Alteraciones neurocognitivas en la esquizofrenia. Análisis factorial
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Objetivo: el déficit en los procesos cognitivos, específicamente en el rendimiento ejecutivo, de los pacientes con esquizofrenia se ha asociado con mala adaptación social. Un modelo factorial de las funciones ejecutivas permitiría detectar la asociación entre el perfil sintomático, el deterioro de la función ejecutiva y las necesidades de rehabilitación. El objetivo de esta investigación fue identificar factores de la función ejecutiva mediante un análisis factorial de las puntuaciones tipificadas de una serie de pruebas neuropsicológicas, en un grupo de pacientes ambulatorios con diagnósticos del espectro de la esquizofrenia.
Metodología: estudio factorial mediante un análisis de componentes principales (ACP) con rotación ortogonal (varimax) de 13 medidas neuropsicológicas estandarizadas.
Resultados: se obtuvieron tres factores independientes: (1) flexibilidad cognitiva, (2) control de la interferencia y memoria de trabajo y (3) velocidad de procesamiento y atención, que proporcionan una medición psicométrica adecuada del desempeño ejecutivo de los pacientes estudiados.
Conclusiones: el análisis revela una estructura compleja de tres dimensiones cognitivas discretas que se pueden medir con una batería de uso común en la clínica.
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Braff DL. Information processing and attention dysfunctions in schizophrenia. Schizophr Bull 1993; 19(2):233–259.
Blanchard JJ, Neale JM. The neuropsychological signature of schizophrenia: Generalized or differential deficit? Am J Psychiatry 1994; 151(1):40–48.
Saykin AJ, Shtasel DL, Gur RE, Kester DB, Mozley LH, Stafiniak P, et al. Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia. Arch Gen Psychiatry 1994; 51(2):124–131.
Bilder RM, Goldman RS, Robinson D, Reiter G, Bell L, Bates JA, et al. Neuropsychology of firstepisode schizophrenia: Initial characterization and clinical correlates. Am J Psychiatry 2000; 157(4):549–559.
Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 1996; 153(3):321–330.
Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the “right stuff”? Schizophr Bull 2000; 26(1):119–136.
Savilla K, Kettler L, Galletly C. Relationships between cognitive deficits, symptoms and quality of life in schizophrenia. Aust N Z J Psychiatry 2008; 42(6):496–504.
Evans J, Bond GR, Meyer PS, Kim HW, Lysaker PH, Gibson PJ, et al. Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia. Schizophr Res 2004; 70(2- 3):331–342.
Johnson-Selfridge M, Zalewski C. Moderator variables of executive functioning in schizophrenia: Meta-analytic findings. Schizophr Bull 2001; 27(2):305–316.
Franco JG, Valero J, Labad-Alquezar A. [Minor physical abnormalities and clinical features in patients with schizophrenia spectrum disorders]. Rev Neurol 2012; 54(8):468–474.
Mulet B, Valero J, Gutiérrez-Zotes A, Montserrat C, Cortés MJ, Jariod M, et al. Sustained and selective attention deficits as vulnerability markers to psychosis. Eur Psychiatry 2007; 22(3):171–176.
Chan RCK, Chen EYH, Cheung EFC, Chen RYL, Cheung HK. The components of executive functioning in a cohort of patients with chronic schizophrenia: A multiple single-case study design. Schizophr Res 2006; 81(2-3):173–189.
Greenwood KE, Morris R, Sigmundsson T, Landau S, Wykes T. Executive functioning in schizophrenia and the relationship with symptom profile and chronicity. J Int Neuropsychol Soc 2008; 14(05):782–792.
Moritz S, Andresen B, Jacobsen D, Mersmann K, Wilke U, Lambert M, et al. Neuropsychological correlates of schizophrenic syndromes in patients treated with atypical neuroleptics. Eur Psychiatry. 2001; 16(6):354–361.
Norman RM, Malla AK, Cortese L, Cheng S, Diaz K, McIntosh E, et al. Symptoms and cognition as predictors of community functioning: a prospective analysis. Am J Psychiatry 1999; 156(3):400–405.
Eckman PS, Shean GD. Impairment in test performance and symptom dimensions of schizophrenia. J Psychiatr Res 2000; 34(2):147–153.
Zakzanis KK. Neuropsychological correlates of positive vs. negative schizophrenic symptomatology. Schizophr Res 1998; 29(3):227–233.
Carter C, Robertson L, Nordahl T, Chaderjian M, Kraft L, O’Shora-Celaya L. Spatial working memory deficits and their relationship to negative symptoms in unmedicated schizophrenia patients. Biol Psychiatry 1996; 40(9):930–932.
Donohoe G, Robertson IH. Can specific deficits in executive functioning explain the negative symptoms of schizophrenia? A review. Neurocase 2003; 9(2):97–108.
Donohoe G, Corvin A, Robertson I. Evidence that specific executive functions predict symptom variance among schizophrenia patients with a predominantly negative symptom profile. Cogn Neuropsychiatry 2006; 11(1):13–32.
Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cogn Psychol 2000; 41(1):49–100.
Homack S, Lee D, Riccio CA. Test review: Delis-Kaplan executive function system. J Clin Exp Neuropsychol 2005; 27(5):599–609.
Chan RCK, Chen EYH, Cheung EFC, Cheung HK. Executive dysfunctions in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2004; 254(4):256–262.
Chan RCK, Chen EYH, Law CW. Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia. Schizophr Res 2006; 82(1):51–64.
Cascella NG, Testa SM, Meyer SM, Rao VA, Diaz-Asper CM, Pearlson GD, et al. Neuropsychological impairment in deficit vs. non-deficit schizophrenia. J Psychiatr Res 2008; 42(11):930–937.
Liddle PF, Morris DL. Schizophrenic syndromes and frontal lobe performance. Br J Psychiatry 1991; 158:340–345.
O’Leary DS, Flaum M, Kesler ML, Flashman LA, Arndt S, Andreasen NC. Cognitive correlates of the negative, disorganized, and psychotic symptom dimensions of schizophrenia. J Neuropsychiatry Clin Neurosci 2000; 12(1):4–15.
Polgár P, Réthelyi JM, Bálint S, Komlósi S, Czobor P, Bitter I. Executive function in deficit schizophrenia: What do the dimensions of the Wisconsin Card Sorting Test tell us? Schizophr Res 2010; 122(1-3):85–93.
Busch RM, McBride A, Curtiss G, Vanderploeg RD. The components of executive functioning in traumatic brain injury. J Clin Exp Neuropsychol 2005; 27(8):1022–1032.
Ardila A, Pineda DA. Factor structure of nonverbal cognition. Int J Neurosci 2000; 104(1-4):125–144.
Boone KB, Pontón MO, Gorsuch RL, González JJ, Miller BL. Factor analysis of four measures of prefrontal lobe functioning. Arch Clin Neuropsychol 1998; 13(7):585–595.
Greve K, Stickle T, Love J, Bianchini K, Stanford M. Latent structure of the Wisconsin Card Sorting Test: A confirmatory factor analytic study. Arch Clin Neuropsychol 2005; 20(3):355–364.
Pineda DA, Merchán V, Rosselli M, Ardila A. Factorial structure of the executive functions in young university students. Rev Neurol 2000; 31(12):1112–1118.
Bugg JM, Chanani S. List-wide control is not entirely elusive: Evidence from picture–word Stroop. Psychon Bull Rev 2011; 18(5):930–936.
Baddeley AD, Allen RJ, Hitch GJ. Binding in visual working memory: The role of the episodic buffer. Neuropsychologia 2011; 49(6):1393–1400.
Tirapu-Ustárroz J, Muñoz-Céspedes JM. Memory and the executive functions. Rev Neurol 2005; 41(8):475–484.
Carlson MC, Fried LP, Xue QL, Bandeen-Roche K, Zeger SL, Brandt J. Association between executive attention and physical functional performance in community-dwelling older women. J Gerontol B Psychol Sci Soc Sci 1999; 54(5):S262–S270.
Birkett P, Brindley A, Norman P, Harrison G, Baddeley A. Control of attention in schizophrenia. J Psychiatr Res 2006; 40(7):579–588.
Nuechterlein KH, Barch DM, Gold JM, Goldberg TE, Green MF, Heaton RK. Identification of separable cognitive factors in schizophrenia. Schizophr Res 2004; 72(1):29–39.
Gladsjo JA, McAdams LA, Palmer BW, Moore DJ, Jeste D V, Heaton RK. A six-factor model of cognition in schizophrenia and related psychotic disorders: Relationships with clinical symptoms and functional capacity. Schizophr Bull 2004; 30(4):739–754.