Executive Dysfunctions in Schizophrenia: A Critical Review of Traditional, Ecological, and Virtual Reality Assessments

Abstract

In recent years, interest has grown in measuring executive function in schizophrenia with ecological and virtual reality (VR) tools. However, there is a lack of critical analysis comparing those tools with traditional ones. This paper aims to characterize executive dysfunction in schizophrenia by comparing ecological and virtual reality assessments with traditional tools, and to describe the neurobiological and psychopathological correlates. The analysis revealed that ecological and VR tests have higher levels of verisimilitude and similar levels of veridicality compared to traditional tools. Both negative symptoms and disorganization correlate significantly with executive dysfunction as measured by traditional tools, but their relationships with measures based on ecological and VR methods are still unclear. Although there is much research on brain correlates of executive impairments in schizophrenia with traditional tools, it is uncertain if these results will be confirmed with the use of ecological and VR tools. In the diagnosis of executive dysfunction, it is important to use a variety of neuropsychological methods—especially those with confirmed ecological validity—to properly recognize the underlying characteristics of the observed deficits and to implement effective forms of therapy.

Cognitive impairment and functional outcomes in schizophrenia: a narrative review

“…There has been recent interest in the use of virtual reality in the assessment of cognitive impairment in schizophrenia (67).…”

New Directions for Symptoms and Diagnosis in Schizophrenia

“…Executive dysfunction in schizophrenia is an important clinical and social problem. Impairments in monitoring, attention shifting, planning, inhibition, rule generation, abstract thinking, and working memory, as well as the loss of skills required for the performance of complex tasks, can negatively impact patients' social and professional functioning as well as their quality of life [172].…”

Trans-ancestry meta-analysis of genome wide association studies of inhibitory control

“…Broadly, these executive functions can be conceptualised as falling into three main categories – cognitive flexibility, working memory, and inhibitory control [ 1 ]. Whereas EFs are linked to a range of positive outcomes such as educational attainment [ 2 ], quality of life [ 3 , 4 ], fewer behavioural problems [ 5 ], and general health-related behaviours [ 6 ], impairments in these cognitive processes are associated with risk for several psychiatric and neurodevelopmental disorders (NDDs) including attention deficit hyperactivity disorder (ADHD) [ 7 – 9 ], autism spectrum disorder (ASD) [ 10 ], obsessive-compulsive disorder (OCD) [ 11 – 13 ], and schizophrenia [ 14 , 15 ].…”