Hostname: page-component-848d4c4894-p2v8j Total loading time: 0.001 Render date: 2024-05-28T10:54:21.631Z Has data issue: false hasContentIssue false

Executive deficits in schizophrenia: mediation by processing speed and its relationships with aging

Published online by Cambridge University Press:  25 August 2020

Flavien Thuaire
Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot – TSA 60401–63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
Fabien Rondepierre
Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Clermont-Ferrand, France
Guillaume T. Vallet
Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot – TSA 60401–63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
Isabelle Jalenques
Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Institut de Psychiatrie-GDR 3557, Université Clermont Auvergne, Clermont-Ferrand, France
Marie Izaute*
Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot – TSA 60401–63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
Author for correspondence: Marie Izaute, E-mail:



Executive deficits are a core characteristic of schizophrenia. Yet, the origin of these impairments remains unclear as they may be caused by processing slowing. This issue is of particular interest for aging insofar as cognitive aging is also associated with a decline in executive functioning and a slowing of processing speed. As schizophrenia patients’ life expectancy increases, a better understanding of the origin of older patients’ cognitive deficits becomes essential so that healthcare can be adapted to suit them. This study aims to determine whether processing speed mediates how schizophrenia affects executive functions and whether these relationships are moderated by age.


Sixty-two schizophrenia patients (27 women) and 62 healthy comparison subjects matched for age (range: 18–76 years), gender and education performed neurocognitive tests to evaluate their executive functions (shifting, updating, inhibition and access) and processing speed.


Processing speed mediated the effect of schizophrenia on the four specific executive functions, and age moderated this mediation for shifting, updating and access, but in different ways. Age moderated the effect of processing speed on shifting, the direct effect of schizophrenia on access, and both the effect of processing speed and the direct effect of schizophrenia on updating.


This research highlights the need to evaluate processing speed routinely during therapeutic follow-up, as it is easy and simple to assess and appears to be at the heart of the cognitive deficits in schizophrenia. Finally, processing speed abilities yield information about the evolution of cognition with aging in schizophrenia.

Original Article
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Albinet, C. T., Boucard, G., Bouquet, C. A., & Audiffren, M. (2012). Processing speed and executive functions in cognitive aging: How to disentangle their mutual relationship? Brain and Cognition, 79(1), 111. ScholarPubMed
Azur, M. J., Stuart, E. A., Frangakis, C., & Leaf, P. J. (2011). Multiple imputation by chained equations: What is it and how does it work? International Journal of Methods in Psychiatric Research, 20(1), 4049. ScholarPubMed
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social the moderator-mediator Variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 11731182. ScholarPubMed
Bowie, C. R., Reichenberg, A., McClure, M. M., Leung, W. L., & Harvey, P. D. (2008). Age-associated differences in cognitive performance in older community dwelling schizophrenia patients: Differential sensitivity of clinical neuropsychological and experimental information processing tests. Schizophrenia Research, 106(1), 5058. ScholarPubMed
Burgess, P. W., & Shallice, T. (1996). Response suppression, initiation and strategy use following frontal lobe lesions. Neuropsychologia, 34(4), 263272. ScholarPubMed
Cassetta, B. D., & Goghari, V. M. (2016). Working memory and processing speed training in schizophrenia: Study protocol for a randomized controlled trial. Trials, 17(1), 116. ScholarPubMed
Chan, R. C. K., Chen, E. Y. H., & Law, C. W. (2006). Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia. Schizophrenia Research, 82(1), 5164. ScholarPubMed
Chan, R. C. K., Huang, J., Guo, L., Cao, X., Hong, X., & Gao, Z. (2010). Executive control in schizophrenia in task involving semantic inhibition and working memory. Psychiatry Research, 179(3), 259266. ScholarPubMed
Cohen, C., Vahia, I., Reyes, P., Diwan, S., Bankole, A., Palekar, N., … Ramirez, P. (2008). Schizophrenia in later life: Clinical symptoms and social well-being. Psychiatric Services, 59(3), 232234. ScholarPubMed
Cona, G., Arcara, G., Amodio, P., Schiff, S., & Bisiacchi, P. S. (2013). Does executive control really play a crucial role in explaining age-related cognitive and neural differences. Neuropsychology, 27(3), 378389. ScholarPubMed
Crowe, S. F., & Stranks, E. K. (2018). The residual Medium and long-term cognitive effects of benzodiazepine Use: An updated meta-analysis. Archives of Clinical Neuropsychology, 33(7), 901911. ScholarPubMed
Dickinson, D., Ramsey, M. E., & Gold, J. M. (2007). Overlooking the obvious: A meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry, 64(5), 532. Scholar
Donohoe, G., Corvin, A., & Robertson, I. H. (2006). Evidence that specific executive functions predict symptom variance among schizophrenia patients with a predominantly negative symptom profile. Cognitive Neuropsychiatry, 11(1), 1332. ScholarPubMed
Fioravanti, M., Bianchi, V., & Cinti, M. E. (2012). Cognitive deficits in schizophrenia: An updated metanalysis of the scientific evidence. BMC Psychiatry, 12(64), 1471–1244. ScholarPubMed
Fisk, J. E., & Sharp, C. A. (2004). Age-related impairment in executive functioning: Updating, inhibition, shifting, and access. Journal of Clinical and Experimental Neuropsychology, 26(7), 874890. ScholarPubMed
Fucetola, R., Seidman, L. J., Kremen, W. S., Faraone, S. V., Goldstein, J. M., & Tsuang, M. T. (2000). Age and neuropsychologic function in schizophrenia: A decline in executive abilities beyond that observed in healthy volunteers. Biological Psychiatry, 48(2), 137146. ScholarPubMed
Garrido, G., Barrios, M., Penadés, R., Enríquez, M., Garolera, M., Aragay, N., … Vendrell, J. M. (2013). Computer-assisted cognitive remediation therapy: Cognition, self-esteem and quality of life in schizophrenia. Schizophrenia Research, 150(2–3), 563569. Scholar
Gold, J. M., Robinson, B., Leonard, C. J., Hahn, B., Chen, S., McMahon, R. P., & Luck, S. J. (2018). Selective attention, working memory, and executive function as potential independent sources of cognitive dysfunction in schizophrenia. Schizophrenia Bulletin, 44(6), 12271234. Scholar
González-Blanch, C., Pérez-Iglesias, R., Rodríguez-Sánchez, J. M., Pardo-García, G., Martínez-García, O., Vázquez-Barquero, J. L., & Crespo-Facorro, B. (2011). A digit symbol coding task as a screening instrument for cognitive impairment in first-episode psychosis. Archives of Clinical Neuropsychology, 26(1), 4858. ScholarPubMed
Grynszpan, O., Perbal, S., Pelissolo, A., Fossati, P., Jouvent, R., Dubal, S., & Perez-Diaz, F. (2011). Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: A meta-analytical study. Psychological Medicine, 41(1), 163173. ScholarPubMed
Harvey, P. D., Parrella, M., White, L., Mohs, R. C., & Davis, K. L. (1999). Convergence of cognitive and functional decline in poor outcome schizophrenia. Schizophrenia Research, 35, 7784.CrossRefGoogle Scholar
Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W. F., … Möller, H. J. (2012). World federation of societies of biological psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World Journal of Biological Psychiatry, 13(5), 318378. ScholarPubMed
Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W. F., … Möller, H. J. (2013). World federation of societies of biological psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: Update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. World Journal of Biological Psychiatry, 14(1), 244. ScholarPubMed
Hayes, A. F. (2018). Introduction to mediation, moderation and conditional process analysis: A regression-based approach (2nd Edn). New York: Guilford Press.Google Scholar
Heinrichs, R. W., & Zakzanis, K. K. (1998). Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12(3), 426445. Scholar
Herold, C. J., Schmid, L. A., Lässer, M. M., Seidl, U., & Schröder, J. (2017). Cognitive performance in patients with chronic schizophrenia across the lifespan. GeroPsych, 30(1), 3544. Scholar
IBM Corp. (2017). IBM SPSS Statistics for Windows, Version 25.0. IBM Corp.Google Scholar
Irani, F., Kalkstein, S., Moberg, E. A., & Moberg, P. J. (2011). Neuropsychological performance in older patients with schizophrenia: A meta-analysis of cross-sectional and longitudinal studies. Schizophrenia Bulletin, 37(6), 13181326. ScholarPubMed
Jersild, A. T. (1927). Mental set and shift. Archives of Psychology, 14(Whole No 89), 582.Google Scholar
Jurado, M. B., & Rosselli, M. (2007). The elusive nature of executive functions: A review of our current understanding. Neuropsychology Review, 17(3), 213233. ScholarPubMed
Kalache, S. M., Mulsant, B. H., Davies, S. J. C., Liu, A. Y., Voineskos, A. N., Butters, M. A., … Rajji, T. K. (2015). The impact of aging, cognition, and symptoms on functional competence in individuals with schizophrenia across the lifespan. Schizophrenia Bulletin, 41(2), 374381. ScholarPubMed
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261276. Scholar
Knowles, E. E. M., Weiser, M., David, A. S., Glahn, D. C., Davidson, M., & Reichenberg, A. (2015). The puzzle of processing speed, memory, and executive function impairments in schizophrenia: Fitting the pieces together. Biological Psychiatry, 78(11), 786793. ScholarPubMed
Kosmidis, M. H., Bozikas, V. P., Vlahou, C. H., Kiosseoglou, G., Giaglis, G., & Karavatos, A. (2005). Verbal fluency in institutionalized patients with schizophrenia: Age-related performance decline. Psychiatry Research, 134(3), 233240. ScholarPubMed
Laurenson, C., Gorwood, P., Orsat, M., Lhuillier, J. P., Le Gall, D., & Richard-Devantoy, S. (2015). Cognitive control and schizophrenia: The greatest reliability of the stroop task. Psychiatry Research, 227(1), 1016. ScholarPubMed
Lee, T., Crawford, J. D., Henry, J. D., Trollor, J. N., Kochan, N. A., Wright, M. J., … Sachdev, P. S. (2012). Mediating effects of processing speed and executive functions in age-related differences in episodic memory performance: A cross-validation study. Neuropsychology, 26(6), 776784. ScholarPubMed
Lee, E. E., Liu, J., Tu, X., Palmer, B. W., Eyler, L. T., & Jeste, D. V. (2018). A widening longevity gap between people with schizophrenia and general population: A literature review and call for action. Schizophrenia Research, 196, 913. ScholarPubMed
Leeson, V. C., Barnes, T. R. E., Harrison, M., Matheson, E., Harrison, I., Mutsatsa, S. H., … Joyce, E. M. (2010). The relationship between IQ, memory, executive function, and processing speed in recent-onset psychosis: 1-year stability and clinical outcome. Schizophrenia Bulletin, 36(2), 400409. ScholarPubMed
Li, K. Z. H., & Bosman, E. A. (1996). Age differences in stroop-like interference as a function of semantic relatedness. Aging, Neuropsychology, and Cognition, 3(4), 272284.CrossRefGoogle Scholar
Lindenmayer, J.-P., McGurk, S. R., Mueser, K. T., Khan, A., Wance, D., Hoffman, L., … Xie, H. (2008). A randomized controlled trial of cognitive remediation Among inpatients with persistent mental illness. Psychiatric Services, 59(3), 241247. ScholarPubMed
Loewenstein, D. A., Czaja, S. J., Bowie, C. R., & Harvey, P. D. (2012). Age-associated differences in cognitive performance in older patients with schizophrenia: A comparison with healthy older adults. American Journal of Geriatric Psychiatry, 20(1), 2940. ScholarPubMed
Luria, A. R. (1966). Higher cortical functions in Man. New York: Basic Book.Google Scholar
McClure, M. M., Bowie, C. R., Patterson, T. L., Heaton, R. K., Weaver, C., Anderson, H., & Harvey, P. D. (2007). Correlations of functional capacity and neuropsychological performance in older patients with schizophrenia: Evidence for specificity of relationships? Schizophrenia Research, 89(1–3), 330338. ScholarPubMed
McGurk, S. R., Twamley, E. W., Sitzer, D. I., McHugo, G. J., & Mueser, K. T. (2007). A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry, 164(12), 17911802. Scholar
Meier, M. H., Caspi, A., Reichenberg, A., Keefe, R. S. E., Fisher, H. L., Harrington, H., … Moffitt, T. E. (2014). Neuropsychological decline in schizophrenia from the premorbid to the postonset period: Evidence from a population-representative longitudinal study. American Journal of Psychiatry, 171(1), 91101. Scholar
Mesholam-Gately, R. I., Giuliano, A. J., Goff, K. P., Faraone, S. V., & Seidman, L. J. (2009). Neurocognition in first-episode schizophrenia: A meta-analytic review. Neuropsychology, 23(3), 315336. ScholarPubMed
Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to Complex “Frontal Lobe” tasks: A latent Variable analysis. Cognitive Psychology, 41(1), 49100. ScholarPubMed
Neill, E., & Rossell, S. L. (2013). Executive functioning in schizophrenia: The result of impairments in lower order cognitive skills? Schizophrenia Research, 150(1), 7680. ScholarPubMed
Ojeda, N., Peña, J., Schretlen, D. J., Sánchez, P., Aretouli, E., Elizagárate, E., … Gutiérrez, M. (2012). Hierarchical structure of the cognitive processes in schizophrenia: The fundamental role of processing speed. Schizophrenia Research, 135(1–3), 7278. ScholarPubMed
Penadés, R., Catalán, R., Puig, O., Masana, G., Pujol, N., Navarro, V., … Gastó, C. (2010). Executive function needs to be targeted to improve social functioning with cognitive remediation therapy (CRT) in schizophrenia. Psychiatry Research, 177(1–2), 4145. Scholar
Petrides, M., & Milner, B. (1982). Deficits on subject-ordered tasks after frontal- and temporal-lobe lesions in man. Neuropsychologia, 20(3), 249262.CrossRefGoogle ScholarPubMed
Prado, C. E., Watt, S., & Crowe, S. F. (2018). A meta-analysis of the effects of antidepressants on cognitive functioning in depressed and non-depressed samples. Neuropsychology Review, 28(1), 3272. ScholarPubMed
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879891. ScholarPubMed
Rabanea-Souza, T., Akiba, H. T., Berberian, A. A., Bressan, R. A., Dias, Á. M., & Lacerda, A. L. T. (2016). Neuropsychological correlates of remission in chronic schizophrenia subjects: The role of general and task-specific executive processes. Schizophrenia Research: Cognition, 3, 3946. ScholarPubMed
Raffard, S., & Bayard, S. (2012). Understanding the executive functioning heterogeneity in schizophrenia. Brain and Cognition, 79(1), 6069. Scholar
Rajji, T. K., & Mulsant, B. H. (2008). Nature and course of cognitive function in late-life schizophrenia: A systematic review. Schizophrenia Research, 102, 122140. ScholarPubMed
Reichenberg, A., & Harvey, P. D. (2007). Neuropsychological impairments in schizophrenia: Integration of performance-based and brain imaging findings. Psychological Bulletin, 133(5), 833858. ScholarPubMed
Rodríguez-sánchez, J. M., Crespo-facorro, B., González-Blanch, C., Pérez-Iglesias, R., & Vázquez-barquero, J. L. (2007). Cognitive dysfunction in first-episode psychosis: The processing speed hypothesis. British Journal of Psychiatry, 191(suppl 51), 107110. Scholar
Rogers, R. D., & Monsell, S. (1995). Costs of a predictable switch between simple cognitive tasks. Journal of Experimental Psychology: General, 124(2), 207231. Scholar
Rose, S. A., Feldman, J. F., & Jankowski, J. J. (2011). Modeling a cascade of effects: The role of speed and executive functioning in preterm/full-term differences in academic achievement. Developmental Science, 14(5), 11611175. ScholarPubMed
Rossell, S. L. (2006). Category fluency performance in patients with schizophrenia and bipolar disorder: The influence of affective categories. Schizophrenia Research, 82, 135138. ScholarPubMed
Salthouse, T. A. (1996). The processing-speed theory of adult age differences in cognition. Psychological Review, 103(3), 403428. ScholarPubMed
Salthouse, T. A., Fristoe, N., McGuthry, K. E., & Hambrick, D. Z. (1998). Relation of task switching to speed, age, and fluid intelligence. Psychology and Aging, 13(3), 445461. ScholarPubMed
Sartory, G., Zorn, C., Groetzinger, G., & Windgassen, K. (2005). Computerized cognitive remediation improves verbal learning and processing speed in schizophrenia. Schizophrenia Research, 75(2–3), 219223. Scholar
Savla, G. N., Twamley, E. W., Thompson, W. K., Delis, D. C., Jeste, D. V., & Palmer, B. W. (2011). Evaluation of specific executive functioning skills and the processes underlying executive control in schizophrenia. Journal of International Neuropsychological Society, 17(1), 1423. Scholar
Silverstein, A. B. (1982). Two-and four-subtest short forms of the Wechsler adult intelligence scale-revised. Journal of Consulting and Clinical Psychology, 50(3), 415418. Scholar
Spector, A., & Biederman, I. (1976). Mental Set and mental shift revisited. American Journal of Psychology, 89(4), 669679.CrossRefGoogle Scholar
Stirling, J., White, C., Lewis, S., Hopkins, R., Tantam, D., Huddy, A., & Montague, L. (2003). Neurocognitive function and outcome in first-episode schizophrenia: A 10-year follow-up of an epidemiological cohort. Schizophrenia Research, 65, 7586. ScholarPubMed
Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18(6), 643662. Scholar
Suzuki, H., Gen, K., & Inoue, Y. (2011). An unblinded comparison of the clinical and cognitive effects of switching from first-generation antipsychotics to aripiprazole, perospirone or olanzapine in patients with chronic schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(1), 161168. ScholarPubMed
Thuaire, F., Rondepierre, F., Bacon, E., Vallet, G. T., Jalenques, I., & Izaute, M. (2020). Executive functions in schizophrenia aging: Differential effects of age within specific executive functions. Cortex, 125, 109121. ScholarPubMed
Tolman, A. W., & Kurtz, M. M. (2012). Neurocognitive predictors of objective and subjective quality of life in individuals with schizophrenia: A meta-analytic investigation. Schizophrenia Bulletin, 38(2), 304315. ScholarPubMed
Turner, G. R., & Spreng, R. N. (2012). Executive functions and neurocognitive aging: Dissociable patterns of brain activity. Neurobiology of Aging, 33(4), 826.e1826.e13. ScholarPubMed
Verhaeghen, P., & Cerella, J. (2002). Aging, executive control, and attention: A review of meta-analyses. Neuroscience & Biobehavioral Reviews, 26(7), 849857. ScholarPubMed
Vita, A., De Peri, L., Barlati, S., Cacciani, P., Deste, G., Poli, R., … Sacchetti, E. (2011). Effectiveness of different modalities of cognitive remediation on symptomatological, neuropsychological, and functional outcome domains in schizophrenia: A prospective study in a real-world setting. Schizophrenia Research, 133(1–3), 223231. ScholarPubMed
Weschsler, D. A. (1989). Echelle d'intelligence de Wechsler pour adultes forme révisée WAIS-R (ECPA).Google Scholar
Westerhausen, R., Kompus, K., & Hugdahl, K. (2011). Impaired cognitive inhibition in schizophrenia: A meta-analysis of the stroop interference effect. Schizophrenia Research, 133, 172181. ScholarPubMed
Wongupparaj, P., Kumari, V., & Morris, R. G. (2015). Executive function processes mediate the impact of working memory impairment on intelligence in schizophrenia. European Psychiatry, 30(1), 17. Scholar
Wykes, T., Reeder, C., Landau, S., Matthiasson, P., Haworth, E., & Hutchinson, C. (2009). Does age matter? Effects of cognitive rehabilitation across the age span. Schizophrenia Research, 113, 252258. ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361370. ScholarPubMed
Supplementary material: File

Thuaire et al. supplementary material

Thuaire et al. supplementary material 1

Download Thuaire et al. supplementary material(File)
File 21.2 KB
Supplementary material: File

Thuaire et al. supplementary material

Thuaire et al. supplementary material 2

Download Thuaire et al. supplementary material(File)
File 16.9 KB