稳定期双相障碍Ⅰ型患者的认知功能及相关因素

Cognitive Function and Related Factors in Euthymic Patients with BipolarⅠDisorder

目的:探讨稳定期双相障碍Ⅰ型患者认知功能损害及其相关因素。方法:纳入来自广州市精神病医院门诊和住院部的符合美国精神障碍诊断与统计手册第四版双相障碍Ⅰ型诊断标准的稳定期患者160例,以及来自本院或其他单位/学校的正常对照145名。采用数字符号、连线测验A(TrailMakingTestA,TMT-A)、数字广度(顺背)、视觉再生检测受试者的注意、记忆功能,用连线测验B(TrailMakingTestB,TMT-B)和数字广度(倒背)检测执行功能,特别是工作记忆和认知灵活性。结果:(1)患者组数字符号[(46.3±11.9)vs.(57.3±12.5)]、数字广度[顺背:(7.7±1.3)vs.(8.1±1.5)、倒背:(4.8±1.3)vs.(5.6±1.8)、总分:(12.5±2.2)vs.(13.68±2.9)]、视觉再生[(9.3±3.1)vs.(10.26±3.3)]、TMT-A[(54.1±19.0)vs.(42.6±16.9)]、TMT-B[(81.8±30.7)vs.(67.0±28.0)]成绩均差于正常对照组(Ps<0.01)。(2)按有(n=98)和无(n=62)精神病性症状将患者组进一步分层分析,方差分析显示组间差异有统计学意义(P<0.05),经LSD检验,2个患者亚组的数字广度(倒背、总分)、TMT-A、TMT-B成绩均差于正常对照组(P<0.05);有精神病性症状患者组的数字符号、数字广度(顺背)、视觉再生成绩也差于正常对照组(P<0.05)。(3)相关分析显示,患者组上述认知指标均与汉密尔顿抑郁量表和/或Young躁狂量表评分弱相关(|r|=0.15～0.26,Ps<0.05),数字符号与病程评分弱相关(r=-0.18,P<0.05);未发现发病年龄和稳定期时间与任何认知功能指标相关(P>0.05)。结论:稳定期双相障碍Ⅰ型患者存在明显的注意、记忆和执行功能损害,并与临床症状等临床特征无明显相关或相关性不强。

Objective： To examine the impairment of cognitive function and its related factors in patients with bipolar disorder （BD） . Methods： Cognitive function and its related factors were studied in 160 euthymic patients with bipolar I disorder （ BD- Ⅰ ）, diagnosed according to Diagnosic and Statistic Manual of Mental Disorder- Fourth Edition （DSM-Ⅳ） criteria , and 145 normal controls using digit symbol, digit span, visual reproduction and trail making test （TMT） . Result： （ 1 ） All indexes of digit symlod, digit span, visual reproduction and trail making text were significantly impared in BD-I patients than in normal controls （ P 〈 0. 05 ） . （ 2 ） BD patients were divided into patients with （ n = 98 ） and without （ n = 62 ） history of psychotic symptoms. Compared with controls, the two subgroups of patient had severer impairments in digit span （ reverse, forward ＋ reverse）, TMT-A and TMT-B respectively （ Ps 〈 0. 05） . Compared with controls, patients with history of psychotic symptoms were impaired also in digit symbol, digit span （forward） and visual reproduction （ P 〈 0. 05 ） . （ 3 ） In BD patients, all indexes of cognitive function were significantly correlated with HAMD and/or YMRS （ ｜ r ｜ =0. 15-0. 26, Ps〈0.05）, and the result of digit symbol was negatively correlated with duration of illness （r= -0. 18, P 〈 0. 05 ） . None of the indexes of cognitive function were significantly correlated with length of euthymia or the age of onset （ P 〉 0. 05 ） , Conelusion： Cognitive fucctions, including attention, memory and executive function, are impaired in euthymic BD-Ⅰ patients, and they are not or jusb mildy correlated with clinical features such as clinical symptoms.