The mean and the individual: integrating variable-centered and person-centered analyses of cognitive recovery in patients with substance use disorders.
The mean and the individual: integrating variable-centered and person-centered analyses of cognitive recovery in patients with substance use disorders.
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DOI：
10.3389/fpsyt.2013.00177
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发表时间：
2013-01-01
影响因子：
4.7
通讯作者：
Freeman, Jason
中科院分区：
文献类型：
--
作者：
Bates, Marsha E;Buckman, Jennifer F;Freeman, Jason
在大多数患有酒精和药物使用障碍的人中观察到神经心理和认知缺陷，并可能干扰治疗过程和结果。虽然，平均而言，大脑和认知改善与禁欲或显着减少物质的使用，更好地了解异质性的时间过程和程度的认知恢复在个人层面上是有用的，以促进工作台到床边的翻译和通知临床决策。本研究整合了以变量为中心和以人为中心的方法，以表征197例物质使用障碍治疗患者认知恢复的多样性。我们在治疗开始时以及6周、26周和52周后评估了执行功能、语言能力、记忆力和复杂信息处理速度。结构方程模型被用来定义潜在的能力结构，并确定样本中认知变化的平均水平，同时最大限度地减少测量误差和实践对特定测试的影响。个体水平的经验增长图的潜在因素得分被用来探索认知变化的原型轨迹。在平均水平上，观察到认知能力在1年内有小到中等的效应量增加。在个体层面，平均变化轨迹也是约一半样本所示的模态个体恢复轨迹。在所有四个认知领域中观察到的其他原型认知变化轨迹包括延迟增益、增益损失和持续增益。总的来说，这些轨迹涵盖了四种潜在能力中86%到94%的个人成长曲线。需要进一步的研究来复制和预测轨迹成员。复制本研究结果将有针对性的治疗计划和正在开发的新的认知干预措施，以提高治疗效果的有益影响。
Neuropsychological and cognitive deficits are observed in the majority of persons with alcohol and drug use disorders and may interfere with treatment processes and outcomes. Although, on average, the brain and cognition improve with abstinence or markedly reduced substance use, better understanding of the heterogeneity in the time-course and extent of cognitive recovery at the individual level is useful to promote bench-to-bedside translation and inform clinical decision making. This study integrated a variable-centered and a person-centered approach to characterize diversity in cognitive recovery in 197 patients in treatment for a substance use disorder. We assessed executive function, verbal ability, memory, and complex information processing speed at treatment entry, and then 6, 26, and 52weeks later. Structural equation modeling was used to define underlying ability constructs and determine the mean level of cognitive changes in the sample while minimizing measurement error and practice effects on specific tests. Individual-level empirical growth plots of latent factor scores were used to explore prototypical trajectories of cognitive change. At the level of the mean, small to medium effect size gains in cognitive abilities were observed over 1year. At the level of the individual, the mean trajectory of change was also the modal individual recovery trajectory shown by about half the sample. Other prototypical cognitive change trajectories observed in all four cognitive domains included Delayed Gain, Loss of Gain, and Continuous Gain. Together these trajectories encompassed between 86 and 94% of individual growth plots across the four latent abilities. Further research is needed to replicate and predict trajectory membership. Replication of the present findings would have useful implications for targeted treatment planning and the new cognitive interventions being developed to enhance treatment outcomes.