Semkovska Maria, Bédard Marc-André, Godbout Lucie, Limoge Frédérique, Stip Emmanuel
Cognitive Neuroscience Center, Université du Québec à Montreal, Canada.
Schizophr Res. 2004 Aug 1;69(2-3):289-300. doi: 10.1016/j.schres.2003.07.005.
Many neuropsychological studies have described deficits of memory and executive functions in patients with schizophrenia, and the severity of these deficits seems to be determinant in predicting the community outcome of these patients [Schizophr. Bull. 26 (2000) 119]. However, neuropsychological evaluation does not provide valuable information about how the cognitive deficits directly affect daily living, that is, which cognitive deficit affects which behavior. The present study aimed at determining whether executive dysfunction in schizophrenia could be directly measured by analyzing three activities of daily living (ADL), in addition to assessing the ecological validity of commonly used neuropsychological tests. Within specific ADL (choosing a menu, shopping the ingredients, cooking a meal), the sequences of behaviors that have been performed by 27 control subjects and 27 patients with schizophrenia were both analyzed by using a preset optimal sequence of behavior. When compared with control subjects, patients with schizophrenia showed more omissions when choosing the menu, more sequencing and repetitions errors during the shopping task, and more planning, sequencing, repetition and omission errors during the cooking task. These behavioral errors correlated significantly with negative, but not with positive symptoms of the patients. Furthermore, they also correlated with the poor performances on executive neuropsychological tests, especially those sensitive to shifting and sequencing abilities, but not with memory tests. These results suggest that executive deficits in schizophrenia may specifically affect ADL and that such deficits can be quantitatively assessed with a behavioral scale of action sequences.
许多神经心理学研究都描述了精神分裂症患者存在记忆和执行功能缺陷，而且这些缺陷的严重程度似乎是预测这些患者社区结局的决定性因素[《精神分裂症通报》26 (2000) 119]。然而，神经心理学评估并未提供有关认知缺陷如何直接影响日常生活的有价值信息，也就是说，哪种认知缺陷会影响哪种行为。本研究旨在确定除了评估常用神经心理学测试的生态效度之外，是否可以通过分析三项日常生活活动（ADL）来直接测量精神分裂症患者的执行功能障碍。在特定的日常生活活动（选择菜单、购买食材、烹饪饭菜）中，使用预先设定的最佳行为顺序对27名对照受试者和27名精神分裂症患者所执行的行为顺序进行了分析。与对照受试者相比，精神分裂症患者在选择菜单时遗漏更多，在购物任务中顺序和重复错误更多，在烹饪任务中计划、顺序、重复和遗漏错误更多。这些行为错误与患者的阴性症状显著相关，但与阳性症状无关。此外，它们还与执行神经心理学测试中的不良表现相关，尤其是那些对转换和排序能力敏感的测试，但与记忆测试无关。这些结果表明，精神分裂症患者的执行功能缺陷可能会特别影响日常生活活动，并且这种缺陷可以通过行为动作顺序量表进行定量评估。
