Oslo University Hospital HF, Division of Mental Health and Addiction, NORMENT, K. G. Jebsen Centre for Psychosis Research, Ullevaal Hospital, Bldg 49, PO Box 4956 Nydalen, N-0424 Oslo, Norway.
Norwegian Centre for Mental Disorders Research (NORMENT), K. G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
J Clin Psychiatry. 2017 Jul;78(7):e750-e757. doi: 10.4088/JCP.16m10880.
Cognitive dysfunctions are core features of psychotic disorders with substantial impact on daily functioning. Vitamin D deficiency has been found to be related to cognitive dysfunctions, but the associations between vitamin D deficiency and cognition in persons with a psychotic disorder are largely unknown.
This cross-sectional study included 225 patients with a DSM-IV psychotic disorder consecutively recruited from 2003 to 2014 and 159 randomly selected healthy controls, assessed by a cognitive test battery, a clinical protocol (including Structured Clinical Interview for DSM-IV Axis I Disorders and Positive and Negative Syndrome Scale), and a physical examination including vitamin D measurements. Multiple regression models were performed to evaluate the effect of vitamin D deficiency (defined serum 25-hydroxyvitamin D [25(OH)D] < 25 nmol/L) on key cognitive domains: processing speed, verbal learning, verbal memory, and executive functioning.
Vitamin D deficiency was significantly associated with decreased processing speed (ie, Digit Symbol Coding) (t = -2.6, P = .01; total model: adjusted R² = 0.40, F6, 374 = 43.8, P < .001) and decreased fluency (ie, verbal fluency) (t = -2.1, P = .04; total model: adjusted R² = 0.35, F6, 373 = 34.2, P < .001) when the results were controlled for age, ethnicity, IQ, patient versus control status, and substance or alcohol abuse. Additional analyses indicated that negative symptoms diluted the association between vitamin D deficiency and processing speed (t = -1.72, P = .09) and verbal fluency (t = -1.35, P = .18) in patients.
The associations between vitamin D deficiency and processing speed and verbal fluency are good arguments for planning large-scale randomized controlled studies in target populations so conclusions can be made about the potential beneficial effect of vitamin D on cognition in psychotic disorders.
认知功能障碍是精神障碍的核心特征，对日常功能有重大影响。已经发现维生素 D 缺乏与认知功能障碍有关，但精神障碍患者中维生素 D 缺乏与认知功能的关系尚不清楚。
本横断面研究纳入了 2003 年至 2014 年连续招募的 225 名 DSM-IV 精神障碍患者和 159 名随机选择的健康对照者，通过认知测试组合、临床方案（包括 DSM-IV 轴 I 障碍的结构性临床访谈和阳性与阴性综合征量表）以及包括维生素 D 测量的体格检查进行评估。采用多元回归模型评估维生素 D 缺乏（定义为血清 25-羟维生素 D [25(OH)D] < 25 nmol/L）对关键认知领域的影响：处理速度、词语学习、词语记忆和执行功能。
维生素 D 缺乏与处理速度（即数字符号编码）（t = -2.6，P =.01；总模型：调整后的 R² = 0.40，F6,374 = 43.8，P <.001）和流畅性（即词语流畅性）（t = -2.1，P =.04；总模型：调整后的 R² = 0.35，F6,373 = 34.2，P <.001）下降显著相关，当结果控制年龄、种族、智商、患者与对照状态以及物质或酒精滥用时。进一步的分析表明，阴性症状削弱了维生素 D 缺乏与处理速度（t = -1.72，P =.09）和词语流畅性（t = -1.35，P =.18）之间的关联在患者中。
维生素 D 缺乏与处理速度和词语流畅性之间的关联为计划在目标人群中进行大规模随机对照研究提供了有力论据，以便就维生素 D 对精神障碍患者认知功能的潜在有益影响得出结论。
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