Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
J Neuropsychol. 2019 Sep;13(3):589-602. doi: 10.1111/jnp.12161. Epub 2018 Apr 23.
Intellectual abilities display high heterogeneity in patients with schizophrenia that might depend on the interaction among neurodevelopmental processes, environmental factors and neurocognitive decline. This study aimed to disentangle the interplay between intellectual level, cognitive status and each cognitive domain, with a focus on speed-related abilities, also including pre-morbid factors. In details, by means of cluster analysis, we identified both in global sample of 452 patients affected by schizophrenia and in a subsample with high pre-morbid functioning, different profiles based on current intellectual level and global cognitive status, analysing the distribution of deficits in each cognitive domains between groups. Then, through regression models, we analysed the contribution of speed-related domains and global cognitive profile to each other cognitive function. Considering the whole sample, results highlight three groups (high, medium and low cognitive level), while among patients with high pre-morbid level, the heterogeneity was best captured by two groups (high and medium level). Still, within each group, a small to high percentage of patients achieved normal score in neurocognitive abilities depending on the cluster they belong to. Speed of processing and psychomotor coordination resulted impaired in all clusters, even in patients with high pre-morbid functioning. The regression analyses revealed significant effects of both cognitive profile and speed-dependent domains on the other cognitive abilities. This study confirms, in a large sample, previous data about the heterogeneity of intellectual and neurocognitive functioning in schizophrenia and highlights the main role of speed-dependent neurocognitive functioning, also as an important target of rehabilitation.
精神分裂症患者的智力表现出高度的异质性,这种异质性可能取决于神经发育过程、环境因素和神经认知衰退之间的相互作用。本研究旨在厘清智力水平、认知状态与每个认知领域之间的相互作用关系,重点关注与速度相关的能力,同时也包括发病前的因素。具体而言,我们通过聚类分析,在 452 名患有精神分裂症的患者的总体样本和具有较高发病前功能的亚样本中,根据当前的智力水平和总体认知状态,确定了不同的模式,分析了不同认知领域之间的缺陷在各组之间的分布。然后,我们通过回归模型分析了与速度相关的领域和总体认知特征对彼此认知功能的贡献。考虑到整个样本,结果突出了三个组(高、中、低认知水平),而在具有高发病前水平的患者中,通过两个组(高和中水平)可以更好地捕捉到异质性。尽管如此,在每个组内,根据他们所属的聚类,仍有小到高比例的患者在神经认知能力方面达到正常分数。在所有聚类中,处理速度和心理运动协调都受损,即使在具有高发病前功能的患者中也是如此。回归分析显示,认知特征和依赖速度的领域对其他认知能力都有显著影响。本研究在一个大样本中证实了先前关于精神分裂症智力和神经认知功能异质性的数据,并强调了依赖速度的神经认知功能的主要作用,这也是康复的一个重要目标。