Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Psychiatry Res. 2024 Oct;340:116126. doi: 10.1016/j.psychres.2024.116126. Epub 2024 Aug 5.
Cognitive impairment represents one of the core features of schizophrenia, involves both neurocognition and social cognition domains, and has a significant negative impact on real-world functioning. The present review provides a framework for the conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. In this conceptualization, primary cognitive impairment can be defined as a consequence of the neurobiological alterations that underlie psychopathological manifestations of the disorder, while secondary cognitive impairment can be defined as the results of a source issue that has a negative impact on cognitive performance. Sources of secondary cognitive impairment are frequent in people with schizophrenia and include several different factors, such as positive and negative symptoms, depressive symptoms, autistic symptoms, pharmacotherapy, substance abuse, metabolic syndrome, social deprivation, and sleep disorders. It can be hypothesized that secondary cognitive impairment may be improved by effectively resolving the source issue, while primary cognitive impairment may benefit from dedicated treatment. Further research is required to confirm this hypothesis, to better characterize the distinction between primary and secondary cognitive impairment in a clinical and in a neurobiological perspective, and to evaluate the impact of systematically assessing and treating secondary cognitive impairment.
认知障碍是精神分裂症的核心特征之一，涉及神经认知和社会认知领域，对现实生活功能有重大负面影响。本综述为精神分裂症中“原发性”和“继发性”认知障碍的概念化和特征提供了一个框架。在这种概念化中，原发性认知障碍可以定义为导致精神病理学表现的神经生物学改变的结果，而继发性认知障碍可以定义为对认知表现有负面影响的源问题的结果。继发性认知障碍的来源在精神分裂症患者中很常见，包括多种不同的因素，如阳性和阴性症状、抑郁症状、自闭症症状、药物治疗、物质滥用、代谢综合征、社会剥夺和睡眠障碍。可以假设，通过有效解决源问题，继发性认知障碍可能会得到改善，而原发性认知障碍可能会受益于专门的治疗。需要进一步的研究来证实这一假设，以便更好地从临床和神经生物学角度描述原发性和继发性认知障碍之间的区别，并评估系统评估和治疗继发性认知障碍的影响。
