a Department of Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
b Department of Psychiatry and Psychotherapy , Protestant Hospital Bethel , Bielefeld , Germany.
Expert Rev Neurother. 2017 Aug;17(8):839-846. doi: 10.1080/14737175.2017.1347040.
Meta-analyses conclude that individuals with depression display neurocognitive deficits. However, the extent to which some of these impairments occur due to secondary influences, and thus in part represent epiphenomena, has rarely been tested. Therefore, the authors examined the impact of performance motivation, attitude towards cognitive assessment, and momentary symptoms during assessment on neuropsychological test results in depression.
Forty-five patients with depression and 60 nonclinical individuals underwent a comprehensive neuropsychological test battery. Before and after the assessment, each participant was asked to complete the Momentary Influences, Attitudes and Motivation Impact on Cognitive Performance Scale (MIAMI).
As hypothesized, patients with depression performed worse than nonclinical controls on most neuropsychological parameters. Group differences achieved a medium effect size for parameters tapping speed and a large effect for parameters tapping accuracy. Yet, only one fourth of the patient population displayed abnormal scores (≥ 1 SD below the population mean). In line with the hypothesis, patients with depression were more fearful of test outcomes, complained more about negative momentary influences, and were less motivated (based on retrospective assessment) than controls, as assessed with the MIAMI. The MIAMI total score mediated the relationship between group status and test scores in three out of four analyses. When MIAMI scores were entered as covariate, group differences were largely reduced.
Patients with depression show a more negative attitude towards testing, lower performance motivation, and more negative momentary influences, all of which induce malperformance. The results suggest that performance dysfunction does not necessarily mirror brain dysfunction in areas hosting cognitive functions but is confounded with other factors. Greater caution is warranted when interpreting the results of neuropsychological tests in depressed patients.
荟萃分析的结论是，抑郁症患者存在神经认知缺陷。然而，这些缺陷中有多少是由于次要影响而产生的，因此在某种程度上代表了现象，这一点很少得到检验。因此，作者研究了在评估过程中的表现动机、对认知评估的态度以及评估过程中的即时症状对抑郁症患者神经心理学测试结果的影响。
45 名抑郁症患者和 60 名非临床个体接受了全面的神经心理学测试。在评估前后，每位参与者都被要求完成瞬间影响、态度和动机对认知表现的影响量表（MIAMI）。
正如假设的那样，抑郁症患者在大多数神经心理学参数上的表现均差于非临床对照组。组间差异在反映速度的参数上达到中等效应量，在反映准确性的参数上达到大效应量。然而，只有四分之一的患者群体表现出异常分数（低于人群平均值 1 个标准差）。与假设一致，抑郁症患者比对照组更害怕测试结果，更频繁地抱怨负面的瞬间影响，且基于回顾性评估，动机更差（根据 MIAMI 评估）。在四项分析中的三项中，MIAMI 总分介导了组间状态和测试分数之间的关系。当将 MIAMI 分数作为协变量输入时，组间差异大大减少。
抑郁症患者对测试的态度更消极，表现动机更低，瞬间影响更负面，所有这些都会导致表现不佳。结果表明，表现障碍不一定反映了承载认知功能的大脑功能区的脑功能障碍，而是与其他因素混淆。在解释抑郁症患者的神经心理学测试结果时，需要更加谨慎。
