (left) .
2/ High DA turnover related to speeded trail-making (frontal modulation of set switching) in those with many ideas-of-reference. In contrast, low DA turnover predicted poor recall in non-paranoid patients and those with little thought disorder

.Fig. (below))
3/ 5-HT metabolism did not independently contribute to the prediction of any cognitive measure . Fig. : Biochemistry: 3 sub-groups) .

4/ But, with regard to the relative activity between monoaminergic systems, increased HVA/5-HIAA ratios predicted visual-reproduction and Mooney’.s face-recognition performance (right-hemisphere functions) in highly symptomatic patients. Decreased HVA/MHPG predicted non-verbal recall. )

Conclusions:
Clinical state and function are differentially sensitive to overall levels of monoamine activity . . . . In particular, right-lateralised cerebral function was sensitive to the relative activities of the monoamines.

Increased NA activity was associated with enhanced frontal but impaired temporal lobe function in non-paranoid syndromes . . . . Low DA activity predicted poor attentional set control in those with ideas-of-reference, but poor recall in non-paranoid patients.

These data, especially the HVA/5-HIAA ratios (see also Oades et al., 2001, and 2002), provide a basis for planning the nature of antipsychotic treatment aimed at patient specific symptom dimensions and cognitive abilities.