Course of Functional Deficits in Late-Life Schizophrenia

描述（由申请人提供）：这是一项关于老年精神分裂症患者功能衰退的过程和前因的合作研究。功能障碍（即社会、职业、自我照顾和独立生活）是影响精神分裂症生活质量和社会成本的主要因素之一，一些证据表明，一些老年精神分裂症患者在晚年会出现功能下降。虽然在其他疾病中，如痴呆和头部创伤，认知能力下降显然是功能下降的先决条件，但关于精神分裂症中功能状态相关的证据在很大程度上是横断面的。本研究采用纵向方法来确定认知和功能缺陷之间的横断面关系是否是认知衰退是功能衰退的先决条件的结果。先前关于认知和功能衰退的研究结果是相互矛盾的，西奈山研究小组研究年龄较大和病情较重的患者发现了衰退，而加州大学圣地亚哥分校的研究小组在类似的时间段内没有发现衰退的证据。为了确定这些差异是由于受试者样本的差异还是采用的方法的差异，西奈山小组将在本研究中采用他们以前的方法和UCSD小组的方法。健康对照者和终生病程不同的门诊老年精神分裂症患者的样本将被随访5年，并采用基于表现的功能技能测量、认知功能评估和临床症状评分进行检查。复杂的数据分析技术将用于确定功能变化的过程，它们与认知和功能状态变化的时间关系，以及它们与终生病史的关联。本研究的结果将阐明精神分裂症的功能状态的过程以及认知和功能改变的时间。研究结果还将为精神分裂症功能变化的生物学基础研究以及该疾病的治疗研究提供信息。在一个被忽视的领域，对老年精神分裂症的研究，这项研究将集中在疾病的一个方面（功能状态的过程），已经研究了100年，但仍然没有很好地理解。

DESCRIPTION (provided by applicant): This is a collaborative study of the course and antecedents of functional decline in geriatric patients with schizophrenia. Functional (i.e., social, occupational, self-care, and independent living) impairment is one of the primary factors that influences both quality of life and societal cost of schizophrenia, with some evidence suggesting that some older patients with schizophrenia experience functional decline in later life. While in other illnesses such as dementia and head trauma it is clear that cognitive decline is an antecedent to functional decline, evidence regarding the correlates of functional status in schizophrenia is largely cross-sectional. The present study adopts a longitudinal approach to determine if the cross-sectional relationships between cognitive and functional deficits are the result of cognitive decline being an antecedent of functional decline. The results of previous studies regarding cognitive and functional decline are contradictory, with the Mt. Sinai group studying older and sicker patients finding decline and the UCSD group finding no evidence of decline in similar time periods. In order to determine if these discrepancies are due to differences in subject samples or the methods employed, the Mt. Sinai group will employ both their previous methods and those of the UCSD group in this study. Samples of healthy controls and ambulatory older schizophrenia patients who vary in their lifetime history of course of illness will be followed for 5 years and examined with performance-based measures of functional skills, assessments of cognitive functioning, and clinical symptom ratings. Sophisticated data analytic techniques will be employed to determine the course of functional changes, their temporal relationships with changes in cognitive and functional status, and their association with lifetime illness history. Findings from this study will clarify the course of functional status in schizophrenia and the timing of cognitive and functional changes. The results will also inform research on the biological basis of functional change in schizophrenia, as well as research on treatment of the illness. In a much-neglected area, the study of schizophrenia in late life, this research will focus on an aspect of the illness (the course of functional status) that has been studied for 100 years, but is still not well understood.