Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China.
Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China; School of Nursing, The Hong Kong Polytechnic University, China.
Schizophr Res. 2024 Jun;268:205-222. doi: 10.1016/j.schres.2023.09.027. Epub 2023 Oct 1.
This study aimed to conduct a systematic review and meta-analysis on cognitive performances of patients with treatment-resistant schizophrenia (TRS) after clozapine treatment and to examine the potential effect of follow-up duration and clozapine dosage.
Five electronic databases were searched and studies were included if treatment-resistant schizophrenia patients were treated with clozapine and with baseline and follow-up cognitive functions assessments. Cognitive measures were categorised into six domains based on DSM-5-TR. Random-effect model analysis was used to pool the effect estimates. Moderator effects of clozapine dosage, follow up duration, duration of illness, age, years of education and change in positive symptoms severity were examined with meta-regression.
Nineteen articles were included with 50 cognitive measures reported. Systematic review found inconsistent results. Twelve cognitive measures were included for meta-analysis and found overall improvement of cognitive performances after clozapine treatment SMD = 0.11 [95 % CI 0.02, 0.20] (p = 0.021). Patients with younger age, more years of education and improvements in positive symptoms are more likely to improve in cognitive performances. Subgroup analysis found significant improvement in studies with follow-up periods of 6-months or longer but not for studies with shorter follow-up periods.
Clozapine may improve some domains of cognitive function, particularly over a longer period. However, the overall inconsistent results suggest that more studies with larger sample size and standard cognitive function assessments would be needed to enhance our understanding of the impact of clozapine on the cognitive functions in the TRS patients.
本研究旨在对接受氯氮平治疗的难治性精神分裂症（TRS）患者的认知表现进行系统评价和荟萃分析，并探讨随访时间和氯氮平剂量的潜在影响。
检索了 5 个电子数据库，并纳入了对 TRS 患者使用氯氮平治疗且具有基线和随访认知功能评估的研究。根据 DSM-5-TR，认知测量分为六个领域。使用随机效应模型分析来汇总效应估计值。使用元回归检查氯氮平剂量、随访时间、疾病持续时间、年龄、受教育年限和阳性症状严重程度变化的调节作用。
纳入了 19 篇文章，报道了 50 项认知测量结果。系统评价发现结果不一致。对 12 项认知测量结果进行荟萃分析，发现氯氮平治疗后认知表现总体上有所改善，SMD=0.11 [95%CI 0.02, 0.20]（p=0.021）。年龄较小、受教育年限较长以及阳性症状改善的患者更有可能改善认知表现。亚组分析发现，随访时间为 6 个月或更长的研究中存在显著改善，但随访时间较短的研究中则没有。
氯氮平可能会改善某些认知功能领域的功能，尤其是在较长时间内。然而，总体上不一致的结果表明，需要更多的大样本量和标准认知功能评估的研究来增强我们对氯氮平对 TRS 患者认知功能影响的理解。
