Schizophrenia Research 157 (2014) 60–62
Contents lists available at ScienceDirect
Schizophrenia Research journal homepage: www.elsevier.com/locate/schres
Amusia and cognitive deficits in schizophrenia: Is there a relationship? Yi Wen a,1, Xueqing Nie a,1, Daxing Wu a,⁎, Hong Liu a, Pin Zhang a, Xuejing Lu a,b a b
Medical Psychological Institute, Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
a r t i c l e
i n f o
Article history: Received 12 December 2013 Received in revised form 18 May 2014 Accepted 18 May 2014 Available online 20 June 2014 Keywords: Schizophrenia Amusia Music perception ability Cognitive ability Psychotic symptoms
a b s t r a c t The current study explored the music perception ability of individuals diagnosed with schizophrenia and its relationship with other cognitive abilities and psychotic symptom severity. The persons with schizophrenia performed significantly worse than the control group on the Montreal Battery of Evaluation of Amusia (MBEA) (p b 0.001). The music perception ability of persons with schizophrenia was related to other cognitive abilities (attention, verbal memory, spatial memory, and executive function) and the severity of psychotic symptoms. © 2014 Elsevier B.V. All rights reserved.
1. Introduction Certain individuals who appear to be born with poor music perception abilities have been classified as having tone-deafness, dysmusia, and dysmelodia (Fry, 1948; Kalmus and Fry, 1980). The term “congenital amusia” is used to distinguish music perception ability impairments caused by brain damage (acquired amusia) from those that result from congenital anomalies (Peretz et al., 2002), which cannot be explained by obvious brain damage, low intelligence, hearing impairment, or lack of environmental stimulation to music. Some studies suggest that approximately 4–5% of the general population may suffer from a congenital defect in distinguishing changes in pitch (Peretz and Hyde, 2003). Recent findings indicate that impairment of domain-general attention, executive, and working memory processes are associated with amusia after stroke (Särkämö et al., 2009), suggesting that acquired amusia is associated with multiple cognitive impairments. Approximately 70–80% of persons with schizophrenia have cognitive impairments, particularly in attention, verbal memory, spatial memory, and executive function (Medalia and Lim, 2004). Schizophrenia is characterized by positive symptoms, such as delusions and hallucinations, and negative symptoms, such as lack of emotion and poor speech (Schultz and Andreasen, 1999). The psychotic symptoms in
⁎ Corresponding author at: Medical Psychological Institute, Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, China. Tel.: + 86 731 85292126; fax: + 86 731 85361328. E-mail address: [email protected] (D. Wu). 1 These authors contributed equally to this work and should be considered co-first authors.
http://dx.doi.org/10.1016/j.schres.2014.05.029 0920-9964/© 2014 Elsevier B.V. All rights reserved.
patients with schizophrenia have been related to abnormal music processing (Gold et al., 2005). We speculate that persons with schizophrenia may have defects in their music perception abilities. Here, we examined the music perception ability of schizophrenia patients and its relationship with other cognitive abilities and the severity of psychotic symptoms. 2. Methods The schizophrenia patients (n = 42, 27 male, 15 female) were recruited from the psychological clinic of the Second Xiangya Hospital of Central South University, China. The subjects in the healthy control group (n = 55, 28 male, 27 female) were recruited from samples from two universities and community agencies (n = 224), and a previous amusia study sample was recruited again (n = 20). To assess musical ability, we used the Montreal Battery of Evaluation of Amusia (MBEA), which includes six subtests: scale, contour, interval, rhythm, meter, and incidental memory (Peretz et al., 2003). The cut-off score for diagnosing amusia is a mean score on the six subtests of b 21.5 (Nan et al., 2010). Of the controls, 7 subjects from the large samples (n = 224) met the amusia criteria along with the 20 subjects from the previous amusia study sample. In the group of schizophrenia patients, 17 subjects met the amusia criteria. The schizophrenia and healthy control groups were matched by age and gender. The following inclusion criteria were used for the two groups: age 16–30, right-handed, no mental retardation or dementia, no color blindness or color feebleness, no severe physical illness or other organic brain disease, no drug or alcohol abuse, no hearing impairment, and no professional music training for more than two years. The
Y. Wen et al. / Schizophrenia Research 157 (2014) 60–62
diagnostic criteria for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) were strictly applied to the subjects in the schizophrenia group. The Queen's Music Questionnaire was administered to screen out subjects with musical experience. The Wechsler Adult Intelligence Scale-Revised for China (WAIS-RC) was used to screen out subjects with an intelligence quotient (IQ) below 80. In the schizophrenia group, the disease course was 19.75 ± 18.84 months. Of the 42 persons with schizophrenia, 10 patients had no medication history, and 32 patients were taking antipsychotic medications. Of the patients using medications, 7 cases took Brisking (2–10 mg/day), 8 took Olanzapine (5–10 mg/day), 5 took Sulpiride (400 mg/day), 6 took Aripiprazole (5–20 mg/day), and 6 took Risperidone (2–4 mg/day). Seven neuropsychological tests were administered to assess working memory, verbal learning and memory, speech comprehension and expression, visual–spatial cognition, attention, and executive function. These tests included the trail making test, Stroop test, verbal fluency task, Benton visual retention test, digit span test from the WAIS-RC, story recall test, and associative learning test from the Wechsler Memory Scale-Revised for China (WMS-RC).
3. Results The schizophrenia group and the healthy control group did not differ in gender or age distribution. The MBEA global mean score (p b 0.05) and the rhythm (p b 0.01), meter (p b 0.001), and incidental memory (p b 0.001) subtest scores differed between the two groups, and the persons with schizophrenia group performed significantly worse than the controls. According to the criterion for diagnosing amusia, subjects were divided into four groups: persons with schizophrenia with amusia, persons with schizophrenia without amusia, healthy controls with amusia, and healthy controls without amusia. One-way analysis of variance (ANOVA) identified significant differences in the scores of the six MBEA subtests and in the MBEA global mean scores (p b 0.001) among these four groups (Table 1). Further analysis with the least significant difference test suggested that the MBEA global mean score and the six subtest scores in the persons with schizophrenia without amusia were significantly lower than the scores of the healthy controls without amusia (p b 0.001). The persons with schizophrenia with amusia performed significantly worse than the healthy controls with amusia on the rhythm, meter, and incidental memory subtests (p b 0.05), but there were no significant differences between these groups on the scale, contour, and interval subtests. This result is similar to the performance of the schizophrenia group and the control group on the MBEA, which may be due to the limited data. The persons with schizophrenia with amusia performed significantly worse than the persons with schizophrenia without amusia on the
61
neuropsychological tests (except the associative learning test and verbal fluency task) (Table 2). There was a significant negative correlation between the MBEA global mean score and the Positive and Negative Syndrome Scale (PANSS) scores, including the PANSS total score (r = − 0.624, p b 0.001), negative scale (r = − 0.533, p b 0.01), positive scale (r = − 0.557, p b 0.01), and general psychopathology scale (r = −0.538, p b 0.01).
4. Discussion The MBEA results suggest that the music perception ability of schizophrenia patients is significantly poorer than that of healthy controls, and that schizophrenia patients have deficits in rhythm and working memory. Kantrowitz et al. (2013) also found significant differences between schizophrenia patients and controls in the melody, rhythm, and memory subtests of the MBEA, which indicates the important role of pitchdeficits in emotion recognition impairment. In this study, our results showed that the persons with schizophrenia with amusia and the healthy controls with amusia did not differ in performance on the scale, contour, and interval subtests, indicating that both groups had defects in pitch discrimination. The performance of persons with schizophrenia with amusia on the neuropsychological tests demonstrates that the music perception ability of persons with schizophrenia is associated with other cognitive abilities (attention, verbal memory, spatial memory, and executive function). This result is consistent with previous findings that musical processing is based on a widely distributed neural network rather than a specific musical neural pathway (Schuppert et al., 2000). The scores of the persons with schizophrenia with and without amusia did not differ significantly on the associative learning test and verbal fluency task, suggesting that defects in pitch discrimination may not affect verbal ability. Cowie et al. (1982) have suggested that individuals can use nonauditory information to understand and produce speech. The correlation analysis showed that the performance of persons with schizophrenia on the MBEA is associated with both positive and negative symptoms. There is no consensus on the relationship between musical ability and positive symptoms. One report showed that only negative symptoms were correlated with the MBEA global score (Hatada et al., 2014). In contrast, another report suggested that the performance of persons with schizophrenia on the music and prosody discrimination task was related to the severity of positive psychotic symptoms (Matsumoto et al., 2006). Other studies demonstrated that music therapy could improve the mental state and symptoms of schizophrenia patients (Peng et al., 2010), and that there is a connection between music perception and psychotic symptoms (Gold et al., 2005). Morrison et al. (2003) performed functional magnetic resonance imaging experiments to study cross-cultural music comprehension. The results demonstrated that listening to culturally different music might
Table 1 Comparison of MBEA score between persons with schizophrenia group and healthy control group (Mean ± SD). Schizophrenia
Scale Contour Interval Rhythm Meter Incidental memory MBEA mean score
Control
Total (n = 42)
Amusia (n = 17)
Non-amusia (n = 25)
Total (n = 55)
Amusia (n = 27)
Non-amusia (n = 28)
22.19 22.67 21.93 21.57 18.36 21.76 21.41
18.12 19.00 18.41 17.29 15.65 18.35 17.80
24.96 25.16 24.32 24.48 20.20 24.08 23.87
23.67 24.18 22.49 24.71 21.89 24.98 23.65
18.93 19.74 18.04 20.63 18.37 21.78 19.58
28.25 28.46 26.79 28.64 25.29 28.07 27.58
± ± ± ± ± ± ±
4.63 4.70 4.07 4.92 4.11 4.24 3.52
± ± ± ± ± ± ±
3.74 4.12 2.53 3.88 3.18 4.21 2.01
± ± ± ± ± ± ±
2.76 3.22 3.05 3.07 3.65 2.25 1.71
± ± ± ± ± ± ±
5.44 5.04 5.09 4.94 5.08 4.16 4.26
⁎ p b 0.05. ⁎⁎ p b 0.01. ⁎⁎⁎ p b 0.001. a t-test between persons with schizophrenia and control. b LSD between persons with schizophrenia with and without amusia and control with and without amusia.
± ± ± ± ± ± ±
3.26 2.84 2.74 3.74 3.90 3.45 1.29
± ± ± ± ± ± ±
2.19 2.06 2.36 1.59 3.55 1.74 1.42
ta
Fb
−1.42 −1.51 −0.61 −3.11⁎⁎ −3.68⁎⁎⁎ −3.74⁎⁎⁎ −2.84⁎
65.7⁎⁎⁎ 54.4⁎⁎⁎ 65.2⁎⁎⁎ 56.4⁎⁎⁎ 29.6⁎⁎⁎ 43.7⁎⁎⁎ 182.0⁎⁎⁎
62
Y. Wen et al. / Schizophrenia Research 157 (2014) 60–62
Table 2 Comparison among schizophrenia with and without amusia group, healthy with and without amusia group in neuropsychological test (mean ± SD). Schizophrenia
Digit span Associative learning Trail A Trail B Story recall Stroop-interfere Verbal fluency Visual retention
t
Amusia (n = 17)
Non-amusia (n = 25)
11.94 12.00 51.75 109.53 15.24 29.21 17.47 7.53
14.40 14.18 40.31 72.99 20.24 17.47 19.32 4.08
± ± ± ± ± ± ± ±
3.17 4.78 21.66 44.20 7.29 21.10 5.09 2.21
± ± ± ± ± ± ± ±
1.66 3.22 21.00 33.57 6.53 10.43 5.58 1.55
Control
−2.98⁎⁎ −1.77 1.71 3.05⁎⁎ −2.33⁎ 2.39⁎ −1.09 5.95⁎⁎⁎
t
Amusia (n = 27)
Non-amusia (n = 28)
14.48 16.93 34.07 73.38 25.67 21.48 19.00 4.56
15.89 18.47 24.36 52.02 27.32 13.14 23.61 3.71
± ± ± ± ± ± ± ±
1.85 2.62 15.26 44.11 7.08 18.91 5.48 1.99
± ± ± ± ± ± ± ±
2.10 2.29 4.52 16.52 5.59 6.03 4.91 1.88
−2.65⁎ −2.32⁎ 3.17⁎⁎ 2.36⁎ −0.96 2.22⁎ −3.29⁎⁎ 1.61
Amusia: Montreal Battery of Evaluation of Amusia (MBEA), including three pitch-based melodic tests (scale, contour and interval), two time-based tests (rhythm and meter) and one memory test. The cut-off score corresponding to 2 SD below the mean global score of the Chinese population was used as the criterion for diagnosing amusia. Digit span: Wechsler Adult Intelligence-Revised in China. Associative learning: Wechsler memory scale-revised in China. Story recall: Wechsler memory scale-revised in China. Trail A or B: trail making test. Stroop-interfere: Stroop test. Verbal fluency: verbal fluency task. Visual retention: Benton visual retention test. ⁎ p b 0.05. ⁎⁎ p b 0.01. ⁎⁎⁎ p b 0.001.
activate similar neural resources, providing further evidence of music's universality (Morrison et al., 2003). Therefore, the MBEA might assess the musical abilities of subjects with an eastern cultural background. This study's limitations include the age span and the influence of the patients' disease course and medication history. Because this is a crosssectional study, we cannot distinguish congenital amusia from acquired amusia. In addition, we cannot interpret the difference in the prevalence of amusia between the persons with schizophrenia and healthy controls due to the inadequate sample sizes. In our future research, we will examine larger samples. Role of Funding Source None. Contributors Dr. Daxing Wu designed the study and wrote the protocol. Ms. Yi Wen conducted the data collection, statistical analyses and Ms. Xueqing Nie preparation of the first draft of the manuscript. All authors subsequently made meaningful contributions to and have approved the final manuscript. Conflicts of interest The authors have declared no conflict of interest in this matter. Acknowledgments We thank Ms. Mulei Li for improving the manuscript in English quality.
References Cowie, R., Douglas-Cowie, E., Kerr, A.G., 1982. A study of speech deterioration in postlingually deafened adults. J. Laryngol. Otol. 96 (02), 101–112. Fry, D.B., 1948. An experimental study of tone deafness. Speech 1, 4–11.
Gold, C., Heldal, T.O., Dahle, T., Wigram, T., 2005. Music therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database Syst. Rev. 2. Hatada, S., Sawada, K., Akamatsu, M., Doi, E., Minese, M., Yamashita, M., Inoue, S., 2014. Impaired musical ability in people with schizophrenia. J. Psychiatry Neurosci. 39 (2), 118–126. Kalmus, H., Fry, D.B., 1980. On tune deafness (dysmelodia): frequency, development, genetics and musical background. Ann. Hum. Genet. 43 (4), 369–382. Kantrowitz, J.T., Jakubovitz, A., Scaramello, N., Laukka, P., Silipo, G., Javitt, D.C., 2013. Are schizophrenia patients amusical? The role of pitch and rhythm in auditory emotion recognition impairments in schizophrenia. Biol. Psychiatry 73 (9) (Suppl. 18-Suppl. 18). Matsumoto, K., Samson, G.T., O'Daly, O.D., Tracy, D.K., Patel, A.D., Shergill, S.S., 2006. Prosodic discrimination in patients with schizophrenia. Br. J. Psychiatry 189 (2), 180–181. Medalia, A., Lim, R., 2004. Treatment of cognitive dysfunction in psychiatric disorders. J. Psychiatr. Pract. 10 (1), 17–25. Morrison, S.J., Demorest, S.M., Aylward, E.H., Cramer, S.C., Maravilla, K.R., 2003. FMRI investigation of cross-cultural music comprehension. NeuroImage 20 (1), 378–384. Nan, Y., Sun, Y., Peretz, I., 2010. Congenital amusia in speakers of a tone language: association with lexical tone agnosia. Brain 133 (9), 2635–2642. Peng, S., Koo, M., Kuo, J., 2010. Effect of group music activity as an adjunctive therapy on psychotic symptoms in patients with acute schizophrenia. Arch. Psychiatr. Nurs. 24 (6), 429–434. Peretz, I., Hyde, K.L., 2003. What is specific to music processing? Insights from congenital amusia. Trends Cogn. Sci. 7 (8), 362–367. Peretz, I., Ayotte, J., Zatorre, R.J., Mehler, J., Ahad, P., Penhune, V.B., Jutras, B., 2002. Congenital amusia: a disorder of fine-grained pitch discrimination. Neuron 33 (2), 185–191. Peretz, I., Champod, A.S., Hyde, K., 2003. Varieties of musical disorders. Ann. N. Y. Acad. Sci. 999 (1), 58–75. Särkämö, T., Tervaniemi, M., Soinila, S., Autti, T., Silvennoinen, H.M., Laine, M., Hietanen, M., 2009. Amusia and cognitive deficits after stroke: is there a relationship? Ann. N. Y. Acad. Sci. 1169 (1), 441–445. Schultz, S.K., Andreasen, N.C., 1999. Schizophrenia. Lancet 353 (9162), 1425–1430. Schuppert, M., Münte, T.F., Wieringa, B.M., Altenmüller, E., 2000. Receptive amusia: evidence for cross-hemispheric neural networks underlying music processing strategies. Brain 123 (3), 546–559.
Contents lists available at ScienceDirect
Schizophrenia Research journal homepage: www.elsevier.com/locate/schres
Amusia and cognitive deficits in schizophrenia: Is there a relationship? Yi Wen a,1, Xueqing Nie a,1, Daxing Wu a,⁎, Hong Liu a, Pin Zhang a, Xuejing Lu a,b a b
Medical Psychological Institute, Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
a r t i c l e
i n f o
Article history: Received 12 December 2013 Received in revised form 18 May 2014 Accepted 18 May 2014 Available online 20 June 2014 Keywords: Schizophrenia Amusia Music perception ability Cognitive ability Psychotic symptoms
a b s t r a c t The current study explored the music perception ability of individuals diagnosed with schizophrenia and its relationship with other cognitive abilities and psychotic symptom severity. The persons with schizophrenia performed significantly worse than the control group on the Montreal Battery of Evaluation of Amusia (MBEA) (p b 0.001). The music perception ability of persons with schizophrenia was related to other cognitive abilities (attention, verbal memory, spatial memory, and executive function) and the severity of psychotic symptoms. © 2014 Elsevier B.V. All rights reserved.
1. Introduction Certain individuals who appear to be born with poor music perception abilities have been classified as having tone-deafness, dysmusia, and dysmelodia (Fry, 1948; Kalmus and Fry, 1980). The term “congenital amusia” is used to distinguish music perception ability impairments caused by brain damage (acquired amusia) from those that result from congenital anomalies (Peretz et al., 2002), which cannot be explained by obvious brain damage, low intelligence, hearing impairment, or lack of environmental stimulation to music. Some studies suggest that approximately 4–5% of the general population may suffer from a congenital defect in distinguishing changes in pitch (Peretz and Hyde, 2003). Recent findings indicate that impairment of domain-general attention, executive, and working memory processes are associated with amusia after stroke (Särkämö et al., 2009), suggesting that acquired amusia is associated with multiple cognitive impairments. Approximately 70–80% of persons with schizophrenia have cognitive impairments, particularly in attention, verbal memory, spatial memory, and executive function (Medalia and Lim, 2004). Schizophrenia is characterized by positive symptoms, such as delusions and hallucinations, and negative symptoms, such as lack of emotion and poor speech (Schultz and Andreasen, 1999). The psychotic symptoms in
⁎ Corresponding author at: Medical Psychological Institute, Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, China. Tel.: + 86 731 85292126; fax: + 86 731 85361328. E-mail address: [email protected] (D. Wu). 1 These authors contributed equally to this work and should be considered co-first authors.
http://dx.doi.org/10.1016/j.schres.2014.05.029 0920-9964/© 2014 Elsevier B.V. All rights reserved.
patients with schizophrenia have been related to abnormal music processing (Gold et al., 2005). We speculate that persons with schizophrenia may have defects in their music perception abilities. Here, we examined the music perception ability of schizophrenia patients and its relationship with other cognitive abilities and the severity of psychotic symptoms. 2. Methods The schizophrenia patients (n = 42, 27 male, 15 female) were recruited from the psychological clinic of the Second Xiangya Hospital of Central South University, China. The subjects in the healthy control group (n = 55, 28 male, 27 female) were recruited from samples from two universities and community agencies (n = 224), and a previous amusia study sample was recruited again (n = 20). To assess musical ability, we used the Montreal Battery of Evaluation of Amusia (MBEA), which includes six subtests: scale, contour, interval, rhythm, meter, and incidental memory (Peretz et al., 2003). The cut-off score for diagnosing amusia is a mean score on the six subtests of b 21.5 (Nan et al., 2010). Of the controls, 7 subjects from the large samples (n = 224) met the amusia criteria along with the 20 subjects from the previous amusia study sample. In the group of schizophrenia patients, 17 subjects met the amusia criteria. The schizophrenia and healthy control groups were matched by age and gender. The following inclusion criteria were used for the two groups: age 16–30, right-handed, no mental retardation or dementia, no color blindness or color feebleness, no severe physical illness or other organic brain disease, no drug or alcohol abuse, no hearing impairment, and no professional music training for more than two years. The
Y. Wen et al. / Schizophrenia Research 157 (2014) 60–62
diagnostic criteria for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) were strictly applied to the subjects in the schizophrenia group. The Queen's Music Questionnaire was administered to screen out subjects with musical experience. The Wechsler Adult Intelligence Scale-Revised for China (WAIS-RC) was used to screen out subjects with an intelligence quotient (IQ) below 80. In the schizophrenia group, the disease course was 19.75 ± 18.84 months. Of the 42 persons with schizophrenia, 10 patients had no medication history, and 32 patients were taking antipsychotic medications. Of the patients using medications, 7 cases took Brisking (2–10 mg/day), 8 took Olanzapine (5–10 mg/day), 5 took Sulpiride (400 mg/day), 6 took Aripiprazole (5–20 mg/day), and 6 took Risperidone (2–4 mg/day). Seven neuropsychological tests were administered to assess working memory, verbal learning and memory, speech comprehension and expression, visual–spatial cognition, attention, and executive function. These tests included the trail making test, Stroop test, verbal fluency task, Benton visual retention test, digit span test from the WAIS-RC, story recall test, and associative learning test from the Wechsler Memory Scale-Revised for China (WMS-RC).
3. Results The schizophrenia group and the healthy control group did not differ in gender or age distribution. The MBEA global mean score (p b 0.05) and the rhythm (p b 0.01), meter (p b 0.001), and incidental memory (p b 0.001) subtest scores differed between the two groups, and the persons with schizophrenia group performed significantly worse than the controls. According to the criterion for diagnosing amusia, subjects were divided into four groups: persons with schizophrenia with amusia, persons with schizophrenia without amusia, healthy controls with amusia, and healthy controls without amusia. One-way analysis of variance (ANOVA) identified significant differences in the scores of the six MBEA subtests and in the MBEA global mean scores (p b 0.001) among these four groups (Table 1). Further analysis with the least significant difference test suggested that the MBEA global mean score and the six subtest scores in the persons with schizophrenia without amusia were significantly lower than the scores of the healthy controls without amusia (p b 0.001). The persons with schizophrenia with amusia performed significantly worse than the healthy controls with amusia on the rhythm, meter, and incidental memory subtests (p b 0.05), but there were no significant differences between these groups on the scale, contour, and interval subtests. This result is similar to the performance of the schizophrenia group and the control group on the MBEA, which may be due to the limited data. The persons with schizophrenia with amusia performed significantly worse than the persons with schizophrenia without amusia on the
61
neuropsychological tests (except the associative learning test and verbal fluency task) (Table 2). There was a significant negative correlation between the MBEA global mean score and the Positive and Negative Syndrome Scale (PANSS) scores, including the PANSS total score (r = − 0.624, p b 0.001), negative scale (r = − 0.533, p b 0.01), positive scale (r = − 0.557, p b 0.01), and general psychopathology scale (r = −0.538, p b 0.01).
4. Discussion The MBEA results suggest that the music perception ability of schizophrenia patients is significantly poorer than that of healthy controls, and that schizophrenia patients have deficits in rhythm and working memory. Kantrowitz et al. (2013) also found significant differences between schizophrenia patients and controls in the melody, rhythm, and memory subtests of the MBEA, which indicates the important role of pitchdeficits in emotion recognition impairment. In this study, our results showed that the persons with schizophrenia with amusia and the healthy controls with amusia did not differ in performance on the scale, contour, and interval subtests, indicating that both groups had defects in pitch discrimination. The performance of persons with schizophrenia with amusia on the neuropsychological tests demonstrates that the music perception ability of persons with schizophrenia is associated with other cognitive abilities (attention, verbal memory, spatial memory, and executive function). This result is consistent with previous findings that musical processing is based on a widely distributed neural network rather than a specific musical neural pathway (Schuppert et al., 2000). The scores of the persons with schizophrenia with and without amusia did not differ significantly on the associative learning test and verbal fluency task, suggesting that defects in pitch discrimination may not affect verbal ability. Cowie et al. (1982) have suggested that individuals can use nonauditory information to understand and produce speech. The correlation analysis showed that the performance of persons with schizophrenia on the MBEA is associated with both positive and negative symptoms. There is no consensus on the relationship between musical ability and positive symptoms. One report showed that only negative symptoms were correlated with the MBEA global score (Hatada et al., 2014). In contrast, another report suggested that the performance of persons with schizophrenia on the music and prosody discrimination task was related to the severity of positive psychotic symptoms (Matsumoto et al., 2006). Other studies demonstrated that music therapy could improve the mental state and symptoms of schizophrenia patients (Peng et al., 2010), and that there is a connection between music perception and psychotic symptoms (Gold et al., 2005). Morrison et al. (2003) performed functional magnetic resonance imaging experiments to study cross-cultural music comprehension. The results demonstrated that listening to culturally different music might
Table 1 Comparison of MBEA score between persons with schizophrenia group and healthy control group (Mean ± SD). Schizophrenia
Scale Contour Interval Rhythm Meter Incidental memory MBEA mean score
Control
Total (n = 42)
Amusia (n = 17)
Non-amusia (n = 25)
Total (n = 55)
Amusia (n = 27)
Non-amusia (n = 28)
22.19 22.67 21.93 21.57 18.36 21.76 21.41
18.12 19.00 18.41 17.29 15.65 18.35 17.80
24.96 25.16 24.32 24.48 20.20 24.08 23.87
23.67 24.18 22.49 24.71 21.89 24.98 23.65
18.93 19.74 18.04 20.63 18.37 21.78 19.58
28.25 28.46 26.79 28.64 25.29 28.07 27.58
± ± ± ± ± ± ±
4.63 4.70 4.07 4.92 4.11 4.24 3.52
± ± ± ± ± ± ±
3.74 4.12 2.53 3.88 3.18 4.21 2.01
± ± ± ± ± ± ±
2.76 3.22 3.05 3.07 3.65 2.25 1.71
± ± ± ± ± ± ±
5.44 5.04 5.09 4.94 5.08 4.16 4.26
⁎ p b 0.05. ⁎⁎ p b 0.01. ⁎⁎⁎ p b 0.001. a t-test between persons with schizophrenia and control. b LSD between persons with schizophrenia with and without amusia and control with and without amusia.
± ± ± ± ± ± ±
3.26 2.84 2.74 3.74 3.90 3.45 1.29
± ± ± ± ± ± ±
2.19 2.06 2.36 1.59 3.55 1.74 1.42
ta
Fb
−1.42 −1.51 −0.61 −3.11⁎⁎ −3.68⁎⁎⁎ −3.74⁎⁎⁎ −2.84⁎
65.7⁎⁎⁎ 54.4⁎⁎⁎ 65.2⁎⁎⁎ 56.4⁎⁎⁎ 29.6⁎⁎⁎ 43.7⁎⁎⁎ 182.0⁎⁎⁎
62
Y. Wen et al. / Schizophrenia Research 157 (2014) 60–62
Table 2 Comparison among schizophrenia with and without amusia group, healthy with and without amusia group in neuropsychological test (mean ± SD). Schizophrenia
Digit span Associative learning Trail A Trail B Story recall Stroop-interfere Verbal fluency Visual retention
t
Amusia (n = 17)
Non-amusia (n = 25)
11.94 12.00 51.75 109.53 15.24 29.21 17.47 7.53
14.40 14.18 40.31 72.99 20.24 17.47 19.32 4.08
± ± ± ± ± ± ± ±
3.17 4.78 21.66 44.20 7.29 21.10 5.09 2.21
± ± ± ± ± ± ± ±
1.66 3.22 21.00 33.57 6.53 10.43 5.58 1.55
Control
−2.98⁎⁎ −1.77 1.71 3.05⁎⁎ −2.33⁎ 2.39⁎ −1.09 5.95⁎⁎⁎
t
Amusia (n = 27)
Non-amusia (n = 28)
14.48 16.93 34.07 73.38 25.67 21.48 19.00 4.56
15.89 18.47 24.36 52.02 27.32 13.14 23.61 3.71
± ± ± ± ± ± ± ±
1.85 2.62 15.26 44.11 7.08 18.91 5.48 1.99
± ± ± ± ± ± ± ±
2.10 2.29 4.52 16.52 5.59 6.03 4.91 1.88
−2.65⁎ −2.32⁎ 3.17⁎⁎ 2.36⁎ −0.96 2.22⁎ −3.29⁎⁎ 1.61
Amusia: Montreal Battery of Evaluation of Amusia (MBEA), including three pitch-based melodic tests (scale, contour and interval), two time-based tests (rhythm and meter) and one memory test. The cut-off score corresponding to 2 SD below the mean global score of the Chinese population was used as the criterion for diagnosing amusia. Digit span: Wechsler Adult Intelligence-Revised in China. Associative learning: Wechsler memory scale-revised in China. Story recall: Wechsler memory scale-revised in China. Trail A or B: trail making test. Stroop-interfere: Stroop test. Verbal fluency: verbal fluency task. Visual retention: Benton visual retention test. ⁎ p b 0.05. ⁎⁎ p b 0.01. ⁎⁎⁎ p b 0.001.
activate similar neural resources, providing further evidence of music's universality (Morrison et al., 2003). Therefore, the MBEA might assess the musical abilities of subjects with an eastern cultural background. This study's limitations include the age span and the influence of the patients' disease course and medication history. Because this is a crosssectional study, we cannot distinguish congenital amusia from acquired amusia. In addition, we cannot interpret the difference in the prevalence of amusia between the persons with schizophrenia and healthy controls due to the inadequate sample sizes. In our future research, we will examine larger samples. Role of Funding Source None. Contributors Dr. Daxing Wu designed the study and wrote the protocol. Ms. Yi Wen conducted the data collection, statistical analyses and Ms. Xueqing Nie preparation of the first draft of the manuscript. All authors subsequently made meaningful contributions to and have approved the final manuscript. Conflicts of interest The authors have declared no conflict of interest in this matter. Acknowledgments We thank Ms. Mulei Li for improving the manuscript in English quality.
References Cowie, R., Douglas-Cowie, E., Kerr, A.G., 1982. A study of speech deterioration in postlingually deafened adults. J. Laryngol. Otol. 96 (02), 101–112. Fry, D.B., 1948. An experimental study of tone deafness. Speech 1, 4–11.
Gold, C., Heldal, T.O., Dahle, T., Wigram, T., 2005. Music therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database Syst. Rev. 2. Hatada, S., Sawada, K., Akamatsu, M., Doi, E., Minese, M., Yamashita, M., Inoue, S., 2014. Impaired musical ability in people with schizophrenia. J. Psychiatry Neurosci. 39 (2), 118–126. Kalmus, H., Fry, D.B., 1980. On tune deafness (dysmelodia): frequency, development, genetics and musical background. Ann. Hum. Genet. 43 (4), 369–382. Kantrowitz, J.T., Jakubovitz, A., Scaramello, N., Laukka, P., Silipo, G., Javitt, D.C., 2013. Are schizophrenia patients amusical? The role of pitch and rhythm in auditory emotion recognition impairments in schizophrenia. Biol. Psychiatry 73 (9) (Suppl. 18-Suppl. 18). Matsumoto, K., Samson, G.T., O'Daly, O.D., Tracy, D.K., Patel, A.D., Shergill, S.S., 2006. Prosodic discrimination in patients with schizophrenia. Br. J. Psychiatry 189 (2), 180–181. Medalia, A., Lim, R., 2004. Treatment of cognitive dysfunction in psychiatric disorders. J. Psychiatr. Pract. 10 (1), 17–25. Morrison, S.J., Demorest, S.M., Aylward, E.H., Cramer, S.C., Maravilla, K.R., 2003. FMRI investigation of cross-cultural music comprehension. NeuroImage 20 (1), 378–384. Nan, Y., Sun, Y., Peretz, I., 2010. Congenital amusia in speakers of a tone language: association with lexical tone agnosia. Brain 133 (9), 2635–2642. Peng, S., Koo, M., Kuo, J., 2010. Effect of group music activity as an adjunctive therapy on psychotic symptoms in patients with acute schizophrenia. Arch. Psychiatr. Nurs. 24 (6), 429–434. Peretz, I., Hyde, K.L., 2003. What is specific to music processing? Insights from congenital amusia. Trends Cogn. Sci. 7 (8), 362–367. Peretz, I., Ayotte, J., Zatorre, R.J., Mehler, J., Ahad, P., Penhune, V.B., Jutras, B., 2002. Congenital amusia: a disorder of fine-grained pitch discrimination. Neuron 33 (2), 185–191. Peretz, I., Champod, A.S., Hyde, K., 2003. Varieties of musical disorders. Ann. N. Y. Acad. Sci. 999 (1), 58–75. Särkämö, T., Tervaniemi, M., Soinila, S., Autti, T., Silvennoinen, H.M., Laine, M., Hietanen, M., 2009. Amusia and cognitive deficits after stroke: is there a relationship? Ann. N. Y. Acad. Sci. 1169 (1), 441–445. Schultz, S.K., Andreasen, N.C., 1999. Schizophrenia. Lancet 353 (9162), 1425–1430. Schuppert, M., Münte, T.F., Wieringa, B.M., Altenmüller, E., 2000. Receptive amusia: evidence for cross-hemispheric neural networks underlying music processing strategies. Brain 123 (3), 546–559.
