Department of Psychology, Queen's University, Kingston, ON, Canada.
Department of Psychology, Queen's University, Kingston, ON, Canada.
Schizophr Res. 2014 Feb;152(2-3):430-4. doi: 10.1016/j.schres.2013.08.004. Epub 2013 Aug 24.
Neurocognitive impairments are the strongest predictor of functional deficits in schizophrenia, but adaptive (i.e., functional) capacity, typically measured with performance-based assessments, yields an objective index of current abilities, whereas real-world functional performance relies on observations of community activity. However, limited experiences in the community may limit the acquisition, retention, or expression of these skills.
We examined the frequency of engagement in behaviors that are assessed in the current "gold standard" in person functional capacity assessment. The UCSD Performance-Based Skills Assessment (i.e., UPSA) examines skills associated with recreational engagement, handling money, scheduling appointments, and navigating public transportation. We used neurocognition, experience, and UPSA performance as predictors of the relationships among cognition and real-world functioning variables.
Neurocognition was a significant correlate of UPSA scores regardless of whether it was forced into the model before or after prior experience, whereas experience was only a significant predictor of UPSA scores when entered before neurocognition. Further, functional capacity, neurocognition, and experience were significant predictors of real-world outcomes and experience remained a significant predictor regardless of the order it was entered into the model.
The amount of current experience with functional tasks is not a rate-limiter of the relationships between neurocognition and functional capacity but does account for some previously unexplained variance in the functional capacity-everyday functioning relationship. These findings underscore the importance of neurocognitive deficits as they relate to functional capacity in schizophrenia, and suggest an incremental functional cost of limited experience with independent living.
神经认知障碍是精神分裂症功能缺陷的最强预测因子，但适应性（即功能）能力，通常通过基于表现的评估来测量，提供了当前能力的客观指标，而现实世界中的功能表现依赖于对社区活动的观察。然而，社区活动经验有限可能会限制这些技能的获得、保留或表达。
我们检查了参与当前“金标准”个体功能能力评估中评估的行为的频率。加州大学圣地亚哥分校基于表现的技能评估（即 UPSA）考察了与娱乐参与、处理金钱、安排约会和导航公共交通相关的技能。我们使用神经认知、经验和 UPSA 表现作为认知和现实世界功能变量之间关系的预测因素。
无论在经验之前还是之后，神经认知都是 UPSA 分数的重要相关因素，而经验只是在进入神经认知之前才是 UPSA 分数的重要预测因素。此外，功能能力、神经认知和经验是现实世界结果的重要预测因素，并且无论其进入模型的顺序如何，经验仍然是一个重要的预测因素。
当前功能性任务经验的多少并不是神经认知和功能能力之间关系的限速因素，但确实解释了功能能力-日常功能关系中一些以前无法解释的差异。这些发现强调了神经认知障碍与精神分裂症功能能力的关系的重要性，并表明有限的独立生活经验会导致功能能力的逐渐增加。
