Psychological Medicine

Original Articles

Interrelated neuropsychological and anatomical evidence of hippocampal pathology in the at-risk mental state

R. Hurlemanna1 c1, F. Jessena1, M. Wagnera1, I. Frommanna1, S. Ruhrmanna2, A. Brockhausa2, H. Pickera2, L. Scheefa3, W. Blocka3, H. H. Schilda3, W. Moller-Hartmanna4, B. Kruga4, P. Falkaia5, J. Klosterkottera2 and W. Maiera1

a1 Department of Psychiatry, University of Bonn, Bonn, Germany

a2 Department of Psychiatry, University of Cologne, Cologne, Germany

a3 Department of Radiology, University of Bonn, Bonn, Germany

a4 Department of Radiology, University of Cologne, Cologne, Germany

a5 Department of Psychiatry, University of Goettingen, Goettingen, Germany


Background Verbal learning and memory deficits are frequent among patients with schizophrenia and correlate with reduced magnetic resonance imaging (MRI) volumes of the hippocampus in these patients. A crucial question is the extent to which interrelated structural-functional deficits of the hippocampus reflect a vulnerability to schizophrenia, as opposed to the disorder per se.

Method We combined brain structural measures and the Rey Auditory Verbal Learning Test (RAVLT) to assess hippocampal structure and function in 36 never-medicated individuals suspected to be in early (EPS) or late prodromal states (LPS) of schizophrenia relative to 30 healthy controls.

Results Group comparisons revealed bilaterally reduced MRI hippocampal volumes in both EPS and LPS subjects. In LPS subjects but not in EPS subjects, these reductions were correlated with poorer performance in RAVLT delayed recall.

Conclusions Our findings suggest progressive and interrelated structural-functional pathology of the hippocampus, as prodromal symptoms and behaviours accumulate, and the level of risk for psychosis increases. Given the inverse correlation of learning and memory deficits with social and vocational functioning in established schizophrenia, our findings substantiate the rationale for developing preventive treatment strategies that maintain cognitive capacities in the at-risk mental state.

(Received October 23 2007)

(Revised January 25 2008)

(Accepted February 28 2008)

(Online publication April 04 2008)


c1 Address for correspondence: R. Hurlemann, M.Sc., M.D., Ph.D., Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. (Email: