Bilder Robert M, Reiter Gail, Bates Jay, Lencz Todd, Szeszko Philip, Goldman Robert S, Robinson Delbert, Lieberman Jeffrey A, Kane John M
Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA.
J Clin Exp Neuropsychol. 2006 Feb;28(2):270-82. doi: 10.1080/13803390500360554.
Despite consensus that schizophrenia is a neurodevelopmental disorder characterized by cognitive deficits, objective data documenting the course of cognitive development remain sparse. We conducted a follow-back study of patients ascertained at the time of their initial episode of schizophrenia or schizoaffective disorder, and a group of demographically matched healthy volunteers. We obtained school records containing standardized achievement test scores from the 1st through 12th grades, and scholastic aptitude test results from the 11th and 12th grades, and examined the developmental trajectories of cognitive performance with respect to prospective examinations conducted following participants' enrollment in our study. We found significant differences in academic achievement tests as early as the first grade, with scores from participants who would later develop schizophrenia lagging behind their peers by 0.8 to 1.1 grade equivalents. This gap widened resulting in a difference between groups of 1.5 to 1.8 grade equivalents by the 12th grade. In the subset of patients for whom SAT scores were available, we found that WAIS-R Full Scale IQ was 11.5 points lower than predicted from earlier SAT scores, suggesting a substantial decline in cognitive ability accompanying the initial episode of illness. These findings suggest that schizophrenia is marked by substantial cognitive deficits in the first grade, that there may be additional subtle decline preceding the overt onset of psychotic symptoms, and that the initial episode of illness is marked by additional decline. These observations may help advance concepts of premorbid cognitive ability in the schizophrenia syndrome and constrain models of pathophysiology.
尽管人们普遍认为精神分裂症是一种以认知缺陷为特征的神经发育障碍，但记录认知发展过程的客观数据仍然稀少。我们对在首次出现精神分裂症或分裂情感性障碍时确诊的患者以及一组人口统计学特征匹配的健康志愿者进行了一项回顾性研究。我们获取了包含从1年级到12年级标准化成绩测试分数的学校记录，以及11年级和12年级的学术能力测试结果，并根据参与者在我们研究中入组后的前瞻性检查来研究认知表现的发展轨迹。我们发现早在一年级时学术成就测试就存在显著差异，后来发展为精神分裂症的参与者的分数比同龄人落后0.8到1.1个年级当量。这种差距不断扩大，到12年级时两组之间的差异达到1.5到1.8个年级当量。在可获得SAT分数的患者子集中，我们发现韦氏成人智力量表（WAIS-R）全量表智商比根据早期SAT分数预测的低11.5分，这表明在疾病首次发作时认知能力大幅下降。这些发现表明，精神分裂症在一年级时就存在显著的认知缺陷，在明显的精神病症状发作之前可能还有额外的细微下降，并且疾病首次发作时还会有额外的下降。这些观察结果可能有助于推进精神分裂症综合征病前认知能力的概念，并限制病理生理学模型。
