24.2 NEUROCOGNITIVE PROFILES IN THE PRODROME TO PSYCHOSIS IN NAPLS-1
24.2 NEUROCOGNITIVE PROFILES IN THE PRODROME TO PSYCHOSIS IN NAPLS-1
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24.2 NAPLS-1 中精神病前驱症状的神经认知概况
作者：
E. Velthorst;E. Meyer;A. Giuliano;J. Addington;K. Cadenhead;Tyrone D. Cannon;B. Cornblatt;T. McGlashan;D. Perkins;M. Tsuang;E. Walker;S. Woods;C. Bearden;L. Seidman
摘要背景绝大多数关于临床高风险人群神经心理学（NP）功能的研究都检查了组平均值，可能掩盖了从严重受损到高功能的一系列亚组。我们的目的是评估NP的概况，并探讨与转换为精神病，功能和诊断结果的关联。方法数据来自北美前驱症状纵向研究（NAPLS-1）第一阶段的324名参与者（平均年龄18.4岁），该研究是一个多中心联盟，对个体进行长达2年半的随访。我们应用Ward的分层聚类方法对166名精神病患者、49名有精神病家族史的非精神病青年和109名健康对照者进行了8项基线神经认知测量。我们测试了集群成员资格是否与精神病的转换，社会和角色功能，以及后续诊断相关。在根据独立开发的临床决策规则对数据进行聚类后重复分析。结果共发现4组神经认知功能异常：显著损害（n = 33）、轻度损害（n = 82）、正常（n = 145）和高度损害（n = 64）。显著受损亚组在处理速度和记忆任务上表现出最大的偏差，转换率为58%，发展为精神分裂症谱系诊断的可能性为40%（轻度受损亚组为24.4%，其他两组为10.3%），并且在基线和12个月时功能显著更差。使用临床决策规则聚类的数据产生了类似的结果，指向高收敛有效性。讨论尽管在两个队列中进行了广泛的神经心理学研究，但这是研究NP聚类特征作为结果异质性的贡献者的首批研究之一。我们的研究结果表明，这四个NP配置文件在其结果上有很大的不同，强调了认知功能在预测疾病进展的相关性。我们的研究结果初步表明，个性化的认知分析应在临床环境中进行探索。
Abstract Background The vast majority of studies of neuropsychological (NP) functioning in Clinical High Risk (CHR) cohorts have examined group averages, possibly concealing a range of subgroups ranging from very impaired to high functioning. Our objective was to assess NP profiles and to explore associations with conversion to psychosis, functional and diagnostic outcome. Methods Data were acquired from 324 participants (mean age 18.4) in the first phase of the North American Prodrome Longitudinal Study (NAPLS-1), a multi-site consortium following individuals for up to 2½ years. We applied Ward’s method for hierarchical clustering data to 8 baseline neurocognitive measures, in 166 CHR individuals, 49 non-CHR youth with a family history of psychosis, and 109 healthy controls. We tested whether cluster membership was associated with conversion to psychosis, social and role functioning, and follow-up diagnosis. Analyses were repeated after data were clustered based on independently developed clinical decision rules. Results Four neurocognitive clusters were identified: Significantly Impaired (n=33); Mildly Impaired (n=82); Normal (n=145) and High (n=64). The Significantly Impaired subgroup demonstrated the largest deviations on processing speed and memory tasks and had a conversion rate of 58%, a 40% chance of developing a schizophrenia spectrum diagnosis (compared to 24.4% in the Mildly Impaired, and 10.3% in the other two groups combined), and significantly worse functioning at baseline and 12-months. Data clustered using clinical decision rules yielded similar results, pointing to high convergent validity. Discussion Despite extensive neuropsychological investigations within CHR cohorts, this is one of the first studies to investigate NP clustering profiles as a contributor to heterogeneity in outcome. Our results indicate that the four NP profiles vary substantially in their outcome, underscoring the relevance of cognitive functioning in the prediction of illness progression. Our findings tentatively suggest that individualized cognitive profiling should be explored in clinical settings.