A meta-analytic investigation of neurocognitive deficits in bipolar illness: profile and effects of clinical state.
A meta-analytic investigation of neurocognitive deficits in bipolar illness: profile and effects of clinical state.
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DOI：
10.1037/a0016277
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发表时间：
2009-09
期刊：
影响因子：
2.4
通讯作者：
Gerraty, Raphael T.
中科院分区：
文献类型：
--
作者：
Kurtz, Matthew M.;Gerraty, Raphael T.
对双相情感障碍患者在疾病的正常、躁狂/混合或抑郁阶段的神经心理学研究进行了荟萃分析。在42项研究中评估了1197例正常心境患者的注意力、工作记忆、言语和非言语记忆、视觉空间功能、心理速度、语言和执行功能，13项研究包括314例躁狂/混合期患者，5项研究包括96例抑郁状态患者。每项研究的Cohen d值计算为患者和对照组在每项神经心理学指标上评分的平均差异，以合并标准差单位表示。分别评估了正常情绪、抑郁和躁狂/混合期患者的结果，然后比较了所有三个阶段患者的测量子集。对于心境正常，结果显示所有神经心理学领域都有损害，绝大多数测量的d值在中等-大范围内（d=.5-.8）。有证据表明，言语学习（d= 0.81）以及延迟言语和非言语记忆（d= 0.80 - 0.92）的测量结果存在较大的效应量损害，而视觉空间功能测量结果的效应量损害较小至中度（d≤ 0.55）。在躁狂/混合或抑郁阶段的疾病测试的患者表现出夸张的损害言语学习的措施，而在抑郁阶段测试的患者表现出更大的衰减音素流畅性的措施。与之前的荟萃分析一致（Arts et al，2007; Bora et al.，2009;罗宾逊等人，2007），这些结果表明，心境正常期间的双相情感障碍的特征在于跨一系列神经认知领域的普遍中度损害，特别是言语学习和记忆的显著损害。这些结果还表明，在急性疾病状态下，这些缺陷的一个子集适度恶化。
A meta-analysis of neuropsychological studies of patients with bipolar disorder in euthymic, manic/mixed or depressed phases of illness was conducted. Measures of attention, working memory, verbal and non-verbal memory, visuospatial function, psychomotor speed, language, and executive-function were evaluated in 42 studies of 1197 patients in euthymia, 13 studies consisting of 314 patients in a manic/mixed phase of illness, and 5 studies of 96 patients in a depressed state. Cohen d-values were calculated for each study as the mean difference between patient and control group score on each neuropsychological measure, expressed in pooled standard deviation units. Results for patients in euthymic, depressed and manic/mixed phases were evaluated separately and then a subset of measures on which patients in all three phases were tested were compared. For euthymia, results revealed impairment across all neuropsychological domains, with d-values in the moderate-large range (d=.5–.8) for the vast majority of measures. There was evidence of large effect-size impairment on measures of verbal learning (d=.81), and delayed verbal and non-verbal memory (d=.80-.92), while effect-size impairment on measures of visuospatial function was small-to-moderate (d≤.55). Patients tested during a manic/mixed or depressed phase of illness showed exaggerated impairment on measures of verbal learning, while patients tested during a depressed phase showed greater decrement on measures of phonemic fluency. Consistent with previous meta-analyses (Arts et al, 2007; Bora et al., 2009; Robinson et al., 2007), these results suggest that bipolar illness during euthymia is characterized by generalized moderate level impairment across an array of neurocognitive domains, with particular marked impairment in verbal learning and memory. These results also show that a subset of these deficits moderately worsen during acute disease states.
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