Where words fail, music speaks: isolated memory processes in a musical patient with schizophrenia.

Processing rule-governed knowledge recruits the procedural memory system rooted in frontal/basal-ganglia circuits, whereas processing memorized idiosyncratic knowledge depends on temporal lobe regions involved in declarative memory (Ullman, 2001). These or related systems likely underlie ruleand memory-based processes in both language and music (Langheim et al., 2002; Patel, 2003; Miranda and Ullman, 2007). Miranda and Ullman (2007) found that “out-of-key” notes – constituting violations of musical tonality rules in familiar and unfamiliar melodies – elicited similar neural responses to grammar rule violations in language, whereas unexpected “in-key” notes in familiar melodies elicited a pattern of brain activity associated with lexical–semantic processing. Tasks requiring detection of violations can reveal whether putative deficits in patients are associated with processing rule-based (procedural) or memorized (declarative) knowledge. We explored these distinct music memory processes in a 31-year-old individual with noteworthy musical aptitude against a backdrop of widespread cognitive impairment and psychotic symptoms (auditory and visual hallucinations, thought broadcasting, and paranoia) due to schizophrenia. The patient was treated with aripiprazole, clozapine, lithium, and sertraline. Extensive neuropsychological testing – as part of the “CBDB/NIH Sibling Study” – revealed performance under the 30th percentile in most domains, including intelligence, graphomotor speed, episodic verbal memory, long-term lexical and semantic retrieval, and working memory. Despite these deficits, the patient played guitar and sang dozens of popular tunes without apparent difficulty. To characterize the specific nature of the patient's spared musical ability, we tested responses to musical violations (task adapted from Miranda, 2007). Sixty melodies (5–18 s in length) were presented: thirty well-known and thirty novel tunes, matched for musical complexity. Half of the melodies contained a note violation (out-of-key or in-key) that lasted 600 ms. Out-of-key violations in both wellknown and novel melodies were inconsistent with musical tonality rules. In-key violations in well-known melodies followed rhythmic and tonal rules but violated the familiar