精神分裂症患者认知功能测评中的努力度效应

Effect of insufficient effort on cognitive assessments in patients with schizophrenia

目的:采用词汇记忆测验(WMT)来探讨精神努力度在精神分裂症患者认知功能测评过程中的效应。方法:入组110例确诊为精神分裂症的患者及110例年龄、性别、受教育年限相匹配的正常对照,施测精神分裂症认知功能成套测验共识版(MCCB),并以词汇记忆测验(WMT)作为测验过程中被试精神努力度的评估指标。根据WMT的通过标准,将被试分为"患者-正常努力"(Sch-NE),"患者-努力不足"(Sch-IE),"对照-正常努力"(Con-NE)和"对照-努力不足"(Con-IE)4组。此外,患者组还完成了阳性和阴性症状量表(PANSS)、瑞文标准推理测验(SPM)及威斯康星卡片分类测验(WCST)。结果:患者组未通过WMT的人数高于对照组(37%vs.8%,P<0.001);患者组WMT各项指标得分均低于对照组[如,即时再认得分(91.0±11.7)vs.(96.8±4.3),P<0.001]。在控制努力度的情况下,患者组MCCB的各项得分(言语流畅分测验除外)均低于对照组[如,MCCB总分(37.8±10.4)vs.(50.9±8.8),P<0.001]。努力度效应显著(迷宫分测验除外),但其效应(Eta2介于1.7%~10.8%)低于组别效应(Eta2介于6.2%~24.7%)。Sch-NE组的MCCB和WCST得分(连线和迷宫分测验除外)均高于Sch-IE组[如,MCCB总分(40.4±9.8)vs.(32.6±9.6),P<0.001]。WMT各项指标得分与MCCB和WCST得分呈正相关(r=0.19~0.45,P<0.05),与PANSS中的阴性量表分、一般精神病理分和反应缺乏因子分呈负相关(r=-0.20^-0.32,P<0.05)。结论:对精神分裂症患者进行认知功能评定的过程中应考虑努力度效应。对努力度的控制可能会影响对分裂症患者认知损害的评估、治疗及相关研究的准确性。

Objective：To explore the effects of different levels of effort on the cognitive assessments in patients with schizophrenia.Methods：One hundred and ten patients with schizophrenia and 110 normal controls were tested with the MATRICS Consensus Cognitive Battery （MCCB） and Word Memory Test （WMT）.The two groups were divided into 4 subgroups of normal effort （NE） and insufficient effort （IE） on WMT,namely,Sch-NE group,Sch-IE group,Con-NE group and Con-IE group.The patients with schizophrenia were also tested with the Positive and Negative Syndrome Scale （PANSS）,Raven＇s Standard progressive Matrices （SPM） and Wisconsin Card Sorting Test （WCST）.Results：The WMT failure rate was significantly higher in schizophrenia patients than in normal controls （37% vs.8%,P 〈0.001）.The patients with schizophrenia generally performed worse than the normal controis in all WMT scores [e.g.,Immediate Recognition,（91.0 ± 11.7） vs.（96.8 ±4.3）,P 〈0.001].With WMT mean score was introduced as covariate variable in the statsfical analyses,the patients with schizophrenia generally performed worse than the normal controls in all cognitive tests except for category fluency test [e.g.,MCCB total score,（37.8 ± 10.4）vs.（50.9 ± 8.8）,P 〈 0.001].The effect of effort was significant for all cognitive tests except maze test （P 〈 0.001）,and was always considerably smaller （Eta2 between 1.7 %-10.8 %） than the group differences （Eta2ranged between 6.2%-24.7%）.The Sch-NE group generally performed higher than the Sch-NE group in all cognitive tests except for trail making test and maze test [e.g.,MCCB total score,（40.4 ±9.8） vs.（32.6 ±9.6）,P 〈 0.001].The WMT scores were positively correlated with the scores of MCCB and WCST（r =0.19-0.45,Ps 〈0.05）,and negatively correlated with the symptom scale scores（r =-0.20--0.32,Ps 〈0.05）.Conclusion：It suggests that mental effort should be taken into consideration in cognitive assessments of schizophrenic patients.Controlling for this variable may have a considerable impact on research,assessment and treatment of cognitive disorders in patients with schizophrenia.