Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden.
Department of Medical sciences, Psychiatry, Uppsala University, Uppsala, Sweden.
JAMA Psychiatry. 2024 May 1;81(5):468-476. doi: 10.1001/jamapsychiatry.2024.0016.
Cognitive impairment contributes significantly to clinical outcome and level of function in individuals with psychotic disorders. These impairments are present already at psychosis onset at a group level; however, the question of heterogeneity in cognitive function among patients has not been systematically investigated.
To provide an updated quantification of cognitive impairment at psychosis onset before patients receive potentially confounding antipsychotic treatment, and to investigate variability in cognitive function compared with healthy controls.
In this systematic review and meta-analysis, PubMed articles were searched up to September 15, 2022.
Original studies reporting data on cognitive function in antipsychotic drug-naive patients with first-episode psychosis (FEP) were included.
Data were independently extracted by 2 researchers. Cognitive tasks were clustered according to 6 domains of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery and the domain of executive function. Random-effects model meta-analyses of mean differences and coefficient of variation ratios (CVRs) were performed, as well as meta-regressions, assessment of study quality, and publication bias.
The main outcome measure was Hedges g for mean differences in cognition and CVR for within-group variability.
Fifty studies were included in the analysis with a total of 2625 individuals with FEP (mean [SD] age, 25.2 [3.6] years, 60% male; 40% female) and 2917 healthy controls (mean [SD] age, 26.0 [4.6]; 55% male; 45% female). In all cognitive domains, the FEP group displayed significant impairment compared with controls (speed of processing: Hedges g = -1.16; 95% CI, -1.35 to -0.98; verbal learning: Hedges g = -1.08; 95% CI, -1.28 to -0.88; visual learning: Hedges g = -1.05; 95% CI, -1.27 to -0.82; working memory: Hedges g = -1.04; 95% CI, -1.35 to -0.73; attention: Hedges g = -1.03; 95% CI, -1.24 to -0.82; reasoning/problem solving: Hedges g = -0.90; 95% CI, -1.12 to -0.68; executive function: Hedges g = -0.88; 95% CI, -1.07 to -0.69). Individuals with FEP also exhibited a larger variability across all domains (CVR range, 1.34-1.92).
Results of this systematic review and meta-analysis identified cognitive impairment in FEP before the initiation of antipsychotic treatment, with large effect sizes. The high variability within the FEP group suggests the need to identify those individuals with more severe cognitive problems who risk worse outcomes and could benefit the most from cognitive remediation.
认知障碍对精神病患者的临床结果和功能水平有重大影响。这些损伤在精神病发病时就已经在群体水平上存在；然而，患者之间的认知功能异质性问题尚未得到系统研究。
在患者接受可能有干扰作用的抗精神病药物治疗之前，提供精神分裂症发病前认知障碍的最新量化数据，并调查与健康对照组相比认知功能的变异性。
在本次系统评价和荟萃分析中，检索了截至 2022 年 9 月 15 日的 PubMed 文章。
纳入了报告第一代抗精神病药物治疗初发精神病（FEP）患者认知功能数据的原始研究。
由 2 名研究人员独立提取数据。根据测量和治疗研究改善精神分裂症认知（MATRICS）共识认知电池和执行功能领域的 6 个领域，对认知任务进行聚类。对均值差异的随机效应模型荟萃分析和变异系数比（CVR）进行了分析，以及元回归、研究质量评估和发表偏倚。
主要结局指标是认知的 Hedges g 均值差异和组内变异的 CVR。
共纳入 50 项研究，共计 2625 名 FEP 患者（平均[标准差]年龄 25.2[3.6]岁，60%为男性；40%为女性）和 2917 名健康对照者（平均[标准差]年龄 26.0[4.6]岁；55%为男性；45%为女性）。在所有认知领域，FEP 组与对照组相比均存在显著的损伤（处理速度：Hedges g=-1.16；95%CI，-1.35 至-0.98；言语学习：Hedges g=-1.08；95%CI，-1.28 至-0.88；视觉学习：Hedges g=-1.05；95%CI，-1.27 至-0.82；工作记忆：Hedges g=-1.04；95%CI，-1.35 至-0.73；注意力：Hedges g=-1.03；95%CI，-1.24 至-0.82；推理/解决问题：Hedges g=-0.90；95%CI，-1.12 至-0.68；执行功能：Hedges g=-0.88；95%CI，-1.07 至-0.69）。FEP 患者的所有领域的变异性也较大（CVR 范围为 1.34-1.92）。
本次系统评价和荟萃分析的结果确定了在开始抗精神病药物治疗之前 FEP 患者的认知障碍，其效应量较大。FEP 组内的高变异性表明需要识别出那些认知问题更严重、有更差结局风险、并能从认知矫正中获益最大的个体。
