Neuropsychological Test Performance to Enhance Identification of Subjects at Clinical High Risk for Psychosis and to Be Most Promising for Predictive Algorithms for Conversion to Psychosis: A Meta-Analysis
Neuropsychological Test Performance to Enhance Identification of Subjects at Clinical High Risk for Psychosis and to Be Most Promising for Predictive Algorithms for Conversion to Psychosis: A Meta-Analysis
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DOI：
10.4088/jcp.15r10197
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发表时间：
2017-01-01
影响因子：
5.3
通讯作者：
Correll, Christoph U.
中科院分区：
文献类型：
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作者：
Hauser, Marta;Zhang, Jian-Ping;Correll, Christoph U.
目的：比较临床精神病高危人群 (CHR)、健康对照 (HC) 或首发精神病 (FEP) 受试者的神经心理学表现。数据来源：截至 2014 年 1 月的系统 PubMed/MEDLINE 搜索，无语言限制，使用搜索词前驱症状或临床高风险或超高风险 AND 认知或个体测试名称。研究选择：报告 CHR 与 HC 神经心理学数据的研究或 FEP 组或将转化为精神病的 CHR 受试者 (CHR-P) 与未转化为精神病的 CHR 受试者 (CHR-NP) 进行比较。数据提取：两位作者独立提取并比较神经认知测试数据。结果：对 32 项研究中 9 个领域的 60 项神经心理学测试和 21 个非重叠样本进行了荟萃分析（CHR = 1,684 名患者，HC = 986，FEP = 405）。与 HC 相比，患有 CHR 的人在 9 个领域中的 7 个领域表现明显较差（Hedges g 效应大小 [95% 置信限] = -0.17 [-0.30, -0.04] [注意力/警惕] 至 -0.42 [-0.64, -0.20] [语言学习、处理速度] 和 -0.43 [-0.68, -0.18] [社会认知]），除了推理/解决问题和工作记忆（在纵向研究中分开）。加州言语学习测试（-0.65 [-0.84，-0.46]）和数字符号测试（-0.63 [-0.86，-0.40]）将组分开得最多。与 FEP 受试者相比，CHR 患者在 6 个领域中的 5 个领域表现明显更好（从 0.29 [0.03, 0.56] [处理速度] 到 0.39 [0.17, 0.62] [注意力/警觉性、语言学习] 和 -0.40 [0.18, 0.64] [工作记忆]），推理/解决问题除外。 CHR-P 和 CHR-NP 的表现明显差于 HC（CHR-NP 中的视觉学习、工作记忆除外）。与 CHR-NP 相比，CHR-P 在 8 个领域中的 6 个领域表现明显较差（从 -0.24 [-0.44, -0.03] [注意力/警惕] 到 -0.49 [-0.76, -0.22] [语言学习] 和 -0.54 [-0.80, -0.27] [视觉学习]），但在推理/问题解决和工作记忆方面没有差异。三个单独的测试（Rey-Osterrieth 复杂图形测试、言语流利度测试/受控口语联想测试和加州言语学习测试）区分了 CHR-P 和 CHR-NP 之间的最佳性能（分别为 -0.49 [-0.82, -0.16]、-0.45 [-0.86, -0.03] 和 -0.40 [-0.80, -0.00]）。结论： CHR 具有轻度至中度的全球性神经心理学表现缺陷，介于 FEP 和 HC 之间。 CHR-P 中的神经心理表现缺陷比 CHR-NP 中更大，但它们重叠，降低了其当前风险分层的效用。
Objective: To compare neuropsychological performance in people at clinical high risk for psychosis (CHR), healthy controls (HCs), or subjects with first-episode psychosis (FEP).Data Sources: Systematic PubMed/MEDLINE search through January 2014, without language restrictions, using search terms prodrome OR clinical high-risk OR ultra-high risk AND cognition OR individual test names.Study Selection: Studies reporting neuropsychological data in CHR versus a HC or FEP groups or comparing CHR subjects who converted to psychosis (CHR-P) with CHR subjects who did not convert to psychosis (CHR-NP).Data Extraction: Two authors independently extracted and compared neurocognitive test data.Results: A meta-analysis was performed on 60 neuropsychological tests from 9 domains in 32 studies with 21 nonoverlapping samples (CHR = 1,684 patients, HC = 986, FEP = 405). Compared to HCs, people with CHR performed significantly worse in 7 of 9 domains (Hedges g effect size [95% confidence limit] = -0.17 [-0.30, -0.04] [attention/vigilance] to -0.42 [-0.64, -0.20] [verbal learning, speed of processing] and -0.43 [-0.68, -0.18] [social cognition]), except reasoning/problem solving and working memory (which separated in longitudinal studies). California Verbal Learning Test (-0.65 [-0.84, -0.46]) and Digit Symbol Test (-0.63 [-0.86, -0.40]) separated groups the most. Compared to FEP subjects, people with CHR performed significantly better in 5 of 6 domains (from 0.29 [0.03, 0.56] [speed of processing] to 0.39 [0.17, 0.62] [attention/vigilance, verbal learning] and -0.40 [0.18, 0.64] [working memory]), except reasoning/problem solving. CHR-P and CHR-NP performed significantly worse than HC (except visual learning, working memory in CHR-NP). Compared to CHR-NP, CHR-P performed significantly worse in 6 of 8 domains (from -0.24 [-0.44, -0.03] [attention/vigilance] to -0.49 [-0.76, -0.22] [verbal learning] and -0.54 [-0.80, -0.27] [visual learning]), without differences in reasoning/problem solving and working memory. Three individual tests (Rey-Osterrieth Complex Figure Test, Verbal Fluency Test/Controlled Oral Word Association Test, and California Verbal Learning Test) discriminated the best between CHR-P and CHR-NP (-0.49 [-0.82, -0.16], -0.45 [-0.86, -0.03], and -0.40 [-0.80, -0.00], respectively).Conclusions: CHR has mild to moderate globally distributed neuropsychological performance deficits that lie between FEP and HCs. Neuropsychological performance deficits are greater in CHR-P than in CHR-NP, but they overlap, reducing their current utility for risk stratification.