Recent Advances in Cognitive Impairment in Schizophrenia：Stage-specific Features and Interventions

doi:10.12114/j.issn.1007-9572.2021.01.010

Abstract

Abstract: Although cognitive impairment occurs in each stage of schizophrenia，its specific trajectory in the development of schizophrenia is still unclear. We analyzed the overall development and stage-specific features of cognitive impairment in schizophrenia，then clarified its developmental trajectory，summarized that temporal changes of cognitive impairment are relatively insignificant，and reviewed relevant interventions. After that，we inferred that schizophrenia may be a cognitive disease in essence，and recommended that future diagnosis and treatment strategies for schizophrenia should be developed based on prevention，recognition and intervention of cognitive impairment.

Key words: Schizophrenia, Cognitive impairment, Cognitive dysfunction, Intervention, Review

摘要： 认知功能障碍贯穿于精神分裂症发生、发展的全过程，但其在疾病进程中的发展轨迹仍不清楚。本文从精神分裂症不同时期认知功能损害特点的角度出发，讨论了关于精神分裂症认知功能障碍的发生和发展过程，明确其发展轨迹以阐明精神分裂症的性质，并回顾了精神分裂症患者认知功能障碍的干预方式，发现精神分裂症患者的认知功能障碍随时间推移相对稳定，其本质可能为一种认知疾病，今后在临床诊断和治疗中需要从认知功能损害的预防、识别和干预等方面建立新的精神分裂症防控策略。

关键词: 精神分裂症, 认知功能损害, 认知功能障碍, 干预, 综述

WANG Xue，ZHOU Yuqiu，LIU Dongwei，WANG Weiliang，MENG Xiangyu，ZHANG Chunyu. Recent Advances in Cognitive Impairment in Schizophrenia：Stage-specific Features and Interventions　[J]. Chinese General Practice, 2021, 24(32): 4121-4125.

王雪，周郁秋，刘东玮，王伟梁，孟祥宇2张春宇. 精神分裂症不同时期认知功能损害特点及干预方式的研究进展[J]. 中国全科医学, 2021, 24(32): 4121-4125.

References

［1］张哲，周福春，何凡，等. 首发精神分裂症患者和精神病高危者的认知功能［J］. 中国心理卫生杂志，2017，31（5）：345-349.
ZHANG Z，ZHOU F C，HE F，et al. Cognitive function in patients with first-episode schizophrenia and individuals at high-risk for psychosis［J］. Chin Ment Heal J，2017，31（5）：345-349.
［2］GREEN M F，HORAN W P，LEE J. Nonsocial and social cognition in schizophrenia：current evidence and future directions［J］. World Psychiatry，2019，18（2）：146-161. DOI：10.1002/wps.20624.
［3］MCCLEERY A，NUECHTERLEIN K H. Cognitive impairment in psychotic illness：prevalence，profile of impairment，developmental course，and treatment considerations?［J］. Dialogues Clin Neurosci，2019，21（3）：239-248. DOI：10.31887/DCNS.2019.21.3/amccleery.
［4］CARRIóN R E，WALDER D J，AUTHER A M，et al. From the psychosis prodrome to the first-episode of psychosis：no evidence of a cognitive decline［J］. J Psychiatr Res，2018，96：231-238. DOI：10.1016/j.jpsychires.2017.10.014.
［5］BORA E，MURRAY R M. Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis：do the cognitive deficits progress over，or after，the onset of psychosis?［J］. Schizophr Bull，2014，40（4）：744-755. DOI：10.1093/schbul/sbt085.
［6］王传跃. 精神分裂症神经发育假说的发展轨迹［J］. 中华精神科杂志，2018，51（1）：3-4. DOI：10.3760/cma.j.issn.1006-7884.2018.01.002.
［7］陈楚侨，杨斌让，王亚. 内表型方法在精神疾病研究中的应用［J］. 心理科学进展，2008，16（3）：378-391.
CHEN C Q，YANG B R，WANG Y. Application of endophenotype approach in psychiatric research［J］. Adv Psychol Sci，2008，16（3）：378-391.
［8］MOLLON J，REICHENBERG A. Cognitive development prior to onset of psychosis［J］. Psychol Med，2018，48（3）：392-403. DOI：10.1017/s0033291717001970.
［9］LIU Y，WANG G D，JIN H，et al. Cognitive deficits in subjects at risk for psychosis，first-episode and chronic schizophrenia patients［J］. Psychiatry Res，2019，274：235-242. DOI：10.1016/j.psychres.2019.01.089.
［10］WOODBERRY K A，GIULIANO A J，SEIDMAN L J. Premorbid IQ in schizophrenia：a meta-analytic review［J］. Am J Psychiatry，2008，165（5）：579-587. DOI：10.1176/appi.ajp.2008.07081242.
［11］KHANDAKER G M，BARNETT J H，WHITE I R，et al. A quantitative meta-analysis of population-based studies of premorbid intelligence and schizophrenia［J］. Schizophr Res，2011，132（2/3）：220-227. DOI：10.1016/j.schres.2011.06.017.
［12］REICHENBERG A，CASPI A，HARRINGTON H，et al. Static and dynamic cognitive deficits in childhood preceding adult schizophrenia：a 30-year study［J］. Am J Psychiatry，2010，167（2）：160-169. DOI：10.1176/appi.ajp.2009.09040574.
［13］MOLLON J，DAVID A S，ZAMMIT S，et al. Course of cognitive development from infancy to early adulthood in the psychosis spectrum［J］. JAMA Psychiatry，2018，75（3）：270-279. DOI：10.1001/jamapsychiatry.2017.4327.
［14］CSNP精神病性障碍研究联盟全体成员，张天宏. 中国精神病临床高危综合征早期识别和干预——CSNP精神病性障碍研究联盟专家共识（2020版）［J］. 中国神经精神疾病杂志，2020，46（4）：193-199.
［15］FUSAR-POLI P，DESTE G，SMIESKOVA R，et al. Cognitive functioning in prodromal psychosis：a meta-analysis［J］. Arch Gen Psychiatry，2012，69（6）：562-571. DOI：10.1001/archgenpsychiatry.2011.1592.
［16］SOLíS-VIVANCO R，RANGEL-HASSEY F，LEóN-ORTIZ P，et al. Cognitive impairment in never-medicated individuals on the schizophrenia spectrum［J］. JAMA Psychiatry，2020，77（5）：543-545. DOI：10.1001/jamapsychiatry.2020.0001.
［17］SEIDMAN L J，SHAPIRO D I，STONE W S，et al. Association of neurocognition with transition to psychosis：baseline functioning in the second phase of the north American prodrome longitudinal study［J］. JAMA Psychiatry，2016，73（12）：1239-1248. DOI：10.1001/jamapsychiatry.2016.2479.
［18］MESHOLAM-GATELY R I，GIULIANO A J，GOFF K P，et al. Neurocognition in first-episode schizophrenia：a meta-analytic review［J］. Neuropsychology，2009，23（3）：315-336.
［19］MCCLEERY A，VENTURA J，KERN R S，et al. Cognitive functioning in first-episode schizophrenia：MATRICS Consensus Cognitive Battery （MCCB） profile of impairment［J］. Schizophr Res，2014，157（1/2/3）：33-39. DOI：10.1016/j.schres.2014.04.039.
［20］ZANELLI J，MOLLON J，SANDIN S，et al. Cognitive change in schizophrenia and other psychoses in the decade following the first episode［J］. Am J Psychiatry，2019，176（10）：811-819.
［21］BERGH S，HJORTH?J C，S?RENSEN H J，et al. Predictors and longitudinal course of cognitive functioning in schizophrenia spectrum disorders，10 years after baseline：the OPUS study［J］. Schizophr Res，2016，175（1/2/3）：57-63. DOI：10.1016/j.schres.2016.03.025.
［22］徐园园，贾竑晓. 精神分裂症临床分期模型的研究进展［J］. 首都医科大学学报，2018，39（2）：213-216.
XU Y Y，JIA H X. The progress on clinical staging model in schizophrenia［J］. J Cap Med Univ，2018，39（2）：213-216.
［23］SZ?KE A，TRANDAFIR A，DUPONT M E，et al. Longitudinal studies of cognition in schizophrenia：meta-analysis［J］. Br J Psychiatry，2008，192（4）：248-257. DOI：10.1192/bjp.bp.106.029009.
［24］IRANI F，KALKSTEIN S，MOBERG E A，et al. Neuropsychological performance in older patients with schizophrenia：a meta-analysis of cross-sectional and longitudinal studies［J］. Schizophr Bull，2011，37（6）：1318-1326. DOI：10.1093/schbul/sbq057.
［25］THOMPSON W K，SAVLA G N，VAHIA I V，et al. Characterizing trajectories of cognitive functioning in older adults with schizophrenia：does method matter?［J］. Schizophr Res，2013，143（1）：90-96. DOI：10.1016/j.schres.2012.10.033.
［26］王丹丹，张晨.精神分裂症患者认知功能的神经免疫机制及非典型抗精神病药物对其影响的研究进展［J］. 上海交通大学学报：医学版，2019，39（7）：795-799.
WANG D D，ZHANG C. Research progress of neuroimmune mechanisms of cognitive function in schizophrenia and effect of atypical antipsychotic drugs on it［J］. J Shanghai Jiao Tong Univ：Med Sci，2019，39（7）：795-799.
［27］SINKEVICIUTE I，BEGEMANN M，PRIKKEN M，et al. Efficacy of different types of cognitive enhancers for patients with schizophrenia：a meta-analysis［J］. NPJ Schizophr，2018，4（1）：22. DOI：10.1038/s41537-018-0064-6.
［28］卓恺明，陆峥. 精神分裂症患者认知训练治疗的原则、方法及展望［J］. 中国心理卫生杂志，2017，31（10）：793-797.
ZHUO K M，LU Z. Cognitive training in patients with schizophrenia：principles，methods and prospects［J］. Chin Ment Heal J，2017，31（10）：793-797.
［29］WYKES T，HUDDY V，CELLARD C，et al. A meta-analysis of cognitive remediation for schizophrenia：methodology and effect sizes［J］. Am J Psychiatry，2011，168（5）：472-485. DOI：10.1176/appi.ajp.2010.10060855.
［30］朱春燕，孙继军，汤剑平，等. 计算机辅助认知矫正治疗对康复期精神分裂症患者认知功能、自尊水平及社会功能的影响［J］. 中国全科医学，2018，21（16）：2003-2008.
ZHU C Y，SUN J J，TANG J P，et al. Effect of computer-assisted cognitive remediation therapy on the improvement of cognitive function，level of self-esteem and social performance in schizophrenia patients during recovery period［J］. Chin Gen Pract，2018，21（16）：2003-2008.
［31］MATSUDA Y，MAKINODAN M，MORIMOTO T，et al. Neural changes following cognitive remediation therapy for schizophrenia［J］. Psychiatry Clin Neurosci，2019，73（11）：676-684. DOI：10.1111/pcn.12912.
［32］PRIKKEN M，KONINGS M J，LEI W N，et al. The efficacy of computerized cognitive drill and practice training for patients with a schizophrenia-spectrum disorder：a meta-analysis［J］. Schizophr Res，2019，204：368-374. DOI：10.1016/j.schres.2018.07.034.
［33］董玲，安翠霞，王学义. 精神分裂症认知功能损害的非药物治疗研究进展［J］. 中华精神科杂志，2014，47（1）：56-58. DOI：10.3760/cma.j.issn.1006-7884.2014.01.016.
［34］JAHSHAN C，RASSOVSKY Y，GREEN M F. Enhancing neuroplasticity to augment cognitive remediation in schizophrenia［J］. Front Psychiatry，2017，8：191. DOI：10.3389/fpsyt.2017.00191.
［35］FIRTH J，STUBBS B，ROSENBAUM S，et al. Aerobic exercise improves cognitive functioning in people with schizophrenia：a systematic review and meta-analysis［J］. Schizophr Bull，2017，43（3）：546-556. DOI：10.1093/schbul/sbw115.
［36］MERVIS J E，CAPIZZI R J，BORODA E，et al. Transcranial direct current stimulation over the dorsolateral prefrontal cortex in schizophrenia：a quantitative review of cognitive outcomes［J］. Front Hum Neurosci，2017，11：44. DOI：10.3389/fnhum.2017.00044.
［37］徐清，程灶火，刘晓伟，等. 重复经颅磁刺激对慢性精神分裂症患者认知功能和血清脑源性神经营养因子水平的影响研究［J］. 中国全科医学，2017，20（25）：3171-3177. DOI：10.3969/j.issn.1007-9572.2017.25.023.
XU Q，CHENG Z H，LIU X W，et al. Effect of rTMS on the cognitive function and sBDNF levels in chronic schizophrenia patients［J］. Chinese General Practice，2017，20（25）：3171-3177. DOI：10.3969/j.issn.1007-9572.2017.25.023.

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