Metis Cognition Ltd.,Kilmington Common,UK; Institute of Psychiatry,Psychology & Neuroscience,King's College London,London,UK;Alzheimer Center,VU Medical Center,Amsterdam,The Netherlands.
CNS Spectr. 2019 Feb;24(1):144-153. doi: 10.1017/S1092852918001657.
A key message from the review of cognitive dysfunction in psychiatry published by Millan et al (2012) was not just that cognitive skills are often compromised in patients with psychiatric disorders, but that deficits in specific domains are common to a number of conditions. The review also highlighted that the magnitude of the observed deficits varied across disorders. A helpful element of the Millan et al study was the inclusion of a table in which the authors sought to convey the domains of cognition and a categorization of the magnitude of the observed deficits.In previous articles, we have considered best practice for the assessment of cognition. In these contributions, we have argued not for the use of specific tests, but instead for measures that meet acceptable standards of reliability, validity, and sensitivity. In the course of our discussions, we have included reference to test validity in the context of considering whether selected measures index appropriate domains of cognition. In this article, we begin with a brief discussion of the requirements for good test selection, especially with respect to issues of sensitivity, reliability, and validity. Thereafter the focus of this article is on the issue of domain validity. We will critically review the specification of the cognitive domains proposed by Millan et al, as well as those selected by authors of meta-analyses characterizing cognitive deficits in major depressive disorders. This focus is solely to make the discussion tractable, though we propose that the issues raised will be applicable across all psychiatric and neurological disorders.
Millan 等人发表的关于精神病学认知功能障碍的综述传达了一个重要信息：患有精神障碍的患者的认知技能往往受损，而特定领域的缺陷在多种情况下都很常见。该综述还强调，观察到的缺陷的严重程度在不同疾病之间存在差异。Millan 等人的研究中有一个有用的元素，即他们在表格中试图传达认知领域的概念，并对观察到的缺陷的严重程度进行分类。
在之前的文章中，我们已经考虑了认知评估的最佳实践。在这些贡献中，我们不是提倡使用特定的测试，而是提倡使用符合可靠性、有效性和敏感性可接受标准的措施。在讨论过程中，我们在考虑选定的措施是否能反映适当的认知领域时，提到了测试有效性的问题。在本文中，我们首先简要讨论了良好测试选择的要求，特别是在敏感性、可靠性和有效性方面的要求。之后，本文的重点是讨论领域有效性的问题。我们将批判性地审查 Millan 等人提出的认知领域的规范，以及那些用于描述重度抑郁症认知缺陷的荟萃分析作者所选择的认知领域。这样做的目的纯粹是为了使讨论易于处理，尽管我们建议提出的问题将适用于所有精神和神经疾病。
