Kharawala Saifuddin, Hastedt Claudia, Podhorna Jana, Shukla Hemlata, Kappelhoff Bregt, Harvey Philip D
Bridge Medical Consulting Ltd., 2 Marsault Court, 11 Kew Foot Road, Richmond TW9 2SS, United Kingdom.
Boehringer Ingelheim International GmbH, Binger Strasse 173, 55216 Ingelheim, Germany.
Schizophr Res Cogn. 2021 Sep 29;27:100217. doi: 10.1016/j.scog.2021.100217. eCollection 2022 Mar.
In schizophrenia, impairments in neurocognition (NC) and social cognition (SC) are associated with reduced functional capacity (FC) and poor real-world functioning (RWF). In this semi-systematic review, we examined this association across a range of research questions. We conducted a systematic search in Embase and MEDLINE from 2005 to 2019, and conducted additional pragmatic searches. After screening of titles, abstracts and full-texts, we included 564 citations, of which 44 (26 primary studies, 15 systematic reviews and 3 narrative reviews) were prioritized for reporting. Both NC and SC were significantly associated with functioning, with slightly stronger association for SC. Effect sizes were generally larger for FC than for RWF. NC showed stronger associations with occupational functioning and independent living, and SC with social functioning. Baseline cognition predicted long-term RWF up to 20 years of follow-up, though long-term data were limited for SC. Cognitive remediation improved RWF functioning, especially when it was combined with psychosocial rehabilitation. SC mediated the relationship of NC with functioning. Negative symptoms appeared to mediate and moderate the association of cognition with functioning. Other factors involved included severity of cognitive dysfunction, metacognition, depression and choice of RWF instrument. We discuss potential implications for studies of pharmacological cognitive interventions in schizophrenia - the relevance of both NC and SC, the advantage of adjunctive psychosocial rehabilitation, the role of relevant moderating and mediating variables, and the challenges with RWF instrument selection. Successful cognitive interventions could allow patients with schizophrenia to improve their potential for community functioning.
在精神分裂症中,神经认知(NC)和社会认知(SC)障碍与功能能力(FC)降低及现实世界功能(RWF)不佳相关。在这项半系统综述中,我们针对一系列研究问题对这种关联进行了考察。我们在2005年至2019年期间对Embase和MEDLINE进行了系统检索,并进行了额外的实用检索。在对标题、摘要和全文进行筛选后,我们纳入了564条引文,其中44条(26项原发性研究、15项系统综述和3项叙述性综述)被优先用于报告。NC和SC均与功能显著相关,SC的关联稍强。FC的效应量通常大于RWF。NC与职业功能和独立生活的关联更强,而SC与社会功能的关联更强。基线认知可预测长达20年随访期的长期RWF,不过SC的长期数据有限。认知康复改善了RWF功能,尤其是与心理社会康复相结合时。SC介导了NC与功能之间的关系。阴性症状似乎介导并调节了认知与功能之间的关联。涉及的其他因素包括认知功能障碍的严重程度、元认知、抑郁和RWF工具的选择。我们讨论了对精神分裂症药理学认知干预研究的潜在影响——NC和SC的相关性、辅助心理社会康复的优势、相关调节和中介变量的作用以及RWF工具选择的挑战。成功的认知干预可使精神分裂症患者提高其社区功能潜力。