Neurocognitive Functioning in Individuals at Clinical High Risk for Psychosis A Systematic Review and Meta-analysis
Neurocognitive Functioning in Individuals at Clinical High Risk for Psychosis A Systematic Review and Meta-analysis
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DOI：
10.1001/jamapsychiatry.2021.1290
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发表时间：
2021-06-16
期刊：
影响因子：
25.8
通讯作者：
Fusar-Poli, Paolo
中科院分区：
文献类型：
--
作者：
Catalan, Ana;Salazar de Pablo, Gonzalo;Fusar-Poli, Paolo
神经认知功能是一种潜在的生物标志物，可以促进精神病临床高危人群（CHR-P）的检测、预后和预防性护理。目前CHR-P中个体神经认知功能的一致性和幅度是undetermined.Objective提供一个更新的证据合成的一致性和幅度的个体在CHR-P.DATA SourcesWeb of Science数据库，科克伦中心注册的评论，和奥维德/PsycINFO和试验注册截至7月1日，2020.研究选择多步文献检索，符合独立研究者进行的系统性综述和荟萃分析以及流行病学观察性研究的荟萃分析的首选报告项目，以识别报告2020 - 2021年个体神经认知功能的原始研究。P.数据提取和综合独立的研究人员提取数据，根据7个测量和治疗研究来改善精神分裂症认知（MATRICS）领域和8个CHR-P领域对神经认知任务进行聚类。随机效应模型荟萃分析，发表偏倚和研究质量评估，主要结果和测量主要效应量测量是CHR-P个体的神经认知功能的模糊限制因子g（1）与健康对照（HC）个体相比或（2）与首发精神病（FEP）个体相比或（3）结果共纳入78项独立研究，包括CHR-P的5162名个体，（平均[SD;范围]年龄，20.2 [3.3; 12.0-29.0]岁; 2529 [49.0%]为女性），2865例HC个体（平均[SD;范围]年龄，21.1 [3.6; 12.6-29.2]岁; 1490 [52.0%]为女性），486例FEP患者（平均[SD;范围]年龄：23.0 [2.0; 19.1-26.4]岁; 267例[55.9%]为女性）。与HC个体相比，CHR-P个体在Stroop颜色词阅读任务上表现出中等至较大的缺陷（g = -1.17; 95% CI，-1.86至-0.48），霍普金斯言语学习测验-修订版（g = -0.86; 95% CI，-1.43至-0.28），数字符号编码检验（g = -0.74; 95% CI，-1.19至-0.29），认知量表符号编码简要评估（g = -0.67; 95% CI，-0.95至-0.39），宾夕法尼亚大学鉴别试验（g = -0.55; 95% CI，-0.97至-0.12），提示任务（g = -0.53; 95% CI，-0.77至-0.28），Rey听觉言语学习测验（g = -0.50; 95% CI，-0.78至-0.21），加州言语学习测验（CVLT）（g = -0.50; 95% CI，-0.64至-0.36）和全国成人阅读测试（g = -0.52; 95% CI，-1.01至-0.03）。在CHR-P的个人比FEP的个人受损较少。从CHR-P状态向精神病的纵向转变与CVLT任务中的中度至重度缺陷相关（g = -0.58; 95%CI，-1.12至-0.05）。荟萃回归发现显着影响年龄和教育对processingspeeds.CONCLUSIONS和相关性的调查结果，从这个荟萃分析支持神经认知功能障碍作为一个潜在的检测和预后的生物标志物在CHR-P的个人。这些发现可能会推进临床研究，并告知预防方法。
IMPORTANCE Neurocognitive functioning is a potential biomarker to advance detection, prognosis, and preventive care for individuals at clinical high risk for psychosis (CHR-P). The current consistency and magnitude of neurocognitive functioning in individuals at CHR-P are undetermined.OBJECTIVE To provide an updated synthesis of evidence on the consistency and magnitude of neurocognitive functioning in individuals at CHR-P.DATA SOURCES Web of Science database, Cochrane Central Register of Reviews, and Ovid/PsycINFO and trial registries up to July 1, 2020.STUDY SELECTION Multistep literature search compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology performed by independent researchers to identify original studies reporting on neurocognitive functioning in individuals at CHR-P.DATA EXTRACTION AND SYNTHESIS Independent researchers extracted the data, clustering the neurocognitive tasks according to 7 Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains and 8 CHR-P domains. Random-effect model meta-analyses, assessment of publication biases and study quality, and meta-regressions were conducted.MAIN OUTCOMES AND MEASURES The primary effect size measure was Hedges g of neurocognitive functioning in individuals at CHR-P (1) compared with healthy control (HC) individuals or (2) compared with individuals with first-episode psychosis (FEP) or (3) stratified for the longitudinal transition to psychosis.RESULTS A total of 78 independent studies were included, consisting of 5162 individuals at CHR-P (mean [SD; range] age, 20.2 [3.3; 12.0-29.0] years; 2529 [49.0%] were female), 2865 HC individuals (mean [SD; range] age, 21.1 [3.6; 12.6-29.2] years; 1490 [52.0%] were female), and 486 individuals with FEP (mean [SD; range] age, 23.0 [2.0; 19.1-26.4] years; 267 [55.9%] were female). Compared with HC individuals, individuals at CHR-P showed medium to large deficits on the Stroop color word reading task (g = -1.17; 95% CI, -1.86 to -0.48), Hopkins Verbal Learning Test-Revised (g = -0.86; 95% CI, -1.43 to -0.28), digit symbol coding test (g = -0.74; 95% CI, -1.19 to -0.29), Brief Assessment of Cognition Scale Symbol Coding (g = -0.67; 95% CI, -0.95 to -0.39), University of Pennsylvania Smell Identification Test (g = -0.55; 95% CI, -0.97 to -0.12), Hinting Task (g = -0.53; 95% CI, -0.77 to -0.28), Rey Auditory Verbal Learning Test (g = -0.50; 95% CI, -0.78 to -0.21), California Verbal Learning Test (CVLT) (g = -0.50; 95% CI, -0.64 to -0.36), and National Adult Reading Test (g = -0.52; 95% CI, -1.01 to -0.03). Individuals at CHR-P were less impaired than individuals with FEP. Longitudinal transition to psychosis from a CHR-P state was associated with medium to large deficits in the CVLT task (g = -0.58; 95% CI, -1.12 to -0.05). Meta-regressions found significant effects for age and education on processing speed.CONCLUSIONS AND RELEVANCE Findings from this meta-analysis support neurocognitive dysfunction as a potential detection and prognostic biomarker in individuals at CHR-P. These findings may advance clinical research and inform preventive approaches.