Richardson-Vejlgaard Randall, Dawes Sharron, Heaton Robert K, Bell Morris D
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons New York, NY 10032, USA.
Psychiatry Res. 2009 Aug 30;169(1):70-4. doi: 10.1016/j.psychres.2008.06.018. Epub 2009 Jul 19.
To determine the validity of substance-abusing (SA) patients' self-reports of cognitive impairments, we assessed the independent contributions of depression, actual neurocognitive performance and an index of cognitive decline, in predicting cognitive complaints in groups of SA patients and normal controls. The SA sample comprised 74 veterans enrolled in day treatment. The non-clinical sample consisted of 150 English-speaking adults. Assessment instruments were as follows: A modified version of the Patient's Assessment of Own Functioning Inventory (PAOFI) containing three subscale on: Memory, Language and Communication, and Higher Cognitive Functions; the Beck Depression Inventory; a battery of neuropsychological tests that measured domains of executive function, processing speed, verbal fluency and verbal and visual memory; and a measure of premorbid intellectual functioning. SA patients reported twice as many PAOFI complaints as non-clinical controls. SA patients' neuropsychological performance was lower than that of non-clinical controls. A higher percentage of SA patients had significant cognitive decline. The SA sample reported more depression. There was no association between PAOFI scores and neuropsychological performance for either group. PAOFI results were not associated with cognitive decline. BDI scores accounted for 12% of the variance in PAOFI total score for the SA sample and 44% for the non-clinical sample in multiple regression analysis. Cognitive complaints were related more to depression than cognitive performance for both SA and non-clinical samples. The results do not support self-report as a valid means of neuropsychological assessment in SA samples, although self-reports may provide other information about perceived cognitive difficulties that may be relevant to clinical evaluation.
为了确定药物滥用（SA）患者认知障碍自我报告的有效性，我们评估了抑郁、实际神经认知表现和认知衰退指数在预测SA患者组和正常对照组认知主诉方面的独立作用。SA样本包括74名参加日间治疗的退伍军人。非临床样本由150名说英语的成年人组成。评估工具如下：患者自我功能评估量表（PAOFI）的修订版，包含三个子量表：记忆、语言与沟通以及高级认知功能；贝克抑郁量表；一组神经心理测试，测量执行功能、处理速度、语言流畅性以及言语和视觉记忆等领域；以及病前智力功能的测量。SA患者报告的PAOFI主诉是非临床对照组的两倍。SA患者的神经心理表现低于非临床对照组。更高比例的SA患者有显著的认知衰退。SA样本报告的抑郁情况更多。两组的PAOFI得分与神经心理表现之间均无关联。PAOFI结果与认知衰退无关。在多元回归分析中，贝克抑郁量表（BDI）得分在SA样本的PAOFI总分变异中占12%，在非临床样本中占44%。对于SA样本和非临床样本，认知主诉与抑郁的相关性均高于与认知表现的相关性。研究结果不支持自我报告作为SA样本中神经心理评估的有效手段，尽管自我报告可能提供有关感知到的认知困难的其他信息，这些信息可能与临床评估相关。
