Importance Cognitive functioning is a core biomarker to advance detection, prognosis and preventive care of individuals at Clinical High-Risk for Psychosis (CHR-P). Objective To provide an updated evidence synthesis of the consistency and magnitude of cognitive functioning in CHR-P individuals. Data Sources Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO and trial registries, up to 1 July 2020. Study Selection Multistep, PRISMA and MOOSE-compliant (PROSPERO protocol: CRD42020192826) literature search, performed by independent researchers to identify original studies reporting on cognitive performance in CHR-P individuals. Data Extraction and Synthesis Independent researchers extracted the data, clustering the cognitive tasks according to 7 MATRICS domains and 8 CHR-P-specific domains. Random-effect model meta-analyses, assessment of publication biases and study quality, meta-regressions were conducted. Main outcomes The primary effect size measure was the Hedges' g of cognitive functioning in CHR-P individuals compared to healthy controls (HC) or first-episode psychosis (FEP) or stratified for the longitudinal transition to psychosis. Results A total of 78 independent studies were included, relating to 5162 CHR-P individuals (mean age 20.16, 49% females), 2865 HC (mean age 21.07, 52% females) and 486 FEP individuals (mean age 23.03, SD=2.01, range 19.1-26.4, 55% females). Compared to HC, CHR-P individuals showed medium to large deficits in the Stroop word (ES=-1.17; 95%CI -1.86 to -0.48), HVLT-R (ES=-0.86; 96%CI -1.43 to -0.28), DST (ES=-0.74; 95%CI -1.19 to -0.29), BACS SC (ES=-0.67; 95%CI -0.95 to -0.39), Hinting (ES=-0.53; 95%CI -0.77 to -0.28), CVLT (ES=-0.50; 95%CI -0.64 to -0.36), WMS VR (ES=-0.75; 95%CI -1.36 to -0.14), TMT-B (ES=-0.66; 95%CI -1.06 to -0.27), NART (ES=-0.52; 95%CI -1.01 to -0.03) and UPSIT (ES=-0.44; 95%CI -0.87 to -0.02) tasks. Longitudinal transition to psychosis was associated with medium to large deficits in the CVLT (ES=-0.58; 95%CI -1.12 to -0.05) and IQ (ES=-0.57; 95%CI -1.13 to -0.05). CHR-P were less impaired than FEP individuals. The results were corrected by publication bias. Meta-regressions found significant effects for age and education and processing speed. Conclusions and Relevance Meta-analytical evidence supports cognitive dysfunction as an established detection and prognostic biomarker in CHR-P individuals. These findings can advance clinical research and inform preventive approaches.
Importanza Il funzionamento cognitivo è uno dei principali marker per migliorare l’individuazione, la prognosi e il trattamento preventivo in individui ad alto rischio clinico di psicosi (CHR-P, Clinical High-Risk for psychosis). Obiettivo Fornire una sintesi aggiornata della consistenza ed entità del funzionamento cognitivo in individui CHR-P. Fonti Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO e registri degli studi clinici, fino al 1° luglio 2020. Selezione degli studi Ricerca multifase nella letteratura, compatibile con i protocolli PRISMA e MOOSE (PROSPERO protocol: CRD42020192826), eseguita da ricercatori indipendenti per identificare studi originali che riportassero dati sulla performance cognitiva in soggetti CHR-P. Estrazione dei dati e Sintesi Ricercatori indipendenti hanno estratto i dati, raggruppando i test cognitivi secondo 7 domini MATRICS e 8 domini CHR-P-specific. Sono state condotte metanalisi di modello random-effect, valutazione dei bias di pubblicazione e della qualità dello studio e infine meta-regressioni. Esiti principali La primary effect size measure era la Hedges’ g del funzionamento cognitivo in soggetti CHR-P confrontati con controlli sani (HC) o al primo episodio di psicosi (FEP) o stratificato per la transizione longitudinale in psicosi. Risultati Sono stati inclusi 78 studi indipendenti, con un totale di 5162 soggetti CHR-P (età media 20.16 anni, 49% donne) 2865 controlli sani (età media 21.07 anni, 52% donne) e 486 soggeti al primo episodio di psicosi (età media 23.03 anni, SD=2.01, range 19.1-26.4, 55% donne). Rispetto ai 4 controlli sani, i soggetti CHR-P hanno mostrato deficit medio-gravi nel test Stroop word (ES=-1.17; 95% CI da -1.86 a -0.48), in HVLT-R (ES=-0.86; 96%CI da -1.43 a -0.28), in DST (ES=-0.74; 95%CI da -1.19 a -0.29), in BACS SC (ES=-0.67; 95%CI da -0.95 a -0.39), in Hinting (ES=-0.53; 95%CI da -0.77 a -0.28), in CVLT (ES=-0.50; 95%CI da -0.64 a -0.36), in WMS VR (ES=-0.75; 95%CI da -1.36 a -0.14), TMT-B (ES=-0.66; 95%CI da -1.06 a -0.27), in NART (ES=-0.52; 95%CI da -1.01 a -0.03) e UPSIT (ES=-0.44; 95%CI da -0.87 a -0.02). Il rischio longitudinale di transizione in psicosi è associato con un deficit medio-grave nel test CVLT (ES=-0.58; 95%CI da - 1.12 a -0.05) e nel IQ (ES=-0.57; 95%CI da -1.13 a -0.05). I soggetti CHR-P hanno mostrato un deficit minore rispetto agli individui con un primo episodio di psicosi. I risultati sono stati corretti per i bias di pubblicazione, le meta-regressioni hanno trovato un effetto significativo per l’età, gli anni di educazione scolastica e la velocità di processamento. Conclusioni e Rilevanza I dati della metanalisi suggeriscono che una disfunzione cognitiva sia un biomarker accertato di identificazione e di prognosi in soggetti CHR-P. Questi risultati possono far progredire la ricerca clinica e ispirare approcci preventivi.
NEUROCOGNITIVE FUNCTIONING IN INDIVIDUALS AT CLINICAL HIGH RISK FOR PSYCHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
SORDI, VERONICA
2020/2021
Abstract
Importance Cognitive functioning is a core biomarker to advance detection, prognosis and preventive care of individuals at Clinical High-Risk for Psychosis (CHR-P). Objective To provide an updated evidence synthesis of the consistency and magnitude of cognitive functioning in CHR-P individuals. Data Sources Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO and trial registries, up to 1 July 2020. Study Selection Multistep, PRISMA and MOOSE-compliant (PROSPERO protocol: CRD42020192826) literature search, performed by independent researchers to identify original studies reporting on cognitive performance in CHR-P individuals. Data Extraction and Synthesis Independent researchers extracted the data, clustering the cognitive tasks according to 7 MATRICS domains and 8 CHR-P-specific domains. Random-effect model meta-analyses, assessment of publication biases and study quality, meta-regressions were conducted. Main outcomes The primary effect size measure was the Hedges' g of cognitive functioning in CHR-P individuals compared to healthy controls (HC) or first-episode psychosis (FEP) or stratified for the longitudinal transition to psychosis. Results A total of 78 independent studies were included, relating to 5162 CHR-P individuals (mean age 20.16, 49% females), 2865 HC (mean age 21.07, 52% females) and 486 FEP individuals (mean age 23.03, SD=2.01, range 19.1-26.4, 55% females). Compared to HC, CHR-P individuals showed medium to large deficits in the Stroop word (ES=-1.17; 95%CI -1.86 to -0.48), HVLT-R (ES=-0.86; 96%CI -1.43 to -0.28), DST (ES=-0.74; 95%CI -1.19 to -0.29), BACS SC (ES=-0.67; 95%CI -0.95 to -0.39), Hinting (ES=-0.53; 95%CI -0.77 to -0.28), CVLT (ES=-0.50; 95%CI -0.64 to -0.36), WMS VR (ES=-0.75; 95%CI -1.36 to -0.14), TMT-B (ES=-0.66; 95%CI -1.06 to -0.27), NART (ES=-0.52; 95%CI -1.01 to -0.03) and UPSIT (ES=-0.44; 95%CI -0.87 to -0.02) tasks. Longitudinal transition to psychosis was associated with medium to large deficits in the CVLT (ES=-0.58; 95%CI -1.12 to -0.05) and IQ (ES=-0.57; 95%CI -1.13 to -0.05). CHR-P were less impaired than FEP individuals. The results were corrected by publication bias. Meta-regressions found significant effects for age and education and processing speed. Conclusions and Relevance Meta-analytical evidence supports cognitive dysfunction as an established detection and prognostic biomarker in CHR-P individuals. These findings can advance clinical research and inform preventive approaches.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/13417