Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
J Affect Disord. 2021 Jun 1;288:107-113. doi: 10.1016/j.jad.2021.03.084. Epub 2021 Apr 3.
Panic disorder (PD) is an anxiety disorder characterized by recurrent panic attacks whose aetiology might be associated with alterations of the prefrontal-amygdala circuitry. The prefrontal cortex is a key region involved in executive functioning (EF) whose disturbance may imply harsh consequences over personal, social, and working aspects of PD patients. Indeed, defining the real involvement of EF in PD could lead to early assessment, better treatment, and rehabilitation options. These could have a substantial impact on the quality of life of these patients and their caregivers, thus reducing long-term health care needs.
We reviewed findings from different studies that investigated executive functioning in PD patients using standardized neuropsychological measures. The review was conducted with the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA). In addition, peer-reviewed human-based research articles were selected and twelve studies were retrieved through a search on PubMed. Four uniquely focused on PD patients, two also included a sample of first-degree relatives, while six included a mixed sample of different psychiatric illnesses, including PD.
The majority of the studies found no alterations in PD patients, suggesting that EF might not be a core deficit in this disorder. However, some studies (N = 4) found EF deficits in selective domains, which included attention and set-shifting processes, cognitive flexibility, decision-making abilities, and working memory in PD patients and/or in their first-degree relatives.
Unbalanced and small samples, unmonitored therapies, and the heterogeneity of cognitive and diagnostic assessment measures might have limited the generalizability of the results.
Overall, the results point towards the hypothesis that PD patients had preserved EF. However, future studies with standardized methodological procedures and with a gold standard assessment of EF will be required to finally exclude its involvement in the disease.
惊恐障碍（PD）是一种以反复出现惊恐发作为特征的焦虑障碍，其病因可能与前额叶-杏仁核回路的改变有关。前额叶皮层是参与执行功能（EF）的关键区域，其紊乱可能对 PD 患者的个人、社交和工作方面产生严重后果。事实上，确定 EF 在 PD 中的实际参与程度可能会导致早期评估、更好的治疗和康复选择。这些可能会对这些患者及其照顾者的生活质量产生重大影响，从而减少长期的医疗保健需求。
我们回顾了使用标准化神经心理学测量方法研究 PD 患者执行功能的不同研究结果。综述是按照系统评价和荟萃分析的首选报告项目（PRISMA）进行的。此外，还选择了同行评议的基于人类的研究文章，并通过在 PubMed 上搜索检索到了 12 项研究。其中 4 项专门针对 PD 患者，2 项还包括一级亲属样本，6 项包括不同精神疾病的混合样本，包括 PD。
大多数研究发现 PD 患者没有改变，这表明 EF 可能不是这种疾病的核心缺陷。然而，一些研究（N=4）发现 PD 患者在选择性领域存在 EF 缺陷，这些领域包括注意力和定势转移过程、认知灵活性、决策能力和工作记忆，以及 PD 患者和/或其一级亲属。
不平衡和小样本、未监测的治疗以及认知和诊断评估措施的异质性可能限制了结果的普遍性。
总体而言，结果表明 PD 患者具有保留的 EF。然而，需要进行具有标准化方法程序和 EF 金标准评估的未来研究，以最终排除其在疾病中的参与。
