精神分裂症认知功能成套测验中文版临床信度及效度的研究

目的 对中文版精神分裂症认知功能成套测验(MCCB)的信度及效度进行临床测试.方法 对122例符合美国精神障碍诊断与统计手册第4版精神分裂症诊断标准的住院患者(患者组)进行MCCB测验,4周后重测,同期接受威斯康星卡片分类测验(WCST)、瑞文推理测验(RAVEN)、色词测验(Stroop)及阳性和阴性症状量表(PANSS)测查;并与122名性别、年龄和文化程度与患者组相匹配的社区正常人(对照组)进行比较.结果 (1)MCCB重测相关系数为0.88,P<0.001;(2)评定者间组内相关系数为0.97,P<0.001;(3)MCCB的A、B版本间的复本相关系数为0.64～0.74,P<0.001;A、B版本间的差异无统计学意义(P>0.05);(4)患者组各个分测验得分均低于对照组(P<0.001);逻辑回归分析,用MCCB区分精神分裂症患者与正常人,符合率达到84.8%(P<0.001),敏感性83.6%,特异性86.1%;(5)关联效度:MCCB与WCST、RAVEN和Stroop呈显著性相关(r=0.54～0.55),P<0.001;(6)结构效度:验证性因素分析证明中文版MCCB与英文版7个维度结构模型拟合良好;(7)MCCB平均完成时间为(58±10)min,耐受性和操作性达到中等偏上水平.结论 中文版MCCB的重测信度、评定者间信度、同质性信度、复本信度、关联效度、结构效度和效标效度等指标满足心理测量学要求,MCCB作为精神分裂症患者认知功能疗效评估的新标准,值得进一步修订和完善.     

老年精神分裂症患者的认知功能研究

目的 探讨老年精神分裂症患者认知功能损害的范围和特点。方法 采用世界卫生组织老年认知功能评价成套神经心理测验(WHO-BCAI)、简易智能状态检查(MMSE)、日常生活量表(ADL)作为主要工具,对老年精神分裂症患者和正常老人进行测试。结果 老年精神分裂症组35例,男19例,女16例,平均年龄(63.24±6.5)岁。正常对照组83例,男42例,女41例,平均年龄(65.9±5.9)岁。MMSE平均总分,老年精神分裂症组(24.9±4.2)分,正常为(28.7±1.1)分;老年精神分裂症组ADL平均总分(27.1±8.1)分,正常组(20.3±1.2)分;WHO-BCAI测验结果显示,两组在7项听觉词汇学习测验、4项语言能力测验、4项视觉辨认测验、5项注销测验、2项连线测验、分类测验、精神运动测验和空间结构测验分别具有显著性差异(P<0.05)。结论 老年精神分裂症患者认知功能有明显障碍,并且范围广泛。     

综合认知训练对社区健康老人认知功能的影响

目的 探索综合认知训练对社区健康老人认知功能的影响.方法 对上海市某街道社区老人(年龄≥70岁),按照每50人一组进行筛查,共筛查347名.151名老人符合入组标准,按类随机方式分为认知训练干预组(90名)和非认知训练组(对照组,61名).对干预组进行12周(共24次)的综合认知训练.干预前后采用中国老年成套神经心理测验(NTBE)、Stroop字色干扰测验中文版及自制健康问卷对两组进行测评.结果 (1)干预前:干预组NTBE中听觉词汇学习1重复数、无关插入数及语义联系3项评分高于对照组(P<0.05～0.01),其他测验两组间差异均无统计学意义(P>0.05).(2)干预后组内比较:干预组NTBE18项、Stroop字色干扰测验6项自身有提高(P≤0.05～0.01).对照组NTBE 9项提高,1项下降;Stroop字色干扰测验1项自身有提高,2项下降(P≤0.05～0.01).(3)干预后组间比较:干预组NTBE 4项、Stroop字色干扰测验2项优于对照组(P≤0.05～0.01).结论 综合认知训练对社区健康老人执行功能、推理能力等认知功能有提高作用.     

男性慢性精神分裂症患者血清脑源性神经营养因子和胶质源性神经营养因子水平及认知功能的对照研究

目的:探讨慢性精神分裂症患者血清脑源性神经营养因子(BDNF)、胶质源性神经营养因子水平(GDNF)和神经认知功能的变化及它们之间关系。方法:入组慢性精神分裂症患者57例和正常对照39名。采用阳性与阴性症状量表(PANSS)评估患者的精神症状。使用酶联免疫吸附法检测血清BDNF、GDNF蛋白水平,采用数字划消测验、连线测验(TMT)、WMS-III空间广度测验(WMS-III SST)、定步调连续加法任务测验(PASAT)、Stroop测验、木块图评估神经认知功能。结果:患者组血清BDNF水平低于对照组,差异有统计学意义(t=9.112,P0.01),患者组血清GDNF与对照组相比差异无统计学意义(t=1.513,P0.05)。患者组数字划消测验、TMT-A、TMT-B、Stroop测验、木块图、WMS-III SST逆行分、PASAT成绩均差于对照组(P0.05)。患者组血清BDNF水平与PANSS阳性症状分、数字划消测验中的错误个数呈负相关(分别为r=-0.295,P=0.026;r=-0.262,P=0.049),血清GDNF水平与Stroop色词干扰测验分呈正相关(r=0.263,P=0.048)。结论:慢性稳定期的精神分裂症患者仍存在广泛的神经认知损害。BDNF可能是精神分裂症的一种素质性标记,可能参与了患者的注意障碍。     

抑郁症首次发病患者睡眠障碍与认知功能的关系

目的:探讨首发抑郁症患者睡眠障碍和认知功能损害的关系。方法:采用17项汉密尔顿抑郁量表(HAMD-17)评估378例首发抑郁症患者的抑郁症状,根据是否伴有睡眠障碍分为睡眠障碍组(HAMD总分≥14分且睡眠因子分≥4分)253例和非睡眠障碍组(HAMD总分≥14分且睡眠因子分≤3分)125例;采用重复性成套神经心理状态测验(RBANS)、威斯康星卡片分类测验(WCST)、Stroop色-词关联测验评估两组认知功能并进行比较。结果:睡眠障碍组RBANS即刻记忆(t=-4.309)、视觉广度(t=-2.321)、注意因子(t=-4.555)、延时记忆(t=-2.282)得分及总分(t=-2.549)、WCST完成分类数(t=-3.459)、学习到学会(t=-2.406)得分显著低于非睡眠障碍组(P0.05或P0.001);错误应答数(t=3.621)、持续性错误百分比(t=3.753)、Stroop色-词关联测验单色时间(t=2.010)、字义干扰反应时(t=2.168)、颜色干扰反应时(t=3.089)显著高于非睡眠障碍组(P0.05或P0.001)。结论:首发抑郁症患者的睡眠障碍与认知功能损害有一定关联;伴睡眠障碍者较不伴睡眠障碍者认知功能损害更严重。     

利培酮、齐拉西酮和阿立哌唑对精神分裂症患者认知功能影响的比较

目的:探讨利培酮、齐拉西酮和阿立哌唑对精神分裂症患者认知功能的影响. 方法:98例急性期精神分裂症患者分为利培酮组32例,齐拉西酮组35例和阿立哌唑组31例,分别予利培酮、齐拉西酮和阿立哌唑治疗8周.以重复性成套神经心理状态测验(RBANS)评价患者认知社会功能变化.结果:利培酮组RBANS注意力(F=0.26)、即刻记忆(F=41.62)和视觉空间结构(F=3.09)变化差异有统计学意义(P均=0.00),但语言(F=17.65)和延迟记忆(F=0.17)变化差异无统计学意义(P均＞0.05).阿立哌唑组RBANS即刻记忆(F=50.66)和语言(F=17.53)变化差异有统计学意义(P均=0.00).齐拉西酮组在即刻记忆(F=51.62)、视觉空间结构(F=63.12)变化差异有统计学意义(P均=0.00).结论:利培酮、阿立哌唑、齐拉西酮虽同属非典型抗精神病药,但对认知功能的影响不尽相同.     

伴发脂代谢异常的男性精神分裂症患者认知功能研究

目的探讨合并脂代谢异常的慢性男性精神分裂症患者认知功能缺损特征。方法对48例伴有脂代谢异常（合并组）及41例无脂代谢异常（单纯组）的持续服用氯氮平超过2年的慢性住院精神分裂症患者进行阳性和阴性症状量表（PANSS）、重复性成套神经心理状态测验（RBANS）及不良反应量表（TESS）评定,以了解其认知功能缺损情况。结果（1）两组之间PANss总分、各因子分及TESS总分均差异无统计学意义（P〉0．05）;（2）伴有脂代谢异常患者组在RBANS测验中,视觉空间因子分低于单纯组,差异有统计学意义（P〈0．01）。结论伴有脂代谢异常慢性精神分裂症患者存在更严重的认知功能损害,其以视觉空间记忆损害更明显。     

伴与不伴抑郁症状的精神分裂症患者临床特征的性别差异

目的:探讨伴与不伴抑郁症状的精神分裂症患者临床症状的性别差异。方法:纳入精神分裂症患者138例及正常对照者94名,采用阳性和阴性症状量表(PANSS)评估患者的精神症状、卡尔加里精神分裂症抑郁量表(CDSS)评估患者的抑郁症状;同时运用重复性神经心理状态测验(RBANS)评估受试者的认知功能。结果:精神分裂症伴有抑郁组PANSS总分及因子分高于不伴抑郁症状组(P均0.001),RBANS总分及因子分低于不伴抑郁症状组(P0.05或P0.01)。性别分层后,PANSS总分及因子分、RBANS总分及因子分在女性精神分裂症患者伴与不伴抑郁症状组间差异有统计学意义(P0.05或P0.01),男性伴与不伴抑郁症状组PANSS总分、阴性症状、一般精神症状分、RBANS总分及即时记忆因子分差异有统计学意义(P0.05或P0.01)。男、女精神分裂症患者CDSS分与PANSS总分呈正相关(P均0.001),而CDSS评分与RBANS总分的相关性只存在于女性精神分裂症患者中(女:r=-0.334,P=0.008)。结论:伴与不伴抑郁症状的精神分裂症患者精神症状及认知功能存在男女性别差异。     

Stroop色词测验在早期识别阿尔茨海默病中的作用

目的评估中文版Stroop色词测验(CWT)在识别轻度认知功能损害(MCI)与轻度阿尔茨海默病(AD)中的作用。方法正常老人94名,遗忘型MCI组86名和轻度AD组51名完成包括简易智力状态检查量表(MMSE)和CWT在内的8种神经心理测验。正常老人、MCI和轻度AD组的MMSE总分分别为(28.2±1.5)分、(26.9±1.9)分和(20.1±2.5)分。CWT由3张卡片、每张50字、4种颜色组成。分析指标包括完成每张卡片的耗时数、正确阅读数和干扰量(SIE)。结果SIE与反映执行功能的连线测验、言语流畅性测验有显著的相关性。不管是正常老人还是认知损害患者,读字(卡片A)均快于颜色命名(卡片B)。以卡片C正确数39个为分界,识别轻度AD的敏感性为80.4%,特异性为86.2%。根据SIE指标发现轻度AD患者在处理速度和正确性的关系方面与MCI组的应答策略不同。结论中文版CWT适合在中国老人中应用,有助于早期识别AD,MCI患者和轻度AD患者针对干扰作用的不同表现。     

难治性强迫症患者认知功能及影响因素

目的：探讨难治性强迫症患者认知功能及影响因素。方法：55例难治性强迫症患者（患者组）及60名正常对照者（对照组）进行Stroop色词测验、可反复测查的成套神经心理状态评估工具（RBANS）以及Yale-Brown强迫量表（YBOCS）评定,对心理测查成绩与一般情况进行相关性分析。结果：患者组RBANS在言语功能分上明显低于正常对照组（P〈0.01）。患者的年龄、起病年龄与RBANS即时记忆分、注意分、总分呈负相关（P〈0.05或P〈0.01）;与Stroop中颜色干扰时呈正相关（P〈0.05或P〈0.01）;YBOCS分与Stroop中字义干扰时呈正相关（P〈0.01）。在RBANS各项评分及总分上,有工作的患者组评分（n=30）高于无工作的患者组（n=25）,差异有统计学意义（P均〈0.01）。结论：难治性强迫症患者言语功能明显受损。年龄、起病年龄和症状严重程度与认知功能有显著相关。有工作可能对强迫症患者认知功能有保护性作用。     

Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia, II: convergent/discriminant validity and diagnostic group comparisons

OBJECTIVE: In a companion article in this issue of the Journal, the authors presented data suggesting that the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is sensitive to the types of impairments observed in schizophrenia, correlates highly with standard measures of intelligence and memory, and is related to employment status in a group of patients with schizophrenia drawn from a tertiary care research center. The objectives of the current study were 1) to determine if evidence of the convergent validity of the RBANS could be replicated in a diagnostically heterogeneous sample drawn from a public mental health system, 2) to examine the relationship of the RBANS to a broad neuropsychological battery, and 3) to compare the performance of patients with schizophrenia and patients with bipolar disorder on a neuropsychological battery and the RBANS. METHOD: The RBANS and a standard neuropsychological battery, including the WAIS-III and Wechsler Memory Scale, 3rd ed. (WMS-III), were given to 150 patients drawn from a larger study of vocational rehabilitation. RESULTS: Correlations of RBANS total scores with WAIS-III and WMS-III variables were highly similar across study groups. The RBANS correlated highly with a composite z score derived from 22 standard measures of IQ, memory, language, motor, attention, and executive function. Principal component analyses of the neuropsychological battery resulted in a six-factor solution: the RBANS correlated most highly with a general ability factor and had limited correlations with measures of motor performance, vigilance, and executive function. Patients with schizophrenia demonstrated greater deficits on the neuropsychological battery and the RBANS than patients with bipolar disorder. CONCLUSIONS: These data suggest that the RBANS is a useful screening instrument for assessing the severity of cognitive impairment in psychiatric populations.     

Construct and predictive validity of the repeatable battery for the assessment of neuropsychological status in the evaluation of stroke patients

To evaluate the construct and predictive validity of a brief neuropsychological assessment battery, consecutive admissions to a hospital receiving inpatient treatment for stroke were tested with the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and other neuropsychological measures. Discriminant and convergent validity were adequate for the Language, Visuospatial/Constructional, Immediate Memory and Delayed Memory indices in the RBANS, but weaker for the Attention Index. Twelve months later, 36 discharged patients were contacted by telephone and interviews using a battery of functional outcome measures. RBANS Total Score predicted indices from the RBANS also predicted cognitive disability as measured by the Functional Independence Measure. Individual indices from the RBANS also predicted instrumental activities of daily living (IADLS) as measured by the Craig Handicap Assessment and Reporting Technique. The present findings suggest that the RBANS can be a useful tool in the neuropsychological evaluation of inpatients with stroke.     

Construct validity of the Repeatable Battery of Neuropsychological Status (RBANS) with acquired brain injury patients

The construct validity of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) indices and subtests in comparison to established neuropsychological measures has yet to be investigated in post-acute adults with a moderate to severe acquired brain injury. A sample of 37 patients from an inpatient brain injury rehabilitation program were administered the RBANS followed by a neuropsychological test battery approximately two weeks later. Significant relationships were observed between most of the RBANS subtests and indices and neuropsychological tests putatively assessing similar cognitive domains. These results provide preliminary support for the construct validity of the RBANS indices and subtests when used with moderate to severe acquired brain injury patients.     

Construct Validity of the Repeatable Battery of Neuropsychological Status (RBANS) with Acquired Brain Injury Patients

The construct validity of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) indices and subtests in comparison to established neuropsychological measures has yet to be investigated in post–acute adults with a moderate to severe acquired brain injury. A sample of 37 patients from an inpatient brain injury rehabilitation program were administered the RBANS followed by a neuropsychological test battery approximately two weeks later. Significant relationships were observed between most of the RBANS subtests and indices and neuropsychological tests putatively assessing similar cognitive domains. These results provide preliminary support for the construct validity of the RBANS indices and subtests when used with moderate to severe acquired brain injury patients.     

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Preliminary Clinical Validity

Neuropsychological assessment of older individuals with dementing illnesses has suffered from a lack of appropriately designed test instruments. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was developed for the dual purposes of identifying and characterizing abnormal cognitive decline in the older adult and as a neuropsychological screening battery for younger patients. The entire battery takes less than 30 minutes to administer, and yields scaled scores for five cognitive domains. The current study reports preliminary clinical validity results with the RBANS, comparing very mildly demented patients with a diagnosis of probable Alzheimer's disease (n = 20) to patients with Huntington's disease (n = 20) and normal controls (n = 40). Although the patient groups had essentially identical total scores on the RBANS, they exhibited opposite profiles, differing significantly on four of the five subsections. The AD patients performed most poorly on Language, and Delayed Memory subsections, while the HD patients obtained their lowest scaled scores on the Attention and the Visuospatial/Constructional subsections. These results are consistent with the neuropsychological profiles of these dementing disorders derived from lengthier standardized tests and experimental investigations. In addition, even those patients who performed above the suggested cut-off points on the MMSE and the Dementia Rating Scale scored significantly below their controls on the RBANS. These data suggest that the RBANS is effective at both detecting and characterizing dementia of different etiologies.     

The Japanese version of RBANS (Repeatable Battery for the Assessment of Neuropsychological Status)]

In Japan, neuropsychological assessment of dementing illnesses has been done mainly using Mini-Mental State Examination (MMSE) and a revised version of Hasegawa Dementia Scale (HDS-R). However, because of a lack of appropriately designed test domains, early detection of senile dementia and/or cognitive impairment is hardly possible, even if using these batteries. This paper is to introduce a Japanese Version of RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) which was originally developed by Randolph and revised by us. The entire battery of Japanese Version RBANS took less than 30 minutes to administer, and yielded scaled scores for five cognitive domains such as immediate memory, visuospatial/constructional ability, language, attention, and delayed memory. On RBANS, abnormal cognitive decline in the older adult was much easily detected, being compared to MMSE and HDS-R: 52 normal volunteer subjects ranging from 24 to 80 years old showed a significant (p < 0.05 on t test) impairment of delayed and immediate memories due to ageing. The aged (60-79) subjects with average scores of MMSE and HDS-R being over 25, significantly showed impairment of both immediate memory (list and story learnings) and delayed memory (list, story and figure recalls). The present data suggest that the Japanese Version RBANS is useful for both detecting and characterizing early dementia, and should be widely utilized for a neuropsychological screening battery in the clinical practice throughout Japan.     

Effort and cognition in schizophrenia patients

OBJECTIVE: The aim of this study was to determine whether low cognitive test scores in schizophrenia patients are due to insufficient effort and, if so, to what extent. METHOD: Mental effort was measured with the Word Memory Test (WMT), an effort test that has been extensively validated. Schizophrenic patients (n=64), non-psychotic psychiatric patients (n=63), neurological controls (n=20), and normal controls (n=44) were tested with a neuropsychological test battery measuring memory, attention and executive functioning. RESULTS: The majority of the schizophrenia patients and a quarter of the psychiatric patients scored below the cut-offs for normal effort on the WMT. Scores on the effort test explained a significant amount of variance in the neuropsychological test performance of schizophrenic patients. This lends support to the notion that cognitive functioning in schizophrenia is compromised by insufficient effort. Furthermore, poor mental effort was related to negative symptoms. CONCLUSIONS: Poor mental effort might be considered a core symptom of schizophrenia, representing an executive, monitoring or motivational problem. Mental effort should be taken into consideration in the neuropsychological assessment of schizophrenic patients and of psychiatric patients in general. Controlling for this variable may have a considerable impact on research, assessment and treatment of cognitive disorders in schizophrenic patients.