Neurocognitive impairment across the lifespan in schizophrenia: an update
Neurocognitive impairment across the lifespan in schizophrenia: an update
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DOI：
10.1016/j.schres.2004.07.005
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发表时间：
2005-04-01
影响因子：
4.5
通讯作者：
Kurtz, MM
中科院分区：
文献类型：
--
作者：
Kurtz, MM
对自1997年以来发表的纵向研究进行了文献回顾和功效分析，这些研究调查了精神分裂症患者神经认知缺陷随时间的轨迹。确定了10项研究，共评价了834例患者，研究入组时平均年龄为24.0-77.8岁。10项研究的把握度估计值在0.26至0.99之间，中等效应量为0.4。尽管广泛的研究间的差异，认知措施的选择，样本量和疾病阶段的研究，出现了几个一致的主题。对主要居住在社区的门诊精神分裂症患者的研究表明，智商和总体认知状态的总体测量结果并没有显示出比良性衰老更大的恶化。此外，神经认知的具体措施的表现是非常一致的年龄研究。事实上，有一些证据表明，智商以及其他神经认知指标可能会在5年的重测间隔内显示出改善。无论患者是首次发病还是慢性病，结果都是一致的。这些结果支持精神分裂症认知缺陷的静态“脑病”模型。相比之下，对中年和老年精神分裂症住院患者的研究揭示了明显不同的结果。有证据表明，在这一人群中，即使在65岁或65岁以上患者短暂的2.5年重测间隔内，认知状态的总体测量值也会下降，在某些情况下，这可能与口面运动障碍的出现有关。总之，这些研究表明，在精神分裂症患者的生命周期中有两种不同的神经认知轨迹，这可能代表了疾病不同阶段不同病理生理机制的表现。(C)2004 Elsevier B. V.保留所有权利。
A literature review and power analysis of longitudinal studies published since 1997 investigating the trajectory of neurocognitive deficits across time in patients with schizophrenia was conducted. Ten studies were identified, evaluating a total of 834 patients with mean ages of 24.0-77.8 years at study entry. Power estimates for the 10 studies ranged widely from 0.26 to 0.99 for a medium effect size of 0.4. Despite wide inter-study differences in cognitive measures selected, sample size and phase of illness studied, several consistent themes emerged. Studies of primarily community-dwelling outpatients with schizophrenia revealed that overall measures of IQ and gross cognitive status do not show deterioration greater than that associated with benign aging. Furthermore, performance on specific measures of neurocognition was remarkably consistent across ages studied. Indeed, there is some evidence that IQ, as well as other neurocognitive measures, may show improvement over a 5-year test-retest interval. Findings were consistent whether patients were in their first episode of illness or chronic. These results support a static "encephalopathy" model of cognitive deficits in schizophrenia. In contrast, studies of middle-aged and elderly institutionalized patients with schizophrenia have revealed markedly different findings. There is evidence in this population of a decline in gross measures of cognitive status even over a brief 2.5-year test-retest interval in patients 65 or older that may, in some cases, be linked to the emergence of orofacial dyskinesia. Taken together, these studies suggest two distinct neurocognitive trajectories during the lifespan in patients with schizophrenia that may represent manifestations of distinct pathophysiological mechanisms of the illness during different phases of the disease. (C) 2004 Elsevier B.V. All rights reserved.