Neuropsychological decline in schizophrenia from the premorbid to the postonset period: evidence from a population-representative longitudinal study.
Neuropsychological decline in schizophrenia from the premorbid to the postonset period: evidence from a population-representative longitudinal study.
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DOI：
10.1176/appi.ajp.2013.12111438
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Moffitt TE
中科院分区：
文献类型：
--
作者：
Meier MH;Caspi A;Reichenberg A;Keefe RS;Fisher HL;Harrington H;Houts R;Poulton R;Moffitt TE
尽管人们普遍认为神经心理衰退是精神分裂症从发病前到慢性发展的一个基本特征，但很少有纵向研究考察精神分裂症发病前和发作后神经心理功能的变化。我们解决了以下悬而未决的问题：神经心理衰退是泛发性的还是局限于特定的精神功能？神经心理衰退是精神分裂症独有的吗？精神分裂症患者在日常生活中也有认知问题吗？参与者是1972-73年间出生在新西兰达尼丁的1037人中具有代表性的队列成员，并前瞻性地跟踪到38岁，95%的人保留了下来。智商和其他特定神经心理功能的评估是在7-13岁精神分裂症发作之前进行的，并在38岁时再次进行。告密者还报告了38岁时的认知问题。精神分裂症患者表现出智商下降以及一系列不同的精神功能，特别是敲击处理速度、学习、执行功能和运动功能。然而，几乎没有证据表明语言能力或记忆延迟下降，精神分裂症患者缺陷的发展进程因精神功能而异。加工速度缺陷从童年到十几岁以后逐渐增加，而语言缺陷很早就出现了，但在中年一直保持不变。神经心理下降是精神分裂症特有的，因为在持续性抑郁症患者、轻度认知障碍儿童、与精神分裂症儿童风险因素相匹配的个人以及精神健康的个人中，没有明显的下降证据。告密者还报告了被诊断为精神分裂症的个人的认知问题。从发病前到发病后，精神分裂症患者的神经心理有很大的下降，但下降的程度和发展进程因精神功能而异。研究结果表明，不同的病理生理机制可能是不同精神功能缺陷的基础。
Despite widespread belief that neuropsychological decline is a cardinal feature of the progression from the premorbid to the chronic form of schizophrenia, few longitudinal studies have examined change in neuropsychological functioning from before to after the onset of schizophrenia. We addressed the following unresolved questions: Is neuropsychological decline generalized versus confined to particular mental functions? Is neuropsychological decline unique to schizophrenia? Do individuals with schizophrenia also have cognitive problems in everyday life? Participants were members of a representative cohort of 1,037 individuals born in Dunedin, New Zealand between 1972-73 and followed prospectively to age 38, with 95% retention. Assessment of IQ and other specific neuropsychological functions was conducted at ages 7-13, before the onset of schizophrenia, and again at age 38. Informants also reported on cognitive problems at age 38. Individuals with schizophrenia showed decline in IQ as well as a range of different mental functions, particularly those tapping processing speed, learning, executive functioning, and motor functioning. There was little evidence of decline in verbal abilities or delayed memory, however, and the developmental progression of deficits in schizophrenia differed across mental functions. Processing speed deficits increased gradually from childhood to beyond the early teen years, whereas verbal deficits emerged early but remained static through midlife. Neuropsychological decline was specific to schizophrenia, as no evidence of decline was apparent among individuals with persistent depression, children with mild cognitive impairment, individuals matched on childhood risk factors for schizophrenia, and psychiatrically healthy individuals. Informants also reported cognitive problems for individuals diagnosed with schizophrenia. There is substantial neuropsychological decline in schizophrenia from the premorbid to post-onset period, but the extent and developmental progression of decline varies across mental functions. Findings suggest that different pathophysiological mechanisms might underlie deficits in different mental functions.
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