Borison R L
Clinical Therapeutics, Augusta, Georgia 30901, USA.
Acta Psychiatr Scand Suppl. 1996;389:5-11. doi: 10.1111/j.1600-0447.1996.tb05942.x.
Conventional neuroleptics can further reduce cognitive function, which is already impaired in most patients with schizophrenia. Although some areas of cognition may remain relatively well preserved in schizophrenia, it has been suggested that the origins of a neurocognitive decline in schizophrenia may be related to a reduction in dopamine activity in the prefrontal cortex. If this is the case, dopamine D2 blockade would be expected to impair some aspects of neurocognitive function further. The level of neurocognitive function in schizophrenia is related to vocational and social ability, and the course of cognitive decline appears to be consistent with a static encephalopathy, rather than progressive dementia. Intensive cognitive retraining in patients with schizophrenia may improve, but not normalize, some aspects of cognitive performance. Most cognitive deficits remain stable, even when improvements in symptoms are obtained with antipsychotic treatment. Drugs such as risperidone, one of the newer serotonin-dopamine antagonists (SDAs), have a better effect on cognitive function than conventional antidopaminergic neuroleptics, and are therefore more likely to enable the patient to benefit from cognitive and other forms of training. Anticholinergic drugs used to treat EPS, or drugs with anticholinergic activity, also impair cognitive function. Consequently, because the need to use anticholinergic drugs is less with the SDA antipsychotics, the cognitive function of patients treated with drugs such as risperidone is likely to be better than it would be if they took a conventional neuroleptic.
传统抗精神病药物会进一步降低认知功能，而大多数精神分裂症患者的认知功能已然受损。尽管精神分裂症患者的某些认知领域可能相对保存完好，但有观点认为，精神分裂症患者神经认知功能衰退的根源可能与前额叶皮质中多巴胺活性降低有关。如果是这样的话，预计多巴胺D2受体阻断会进一步损害神经认知功能的某些方面。精神分裂症患者的神经认知功能水平与职业和社交能力相关，认知衰退的进程似乎与静止性脑病一致，而非进行性痴呆。对精神分裂症患者进行强化认知再训练可能会改善，但无法使认知表现的某些方面恢复正常。即使通过抗精神病药物治疗使症状有所改善，大多数认知缺陷仍保持稳定。诸如利培酮（新型5-羟色胺-多巴胺拮抗剂之一）这类药物对认知功能的影响优于传统的抗多巴胺能抗精神病药物，因此更有可能使患者从认知训练和其他形式的训练中获益。用于治疗锥体外系反应的抗胆碱能药物或具有抗胆碱能活性的药物也会损害认知功能。因此，由于使用SDA抗精神病药物时对抗胆碱能药物的需求较少，使用利培酮等药物治疗的患者的认知功能可能比服用传统抗精神病药物时更好。
