首发精神分裂症患者的认知控制缺陷与早期大脑发育的复杂偏差有关。
Cognitive control deficit in patients with first-episode schizophrenia is associated with complex deviations of early brain development.
作者信息
Gay Olivier, Plaze Marion, Oppenheim Catherine, Gaillard Raphael, Olié Jean-Pierre, Krebs Marie-Odile, Cachia Arnaud
机构信息
From the INSERM UMR 894, Centre de Psychiatrie & Neurosciences, CNRS GDR 3557, Institut de Psychiatrie, Paris, France (Gay, Plaze, Oppenheim, Gaillard, Olié, Krebs, Cachia); the Université Paris Descartes, Sorbonne Paris Cité, Paris, France (Gay, Plaze, Oppenheim, Gaillard, Olié, Krebs, Cachia); the Service Hospitalo-Universitaire, Centre Hospitalier Sainte-Anne, Paris, France (Gay, Plaze, Gaillard, Olié, Krebs); the Service d'Imagerie Morphologique et Fonctionnelle, Centre Hospitalier Sainte-Anne, Paris, France (Oppenheim); the CNRS UMR 8240, Laboratoire de Psychologie du Développement et de l'Éducation de l'Enfant, Paris, France (Cachia); and the Institut Universitaire de France, Paris, France (Cachia).
出版信息
J Psychiatry Neurosci. 2016 Sep 23;41(6):150267. doi: 10.1503/jpn.150267.
BACKGROUND
Several clinical and radiological markers of early neurodevelopmental deviations have been independently associated with cognitive impairment in patients with schizophrenia. The aim of our study was to test the cumulative and/or interactive effects of these early neurodevelopmental factors on cognitive control (CC) deficit, a core feature of schizophrenia.
METHODS
We recruited patients with first-episode schizophrenia-spectrum disorders, who underwent structural MRI. We evaluated CC efficiency using the Trail Making Test (TMT). Several markers of early brain development were measured: neurological soft signs (NSS), handedness, sulcal pattern of the anterior cingulate cortex (ACC) and ventricle enlargement.
RESULTS
We included 41 patients with schizophrenia in our analysis, which revealed a main effect of ACC morphology ( = 0.041) as well as interactions between NSS and ACC morphology ( = 0.005), between NSS and handedness ( = 0.044) and between ACC morphology and cerebrospinal fluid (CSF) volume ( = 0.005) on CC measured using the TMT-B score - the TMT-A score.
LIMITATIONS
No 3- or 4-way interactions were detected between the 4 neurodevelopmental factors. The sample size was clearly adapted to detect main effects and 2-way interactions, but may have limited the statistical power to investigate higher-order interactions. The effects of treatment and illness duration were limited as the study design involved only patients with first-episode psychosis.
CONCLUSION
To our knowledge, our study provides the first evidence of cumulative and interactive effects of different neurodevelopmental markers on CC efficiency in patients with schizophrenia. Such findings, in line with the neurodevelopmental model of schizophrenia, support the notion that CC impairments in patients with schizophrenia may be the final common pathway of several early neurodevelopmental mechanisms.
背景
早期神经发育偏差的几种临床和放射学标志物已分别与精神分裂症患者的认知障碍相关联。我们研究的目的是测试这些早期神经发育因素对认知控制（CC）缺陷（精神分裂症的核心特征）的累积和/或交互作用。
方法
我们招募了首次发作的精神分裂症谱系障碍患者，并对他们进行了结构磁共振成像（MRI）检查。我们使用连线测验（TMT）评估CC效率。测量了几个早期大脑发育的标志物：神经软体征（NSS）、利手、前扣带回皮质（ACC）的脑沟模式和脑室扩大。
结果
我们纳入了41例精神分裂症患者进行分析，结果显示ACC形态的主效应（P = 0.041）以及NSS与ACC形态之间（P = 0.005）、NSS与利手之间（P = 0.044）以及ACC形态与脑脊液（CSF）体积之间（P = 0.005）对使用TMT-B分数减去TMT-A分数测量的CC有交互作用。
局限性
在这4个神经发育因素之间未检测到三向或四向交互作用。样本量显然适合检测主效应和双向交互作用，但可能限制了研究高阶交互作用的统计效力。由于研究设计仅涉及首次发作精神病患者，治疗和病程的影响有限。
结论
据我们所知，我们的研究首次提供了不同神经发育标志物对精神分裂症患者CC效率的累积和交互作用的证据。这些发现与精神分裂症的神经发育模型一致，支持了精神分裂症患者的CC损害可能是几种早期神经发育机制的最终共同途径这一观点。
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