Lees Jane, Applegate Eve, Emsley Richard, Lewis Shôn, Michalopoulou Panayiota, Collier Tracey, Lopez-Lopez Cristina, Kapur Shitij, Pandina Gahan J, Drake Richard J
Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK.
Institute of Population Health, University of Manchester, Manchester, UK.
Psychopharmacology (Berl). 2015 Nov;232(21-22):3873-82. doi: 10.1007/s00213-015-3960-8. Epub 2015 May 29.
Cognitive impairment associated with schizophrenia is a key predictor of functional outcomes. The FDA-accepted MATRICS Consensus Cognitive Battery (MCCB) is held to be the gold standard measure but there are concerns about its ease of administration, reliance on language causing problems with translation and possible practice effects. The CogState Schizophrenia Battery (SB) is suggested as a non-language-based alternative but there is no substantial, independent comparison.
The objective of this study was to assess the reliability and validity of these two assessment batteries.
One hundred forty-three participants with DSM-IV schizophrenia and schizoaffective disorder were recruited into three similar studies. Each study administered MCCB and SB tests on consecutive days (baseline 1 and 2) and follow-up 3-4 weeks later.
Batteries' test-retest reliability was similar: SB composites correlated r = 0.66-0.78 between baselines, MCCB domains r = 0.69-0.90. Baseline 2 and follow-up SB composites correlated r = 0.65-0.80 and MCCB domains r = 0.62-0.87. MCCB tasks' practice effects (Glass' ∆ = 0.02-0.46) exceeded SB's (Glass' ∆ = 0.02-0.34). While the batteries' total scores correlated strongly (r = 0.79-0.82), apparently equivalent cognitive domains on each battery (e.g. psychomotor-attention) correlated r = 0.22-0.60, indicating substantial differences between some supposed counterparts.
Clinical trials using either battery would benefit from initial practice sessions to ameliorate practice effects but the SB may be more suitable to measure change in the absence of repeated baselines. The MCCB domains' better correlations with social skills performance suggest that it may have an advantage for measuring cognition in relation to functional outcome.
与精神分裂症相关的认知障碍是功能预后的关键预测指标。美国食品药品监督管理局(FDA)认可的MATRICS共识认知成套测验(MCCB)被视为金标准测量方法,但人们担心其实施的便捷性、对语言的依赖会导致翻译问题以及可能存在的练习效应。有人建议使用CogState精神分裂症成套测验(SB)作为一种基于非语言的替代方法,但尚无充分的独立比较研究。
本研究的目的是评估这两种评估成套测验的信度和效度。
143名符合《精神疾病诊断与统计手册》第四版(DSM-IV)精神分裂症和分裂情感性障碍诊断标准的参与者被纳入三项类似研究。每项研究在连续两天(基线1和基线2)进行MCCB和SB测试,并在3至4周后进行随访。
两种成套测验的重测信度相似:基线之间,SB综合得分的相关系数r = 0.66 - 0.78,MCCB各领域的相关系数r = 0.69 - 0.90。基线2与随访时,SB综合得分的相关系数r = 0.65 - 0.80,MCCB各领域的相关系数r = 0.62 - 0.87。MCCB任务的练习效应(格拉斯增量∆ = 0.02 - 0.46)超过了SB的练习效应(格拉斯增量∆ = 0.02 - 0.34)。虽然两种成套测验的总分相关性很强(r = 0.79 - 0.82),但每种成套测验上看似等效的认知领域(如精神运动性注意力)的相关系数r = 0.22 - 0.60,这表明一些所谓的对应领域之间存在实质性差异。
使用这两种成套测验的临床试验都将受益于初始练习环节,以减轻练习效应,但在没有重复基线的情况下,SB可能更适合测量变化。MCCB各领域与社交技能表现的相关性更好,这表明它在测量与功能预后相关的认知方面可能具有优势。