Goldberg Zoey, Kuslak Brina, Kurtz Matthew M
Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT 06459, United States.
Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT 06459, United States.
J Affect Disord. 2023 Jun 1;330:74-82. doi: 10.1016/j.jad.2023.02.137. Epub 2023 Mar 2.
The number of randomized, controlled studies of cognitive remediation (CR) for mood disorders (major depressive disorder [MDD] and bipolar illness [BD]), has grown substantially over the past 10 years. The role of study quality, participant characteristics, and intervention features in CR treatment effects remains largely unknown.
Electronic databases were searched up to February 2022 using variants of the key words: "cognitive remediation", "clinical trials", "major depressive disorder" and "bipolar disorder". This search produced 22 unique randomized, controlled trials that met all inclusion criteria for the study. Data were extracted by 3 authors with strong reliability (>90 %). Primary cognitive, and secondary symptom and functional outcomes were assessed with random effects models.
The meta-analysis (993 participants) revealed that CR produced significant small-to-moderate size effects in attention, verbal learning and memory, working memory and executive function (Hedge's g = 0.29-0.45). CR produced a small-moderate effect on one secondary outcome: depressive symptoms (g = 0.33). CR programs that used an individualized approach produced larger effects on executive function. Samples with lower baseline IQ were more likely to benefit from CR on measures of working memory. Sample age, education, gender, or baseline depressive symptomatology did not serve as barriers to treatment gains, and observed effects were not epiphenomena of poorer design quality.
The number of RCTs remains low.
CR produces small to moderate improvements in cognition and depressive symptoms in mood disorders. Future research should study how CR might be optimized to help generalize CR-related cognitive and symptom improvements to function.
在过去10年中，针对情绪障碍（重度抑郁症[MDD]和双相情感障碍[BD]）的认知康复（CR）随机对照研究数量大幅增加。研究质量、参与者特征和干预特征在CR治疗效果中的作用仍 largely unknown。
截至2022年2月，使用关键词“认知康复”、“临床试验”、“重度抑郁症”和“双相情感障碍”的变体对电子数据库进行检索。该检索产生了22项符合该研究所有纳入标准的独特随机对照试验。数据由3名可靠性强（>90%）的作者提取。使用随机效应模型评估主要认知、次要症状和功能结局。
荟萃分析（993名参与者）显示，CR在注意力、言语学习和记忆、工作记忆和执行功能方面产生了显著的小到中等大小的效应（Hedge's g = 0.29 - 0.45）。CR对一个次要结局产生了小到中等的效应：抑郁症状（g = 0.33）。采用个体化方法的CR项目对执行功能产生了更大的效应。基线智商较低的样本在工作记忆测量中更有可能从CR中获益。样本年龄、教育程度、性别或基线抑郁症状并不是治疗获益的障碍，观察到的效应也不是设计质量较差的附带现象。
随机对照试验的数量仍然较少。
CR在情绪障碍的认知和抑郁症状方面产生了小到中等程度的改善。未来的研究应探讨如何优化CR，以帮助将与CR相关的认知和症状改善推广到功能方面。
