Kurtz Matthew M, Seltzer James C, Fujimoto Marco, Shagan Dana S, Wexler Bruce E
Department of Psychology, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT 06459, United States.
Schizophr Res. 2009 Feb;107(2-3):267-74. doi: 10.1016/j.schres.2008.10.014. Epub 2008 Nov 8.
Few studies have investigated predictors of response to cognitive remediation interventions in patients with schizophrenia. Predictor studies to date have selected treatment outcome measures that were either part of the remediation intervention itself or closely linked to the intervention with few studies investigating factors that predict generalization to measures of everyday life-skills as an index of treatment-related improvement. In the current study we investigated the relationship between four measures of neurocognitive function, crystallized verbal ability, auditory sustained attention and working memory, verbal learning and memory, and problem-solving, two measures of symptoms, total positive and negative symptoms, and the process variables of treatment intensity and duration, to change on a performance-based measure of everyday life-skills after a year of computer-assisted cognitive remediation offered as part of intensive outpatient rehabilitation treatment. Thirty-six patients with schizophrenia or schizoaffective disorder were studied. Results of a linear regression model revealed that auditory attention and working memory predicted a significant amount of the variance in change in performance-based measures of everyday life skills after cognitive remediation, even when variance for all other neurocognitive variables in the model was controlled. Stepwise regression revealed that auditory attention and working memory predicted change in everyday life-skills across the trial even when baseline life-skill scores, symptoms and treatment process variables were controlled. These findings emphasize the importance of sustained auditory attention and working memory for benefiting from extended programs of cognitive remediation.
很少有研究调查精神分裂症患者对认知康复干预反应的预测因素。迄今为止的预测研究选择的治疗结果测量指标，要么是康复干预本身的一部分，要么与干预密切相关，很少有研究调查那些能够预测推广到日常生活技能测量指标（作为治疗相关改善指标）的因素。在本研究中，我们调查了神经认知功能的四项测量指标（即晶态语言能力、听觉持续注意力和工作记忆、语言学习和记忆以及解决问题能力）、两项症状测量指标（即阳性和阴性症状总分）与治疗强度和持续时间等过程变量之间的关系，这些变量与作为强化门诊康复治疗一部分提供的为期一年的计算机辅助认知康复后基于表现的日常生活技能测量指标的变化情况。我们对36名精神分裂症或分裂情感性障碍患者进行了研究。线性回归模型的结果显示，即使在控制了模型中所有其他神经认知变量的方差后，听觉注意力和工作记忆仍能预测认知康复后基于表现的日常生活技能测量指标变化中的大量方差。逐步回归显示，即使在控制了基线生活技能得分、症状和治疗过程变量后，听觉注意力和工作记忆仍能预测整个试验过程中日常生活技能的变化。这些发现强调了持续听觉注意力和工作记忆对于从长期认知康复计划中获益的重要性。
