Royall D R, Mahurin R K, True J E, Anderson B, Brock I P, Freeburger L, Miller A
Department of Psychiatry, University of Texas Health Science Center at San Antonio 78284-7792.
Am J Psychiatry. 1993 Dec;150(12):1813-9. doi: 10.1176/ajp.150.12.1813.
Executive deficits have traditionally been associated with frontal lobe brain damage. They are relevant to a variety of disabling mental conditions, including schizophrenia and Alzheimer's disease. To measure these deficits, the authors developed the Executive Interview, a 25-item, 15-minute interview. It has been validated among elderly subjects across a wide range of functional impairment.
Forty young, chronically ill schizophrenic residents of a state mental health facility and 104 elderly residents, representing three levels of care, of a comprehensive retirement community were tested with the Executive Interview and the Mini-Mental State.
When age, gender, education, and number of prescribed medications were controlled, cognitive impairment on the Executive Interview and Mini-Mental State rose with level of care. The Executive Interview alone discriminated between subjects at each level of care, and it was more sensitive to cognitive impairment than the Mini-Mental State. Executive Interview scores correlated the strongest with level of care. Mini-Mental State scores, number of prescribed medications, and age also correlated significantly. Schizophrenic patients showed as much executive impairment on the Executive Interview as elderly subjects at the same level of care despite significant differences in age, sex, and neuroleptic use. Executive Interview and Mini-Mental State scores were highly correlated among the elderly but less so among the schizophrenic patients. Cross-group differences were also found in the pattern of failure on selected Executive Interview items despite similar total Executive Interview scores.
Increasing executive dyscontrol is associated with the need for increasing levels of care and supervision. This finding is neither age nor disease specific. Cross-group differences on selected Executive Interview items suggest the existence of disease-specific patterns of failure. Their recognition could prove useful in the identification of anatomically or pathophysiologically distinct subgroups among patients with executive dyscontrol.
执行功能缺陷传统上与额叶脑损伤相关。它们与多种致残性精神疾病有关，包括精神分裂症和阿尔茨海默病。为了测量这些缺陷，作者开发了执行功能访谈，这是一个包含25个项目、时长15分钟的访谈。它已在广泛功能损害的老年受试者中得到验证。
对一家州立心理健康机构的40名年轻慢性精神分裂症住院患者以及一个综合退休社区代表三个护理级别的104名老年居民进行了执行功能访谈和简易精神状态检查。
在控制年龄、性别、教育程度和处方药物数量后，执行功能访谈和简易精神状态检查中的认知损害随护理级别升高而增加。仅执行功能访谈就能区分每个护理级别的受试者，并且它对认知损害比简易精神状态检查更敏感。执行功能访谈得分与护理级别相关性最强。简易精神状态检查得分、处方药物数量和年龄也显著相关。尽管年龄、性别和抗精神病药物使用存在显著差异，但精神分裂症患者在执行功能访谈中表现出的执行功能损害与相同护理级别的老年受试者一样多。老年受试者中执行功能访谈和简易精神状态检查得分高度相关，但精神分裂症患者中相关性较低。尽管执行功能访谈总分相似，但在选定的执行功能访谈项目上的失败模式也存在跨组差异。
执行功能失控加剧与护理和监督水平提高的需求相关。这一发现既不具有年龄特异性也不具有疾病特异性。选定的执行功能访谈项目上的跨组差异表明存在特定疾病的失败模式。它们的识别可能有助于在执行功能失控患者中识别出解剖学或病理生理学上不同的亚组。
