Objective To investigate cognitive impairment and the association with the grey matter volume in schizophrenia patients (NAS) with residual symptoms after antipsychotic drug treatment.Methods Eighteen NAS patients and 18 controls matched with age and education were recruited.Each subject was measured by neuropsychological cognitive tests,auditory event-evoked potential (P300) and MRI scans.The patient's symptoms were evaluated by using the PANSS and Clinical Global Impression Scale-Severity (CGI-S),while the side-effects of antipsychotics were evaluated by using the Extrapyramidal Side Effects Scale (SAS).Abnormal Involuntary Movement Scale (AIMS) and Barnes Akathisia Rating Scale (BARS).Then the difference between patients and controls and the associations between different measures were analyzed.Results Compared with control group,NAS patients showed abnormalities in most of the neuropsychological tests,including the poor performance in Continuous Performance Test (CPT):2-D,3-D (2.5 ±1.2,2.1±1.2 vs.3.5 ±0.6,2.9 ±0.8 for2-D,t=-3.088,-2.563,both P＜0.05) and the Stroop color word interference test (77.1 ± 16.6,32.4 ± 7.3,32.4 ± 7.3 vs.89.3 ± 8.9,41.8 ± 6.8,41.8 ± 6.8,t =-2.733,-4.015,-4.015,all P ＜ 0.05).The patients also showed poorer performance in groove nail plate test (69.8 ± 10.9,77.3 ± 11.4 vs.56.7 ± 7.1,68.7 ± 10.9,t =-4.015,2.313,both P ＜0.05),Color connection test (46.3 ± 18.1 vs.37.4 ± 10.6,t =4.638,P ＜ 0.05) and Category fluency test (11.8 ± 5.1 vs.15.6 ± 3.5,t =-2.593,P ＜ 0.05).NAS patients showed longer P300 N2 latency (237.1 ± 19.6) than controls (217.6 ± 26.5,t =2.966,P ＜ 0.05) while no difference on amplitude between groups.Further analyses showed the positive correlation between P30o amplitude and the performance of the maze test,the color of the connection test and the correct number of Wisconsin card number test (r =0.493,0.527,0.512,all P ＜ 0.05),while negative correlations were also found with the wrong number of Wisconsin card number test and groove nail plate test (r =-0.571,-0.512,both P ＜ 0.05).Finally we found that the P300 latency was related to regional gray matter volume at the right superior temporal gyrus and middle temporal gyrus,right posterior lobe of the cerebellar tonsils,and the second half of lobular.Conclusion There may be extensively damage in cognitive function of the patients.%目的 分析经抗精神病药治疗后病情基本稳定但仍残留部分症状的非急性期精神分裂症患者认知功能、听觉事件诱发电位P300和脑灰质体积的相关性.方法 采用听觉事件诱发电位P300、神经心理认知测验对18例非急性期精神分裂症患者(患者组)和18名健康对照者(对照组)进行认知功能检测;采用PANSS和临床总体印象量表(Clinical Global Impression Scale-Severity,CGI-S)评定患者的精神症状,锥体外系副反应量表(Extrapyramidal Side Effects Scale,SAS)、不自主运动量表(Abnormal Involuntary Movement Scale,AIMS)和静坐不能量表(Barnes Akathisia Rating Scale,BARS)评定既往使用抗精神病药的不良反应情况.利用磁共振和脑诱发电位仪分别对患者和对照者进行脑部影像学、神经电生理检查.结果 神经心理认知功能测验中持续性操作测验(Continuous Performance Test,CPT)两位数和三位数测验患者组(2.5±1.2、2.1±1.2)较对照组(3.5±0.6、2.9±0.8)评分低(t=-3.088、-2.563,均P＜0.05);Stroop色词干扰测试的单词、颜色和色词测试总分患者组(77.1 ±16.6、32.4±7.3和32.4±7.3)均较对照组(89.3±8.9、41.8±6.8、41.8±6.8)评分低(t=-2.733、-4.015、-4.015,均P＜0.05);沟槽钉板测验利手和非利手患者组(69.9±10.9、77.3±11.4)较对照组(56.7±7.1、68.7±10.8)完成测试时间延长(t=-4.015、2.313,均P＜0.05);颜色连线2患者组(46.3±18.1)较对照组(37.4±10.6)测试完成时间长(=4.638,P＜0.05);范畴流利测验患者组(11.8±5.1)较对照组(15.6±3.5)评分低(t=-2.593,P＜0.05),2组间比较差异有统计学意义.患者组的P300潜伏期N2(237.1±19.6)与对照组(217.6±26.6)比较延长(=2.966,P＜0.05),波幅差异无统计学意义.P300波幅与迷宫测试、颜色连线及威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)正确数呈正相关(r=0.493、0.527、0.512,均P＜0.05),与沟槽钉板、WCST错误数呈负相关(r=-0.571、-0.512,均P＜0.05).患者组的内侧前额叶、右侧颞叶和小脑部分区域的灰质体积较对照组下降,差异有统计学意义,P300潜伏期与局部脑灰质体积(右颞叶的颞上回和颞中回、右后叶小脑扁桃体、右侧小脑后叶、下半小叶)呈负相关(均P＜0.01).结论 非急性期精神分裂症患者的认知功能存在广泛损害.患者内侧前额叶、颞叶、小脑灰质体积异常,且右侧颞叶、右侧小脑局部灰质体积与P300潜伏期相关,提示颞叶、小脑等区域可能是P300异常的脑结构和功能基础.
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