González-Blanch César, Crespo-Facorro Benedicto, Alvarez-Jiménez Mario, Rodríguez-Sánchez José Manuel, Pérez-Iglesias Rocío, Pelayo-Terán José María, Martínez-García Obdulia, Vázquez-Barquero José Luis
Mental Health Centre, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.
Can J Psychiatry. 2008 Dec;53(12):839-47.
To investigate potential changes and associations in clinical dimensions and cognitive functioning after the first 6 weeks of pharmacological treatment as the relation between cognitive and clinical change may have an impact in determining the importance of cognition as a treatment target.
Patients (n = 42) completed a brief battery of 5 neurocognitive tests within 72 hours of commencing, and 6 weeks after, standard pharmacological treatment. The cognitive testing comprised 5 domains: attention, visuomotor speed, declarative memory, working memory, and executive function. Volunteers (n = 43) were recruited to control for practice effects.
Patients and control subjects improved over time in the raw scores in cognitive tests. Patients' performance, at baseline and end point assessments, was below that of the control subjects in all cognitive variables, except the Stroop interference score. No interaction effect between time and group was found. Further, after controlling for practice effects and adjusting for multiple comparisons, patients' cognitive performance showed no significant improvement. Accordingly, there was no association between clinical improvement and cognitive change. This lack of association was also observed in the subgroup of people who showed decreased scores in negative symptoms.
Cognitive response is not clearly enhanced by antipsychotic drugs and it is not a by-product of clinical recovery during the acute phase (first 6 weeks) of a first-episode nonaffective psychosis.
研究药物治疗前6周后临床指标和认知功能的潜在变化及关联，因为认知与临床变化之间的关系可能会影响确定认知作为治疗靶点的重要性。
42名患者在开始标准药物治疗后72小时内及6周后完成了一组简短的5项神经认知测试。认知测试包括5个领域：注意力、视觉运动速度、陈述性记忆、工作记忆和执行功能。招募了43名志愿者以控制练习效应。
随着时间推移，患者和对照受试者在认知测试的原始分数上均有所提高。在基线和终点评估中，除了斯特鲁普干扰分数外，患者在所有认知变量上的表现均低于对照受试者。未发现时间和组间的交互作用。此外，在控制练习效应并对多重比较进行校正后，患者的认知表现没有显著改善。因此，临床改善与认知变化之间没有关联。在阴性症状得分降低的人群亚组中也观察到这种缺乏关联的情况。
抗精神病药物并不能明显增强认知反应，且在首发非情感性精神病的急性期（前6周），认知反应并非临床康复的副产品。
