Neuropsychological near normality and brain structure abnormality in schizophrenia.
Neuropsychological near normality and brain structure abnormality in schizophrenia.
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DOI：
10.1176/appi.ajp.2008.08020258
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发表时间：
2009-02
期刊：
影响因子：
--
通讯作者：
Peterson BS
中科院分区：
文献类型：
--
作者：
Wexler BE;Zhu H;Bell MD;Nicholls SS;Fulbright RK;Gore JC;Colibazzi T;Amat J;Bansal R;Peterson BS
认知缺陷在精神分裂症中很突出。在广泛的认知测试中，患者的平均得分比正常水平低一个标准差。然而，人们一再注意到，20%-25%的患者与这种一般模式不同，在神经心理学测试中得分接近正常。这项研究使用脑形态测量来1）识别与更严重的认知缺陷相关的脑异常，2）帮助确定认知相对完整的患者是否表现更好，因为他们患有不太严重的疾病或因为他们患有不同的疾病。如果患者在注意力和言语和非言语工作记忆的四项测试中得分在健康对照受试者（N=30）的0.5标准差范围内，则将其分配到神经心理接近正常（N=21）亚组，如果他们的得分低于对照受试者至少1.0标准差，则将其分配到神经心理受损（N= 54）组。亚组分配确认与加州言语学习测试和降解刺激连续性能测试。心室隔室、海马、杏仁核、丘脑、小脑和区域皮质灰质和白色物质的体积是因变量。采用线性混合模型多变量分析，以性别、年龄和身高为协变量，评价组间差异。神经心理学接近正常和神经心理学受损的患者与健康对照受试者相比，灰质明显较小，第三脑室体积较大。然而，只有神经心理学受损的患者与健康对照组相比，其白色物质明显更小，侧脑室体积更大。尽管神经心理学受损和神经心理学接近正常的患者在其灰质中具有显著的神经病理学，但神经心理学接近正常的组中相对缺乏白色物质病理学提示疾病过程中存在差异的可能性。
Cognitive deficits are prominent in schizophrenia. Patients have an average score one standard deviation below normal on a broad spectrum of cognitive tests. It has been repeatedly noted, however, that 20%–25% of patients differ from this general pattern and score close to normal on neuropsychological testing. This study used brain morphometry to 1) identify brain abnormalities associated with more severe cognitive deficits and 2) help determine whether cognitively relatively intact patients perform better because they have less severe illness or because they have a different illness. Patients were assigned to a neuropsychologically near normal (N=21) subgroup if they scored within 0.5 standard deviation of healthy comparison subjects (N=30) on four tests of attention and verbal and nonverbal working memory, and to a neuropsychologically impaired (N= 54) group if they scored at least 1.0 standard deviation below that of comparison subjects. Subgroup assignments were confirmed with the California Verbal Learning Test and degraded-stimulus Continuous Performance Test. Volumes of ventricular compartments, hippocampus, amygdala, thalamus, cerebellum, and regional cortical gray and white matter were dependent variables. Differences among groups were evaluated by using linear mixed-model multivariate analyses with gender, age, and height as covariates. Both neuropsychologically near normal and neuropsychologically impaired patients had markedly smaller gray matter and larger third ventricle volumes than healthy comparison subjects. Only neuropsychologically impaired patients, however, had significantly smaller white matter and larger lateral ventricle volumes than healthy comparison subjects. Although both neuropsychologically impaired and neuropsycho-logically near normal patients have marked neuropathology in their gray matter, the relative absence of white matter pathology in the neuropsychologically near normal group suggests the possibility of differences in the disease process.
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