背景:与精神分裂症(CIAS)相关的认知障碍对日常功能产生负面影响,生活质量,和恢复,然而,缺乏有效的药物治疗和临床实践评估。尽管建立了改善精神分裂症认知的测量和治疗研究(MATRICS)共识认知电池(MCCB)的临床研究取得了关键进展,在临床实践中,对于大多数临床医生来说,实施完整的MCCB太耗时且成本效益低。
方法:在这里,我们讨论与交付格式相关的当前评估(基于访谈和基于绩效),有效性,便于临床医生和患者使用,可靠性/再现性,成本效益,以及临床实施的适用性。还提出了改进认知评估的关键挑战和未来机遇。
结果:需要30分钟才能完成的当前评估在临床环境中具有价值,但是相关的工作人员培训和所需的时间可能会妨碍他们在大多数临床环境中的应用。认知缺陷的初始分析可能需要约30分钟来帮助选择基于证据的治疗方法;通过简短评估(持续时间10-15分钟)进行后续监测以检测与治疗相关的对整体认知的影响可以补充这种方法。有必要对经过验证的简短认知测试进行指导,以战略性地监测CIAS的治疗效果。
结论:随着基于技术和远程评估的进步,开发经过验证的远程和亲自评估格式,以及实施所需的必要培训模式和基础设施,可能对未来的临床实践具有越来越大的临床意义。
BACKGROUND: Cognitive impairment associated with schizophrenia (CIAS) negatively impacts daily functioning, quality of life, and recovery, yet effective pharmacotherapies and practical assessments for clinical practice are lacking. Despite the pivotal progress made with establishment of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) for clinical research, implementation of the full MCCB is too time-consuming and cost-ineffective for most clinicians in clinical practice.
METHODS: Here we discuss current assessments in relation to delivery format (interview-based and performance-based), validity, ease of use for clinicians and patients, reliability/reproducibility, cost-effectiveness, and suitability for clinical implementation. Key challenges and future opportunities for improving cognitive assessments are also presented.
RESULTS: Current assessments that require 30 min to complete would have value in clinical settings, but the associated staff training and time required might preclude their application in most clinical settings. Initial profiling of cognitive deficits may require about 30 min to assist in the selection of evidence-based treatments; follow-up monitoring with brief assessments (10-15 min in duration) to detect treatment-related effects on global cognition may complement this approach. Guidance on validated brief cognitive tests for the strategic monitoring of treatment effects on CIAS is necessary.
CONCLUSIONS: With increased advancements in technology-based and remote assessments, development of validated formats of remote and in-person assessment, and the necessary training models and infrastructure required for implementation, are likely to be of increasing clinical relevance for future clinical practice.