Almeida O P, Howard R J, Levy R, David A S, Morris R G, Sahakian B J
Section of Old Age Psychiatry, Institute of Psychiatry, London.
Psychol Med. 1995 Jul;25(4):685-98. doi: 10.1017/s0033291700034942.
The cognitive performance of 47 elderly psychotic patients with onset of symptoms in late life (late paraphrenia) was compared to that of 33 controls matched for age, sex, ethnic origin, number of years of education, and pre-morbid IQ as measured by the NART. Neuropsychological indices of general cognitive functioning (MMSE, CAMCOG, WAIS-R verbal and performance scores) showed that patients were performing the tasks at a significantly lower level than controls. Patients also showed a trend to have a lower span capacity than controls, particularly at the spatial span subtest. There was no obvious impairment of learning as measured by the digit and spatial recurring span tasks nor of simultaneous matching-to-sample ability. However, patients' performance on a delayed-matching-to-sample procedure was significantly worse than that of controls. In addition, patients performed worse than controls on the Recognition Memory Test for Faces, but not for Words. Finally, the performance of patients on tests assessing executive functioning (Verbal Fluency Test, Computerized Extra and Intra-Dimensional Shift Task, Computerized Spatial Working Memory Task, and Computerized Tower of London Task) was consistently worse than that of controls. These results suggest that psychotic states arising in late life are predominantly associated with a decline on measures of general cognitive ability and executive functioning. The neuropsychological meaning of these findings is discussed in the light of cognitive models of psychotic symptoms, as well as of schizophrenia and dementia research. We concluded that the lack of a clear pattern of impairment among these patients may be the result of their clinical and cognitive diversity.
将47例晚年出现症状的老年精神病患者（晚发性妄想痴呆）的认知表现，与33名在年龄、性别、种族、受教育年限以及用国家成人阅读测验（NART）测得的病前智商方面相匹配的对照组进行了比较。一般认知功能的神经心理学指标（简易精神状态检查表、剑桥认知检查表、韦氏成人智力量表修订版言语和操作分数）显示，患者完成任务的水平明显低于对照组。患者在广度能力方面也有低于对照组的趋势，尤其是在空间广度子测验中。通过数字和空间重复广度任务测得的学习能力以及同时进行的样本匹配能力均未出现明显损害。然而，患者在延迟样本匹配程序中的表现明显比对照组差。此外，患者在面部识别记忆测试中的表现比对照组差，但在词语识别记忆测试中并非如此。最后，患者在评估执行功能的测试（言语流畅性测试、计算机化的额外维度和维度内转换任务、计算机化的空间工作记忆任务以及计算机化的伦敦塔任务）中的表现始终比对照组差。这些结果表明，晚年出现的精神状态主要与一般认知能力和执行功能测量指标的下降有关。根据精神病症状的认知模型以及精神分裂症和痴呆症研究，对这些发现的神经心理学意义进行了讨论。我们得出结论，这些患者中缺乏明确的损害模式可能是其临床和认知多样性的结果。
