Dickinson Dwight, Coursey Robert D
VA Capitol Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, 10 N Greene Street, Room 6A-165 (BT/MIRECC), Baltimore, MD 21201, USA.
Schizophr Res. 2002 Jul 1;56(1-2):161-70. doi: 10.1016/s0920-9964(01)00229-8.
Existing literature on the neurocognitive correlates of community functioning in schizophrenia has not adequately focused on the relationships among the correlated variables. In a sample of 40 outpatients with schizophrenia and related disorders, we studied two sets of variables that we expected to be related to broad ratings of community functioning: (1) the Wechsler Adult Intelligence Scale-III (WAIS-III) index scores for verbal comprehension, perceptual organization, working memory, and processing speed; and (2) positive, negative, disorganized and affective symptom variables. Of the WAIS-III index scores, working memory and processing speed entered a stepwise regression, together accounting for substantial variance in functional ratings (R(2)=0.37). However, only processing speed remained significantly associated with community functioning after controlling for the other indexes. In relation to community functioning, the remaining indexes appeared to be overlapping markers of general cognitive ability, rather than specific measures of discrete cognitive domains. Addition of positive and negative symptom variables in a further analysis greatly increased the explained functional variance (R(2)=0.65). Processing speed overlapped substantially with negative symptoms in predicting functioning, while the other WAIS-III indexes were independent of symptomatology. Results illustrate the importance of (1) knowing which neurocognitive variables have specific relationships to community functioning and which reflect the influence of more general cognitive ability in daily life, and (2) appreciating areas of overlap and independence among classes of correlates of functioning, such as neurocognitive and symptom variables. This improved understanding has implications for predictive models of community functioning, for cognitive rehabilitation and deficit compensation strategies, and for assessment practice.
关于精神分裂症患者社区功能的神经认知相关性的现有文献，尚未充分关注相关变量之间的关系。在一个由40名精神分裂症及相关障碍门诊患者组成的样本中，我们研究了两组我们预期与社区功能广泛评分相关的变量：（1）韦氏成人智力量表第三版（WAIS - III）的言语理解、知觉组织、工作记忆和处理速度指数得分；以及（2）阳性、阴性、紊乱和情感症状变量。在WAIS - III指数得分中，工作记忆和处理速度进入逐步回归，共同解释了功能评分中的大量方差（R(2)=0.37）。然而，在控制其他指标后，只有处理速度仍与社区功能显著相关。就社区功能而言，其余指标似乎是一般认知能力的重叠标志物，而非离散认知领域的具体测量指标。在进一步分析中加入阳性和阴性症状变量，极大地增加了解释的功能方差（R(2)=0.65）。在预测功能方面，处理速度与阴性症状有很大重叠，而其他WAIS - III指标与症状学无关。结果表明了以下两点的重要性：（1）了解哪些神经认知变量与社区功能有特定关系，哪些反映了日常生活中更一般认知能力的影响；（2）认识到功能相关类别（如神经认知和症状变量）之间的重叠和独立领域。这种更好的理解对社区功能的预测模型、认知康复和缺陷补偿策略以及评估实践都有影响。
