老年精神分裂症患者前瞻性记忆的损伤阶段初探

Cognitive stages of prospective memory impairment in the elderly with schizophrenia

目的:初步探讨老年精神分裂症患者基于事件的前瞻性记忆(EBPM)和基于时间的前瞻性记忆(TBPM)的损伤阶段。方法:选取符合美国精神障碍诊断与统计手册第4版诊断标准住院老年精神分裂症患者41例以及年龄、受教育程度相匹配的正常老年对照55例,采用自行编制的前瞻性记忆实验室范式评估EBPM总分、TBPM总分及各项内部指标得分,使用简明精神病评定量表(BPRS)与简明阴性症状量表(BNSS)评估患者的精神病性症状及阴性症状。采用持续注意测验(CPT)评估被试对信号/噪音的区分度d';采用威斯康星卡片分类测验(WCST)和语义流畅性(CF)评估被试的执行功能,分别记录完成分类数和正确应答数。结果:精神分裂症组EBPM[4(0,8)vs.6(0,8),P<0.01]与TBPM得分[2(0,8)vs.6(0,8),P<0.01]均低于对照组;精神分裂症组EBPM任务替换分[2(0,8)vs.1(0,8),P<0.05]和TBPM任务漏报分[2(0,8)vs.0(0,6),P<0.01]高于对照组;此外,精神分裂症组TBPM回顾性再认分也明显低于对照组[7(0,7)vs.7(5,7),P<0.01]。结论:老年精神分裂症患者EBPM和TBPM均存在明显受损,受损阶段可能主要是自我启动的线索觉察与意图提取。此外,TBPM可能还在意图保持阶段有受损。

Objective：To elucidate the cognitive stages of event-based PM （EBPM） and time-based PM （TBPM） impairment in elderly with schizophrenia.Methods：Forty-one patients who were diagnosed as schizophrenia according to the criteria of Diagnostic and Statistic Manual of Mental Disorders,Fourth Edition （DSM-Ⅳ） and 55 normal elderly were enrolled in the study.Computerized EBPM and TBPM tasks were administered to them to measure level of PM.The Continuous Performance Test-Identical Pairs,Category Fluency,and Wisconsin Card Sorting Test were used to evaluate attention and executive function.The Brief Psychiatric Rating Scale （BPRS）,and Brief Negative Symptoms Scale （BNSS） were used to assess the severity of clinical symptoms.Results：The patients performed worse than controls on both EBPM total score [4（0,8） vs.6（0,8）,P ＜0.01] and TBPM total score [2（0,8） vs.6（0,8）,P ＜0.01].The patients with schizophrenia showed more errors of task substitution on EBPM [2（0,8） vs.1（0,8）,P＜0.05] and loss of time [2（0,8） vs.0（0,6）,P＜0.01] on TBPM.Moreover,the patients got lower score on a post-test multiple-choice recognition trial on TBPM [7（0,7） vs.7（5,7）,P ＜0.01].Conclusion：These findings indicate that the deficits on cue detection and self-initiated intention retrieval may be the key reason that underlie EBPM and TBPM impairment in elderly with schizophrenia.Furthermore,the weak maintenance stage might also contribute to TBPM failure.