Department of Psychiatry, Shatin Hospital, Hong Kong, Hong Kong SAR.
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
Neurogastroenterol Motil. 2019 Nov;31(11):e13696. doi: 10.1111/nmo.13696. Epub 2019 Aug 7.
It is unknown whether cognitive dysfunction found in patients with irritable bowel syndrome (IBS) was attributable to the different subtypes, ongoing pathophysiological processes, trait characteristics, or psychiatric comorbidity.
Forty Rome-III patients with IBS (20 diarrhea-predominant [IBS-D] and 20 constipation-predominant [IBS-C]) and 40 age-, sex-, education-matched healthy controls were systematically recruited and compared on their cognitive function with continuous performance test (CPT), Wisconsin Card Sorting Test (WCST) and emotional Stroop test. Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-15 (PHQ-15) and a structured bowel symptom questionnaire were performed to measure anxiety, depressive, somatization, and bowel symptoms, respectively. Psychiatric diagnoses were ascertained with SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders).
Patients with IBS showed significantly increased standard deviation of reaction time (SDRT) (P = .003) on CPT, increased failure to maintain set (FMS) (P=.002), and percentage of perseverative errors (P = .003) on WCST. SDRT did not correlate with illness chronicity or bowel symptoms. FMS correlated with bowel symptom severity. In logistic regression models controlled for BAI, BDI-II, and PHQ-15, SDRT (AOR = 1.08, P = .025), but not FMS (P = .25) or percentage of perseverative errors (P = .24), significantly differentiated IBS from controls. Cognitive function was not significantly different between IBS-C and IBS-D (P > .05), or between pure IBS (n = 22) and IBS with generalized anxiety disorder (GAD) (n = 17) (P > .05).
CONCLUSIONS & INFERENCES: Patients with IBS showed attentional and executive function impairment irrespective of subtypes but otherwise heterogeneous in terms of its state-trait correlations and overlap with anxiety comorbidity.
目前尚不清楚肠易激综合征（IBS）患者的认知功能障碍是否归因于不同的亚型、持续的病理生理过程、特质特征或精神共病。
系统招募了 40 名罗马 III 型 IBS 患者（20 名腹泻为主型[IBS-D]和 20 名便秘为主型[IBS-C]）和 40 名年龄、性别、教育程度匹配的健康对照者，并通过连续作业测试（CPT）、威斯康星卡片分类测试（WCST）和情绪斯特鲁普测试比较他们的认知功能。采用贝克焦虑量表（BAI）、贝克抑郁量表-II（BDI-II）、患者健康问卷-15（PHQ-15）和结构化肠道症状问卷分别评估焦虑、抑郁、躯体化和肠道症状。采用 SCID-I（DSM-IV 轴 I 障碍的结构化临床访谈）确定精神科诊断。
IBS 患者的 CPT 反应时标准差（SDRT）显著增加（P=0.003），WCST 的失败维持设定（FMS）和持续错误百分比（P=0.003）也显著增加。SDRT 与疾病慢性期或肠道症状无关。FMS 与肠道症状严重程度相关。在控制 BAI、BDI-II 和 PHQ-15 后，逻辑回归模型显示 SDRT（优势比[OR] 1.08，P=0.025），而不是 FMS（P=0.25）或持续错误百分比（P=0.24），可显著区分 IBS 与对照组。IBS-C 和 IBS-D 之间的认知功能无显著差异（P>0.05），或单纯 IBS（n=22）与 IBS 伴广泛性焦虑障碍（GAD）（n=17）之间无显著差异（P>0.05）。
无论亚型如何，IBS 患者均表现出注意力和执行功能障碍，但就其状态-特质相关性及其与焦虑共病的重叠情况而言，存在异质性。
