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首页> 外文期刊>The journal of clinical psychiatry >Effects of lithium on cognitive performance: a meta-analysis.
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Effects of lithium on cognitive performance: a meta-analysis.

机译：锂对认知能力的影响：一项荟萃分析。

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BACKGROUND: Cognitive impairment is underrecognized among patients with bipolar disorder and may represent not only effects of the illness but also adverse effects of its treatments. Among these, lithium is the best-studied mood stabilizer. As its cognitive effects are mixed and not well-known, we assessed reported effects of lithium on cognitive performance. DATA SOURCES: MEDLINE, PsycINFO, and EMBASE databases (1950 to December 2008) were queried with the keywords lithium, cognit*, neurocognit*, neuropsych*, psycholog*, attention, concentration, processing speed, memory, executive, and learning. Database searches were supplemented with bibliographic cross-referencing by hand. The literature search was conducted independently by 2 authors (A.P.W. and T.S.W.) during August and September 2008, and questions about appropriate inclusion or exclusion were resolved between them by consensus. STUDY SELECTION: Of 586 reports initially identified as being of potential interest, 12, involving 539 subjects, met our inclusion criteria: (1) cognitive performance compared between subjects taking lithium and comparable subjects not taking lithium; comparability was assured by: (2) patients with the same affective disorder diagnoses in euthymic or remitted status or healthy volunteers; (3) groups of similar age and sex; (4) similar intelligence, education, or occupation; (5) similar distribution of other concurrent psychotropic drugs; and (6) cognitive abilities (outcomes) assessed with performance-based measures. DATA EXTRACTION: Standardized mean-difference effect size (ES), corrected for small-sample bias (Hedges' g), was computed for cognitive tasks in each study. ES estimates were transformed so that positive values indicate poorer performance by lithium-treated subjects. Infrequently, when means and standard deviations were not provided, ES was estimated from reported values of t, F, or z tests. For analysis, similar neurocognitive tests were grouped a priori based on the cognitive domains they aimed to assess. DATA SYNTHESIS: We identified 12 studies involving 276 lithium-treated and 263 similar or the same subjects, lithium-free. Lithium was taken for a mean duration of 3.9 years by affective disorder patients and 2.5 weeks by healthy volunteers, yielding a mean daily trough serum concentration of 0.80 mEq/L. Overall, lithium treatment was associated with small but significant impairment in immediate verbal learning and memory (ES = 0.24; 95% CI, 0.05-0.43) and creativity (ES = 0.33; 95% CI, 0.02-0.64), whereas delayed verbal memory, visual memory, attention, executive function, processing speed, and psychomotor performance were not significantly affected. Selectively, among the 326 affective-disorder patients, in addition to these overall impairments, long-term lithium treatment also was associated with even greater impairment in psychomotor performance (ES = 0.62; 95% CI, 0.27-0.97), with no evidence of cognitive improvements. CONCLUSIONS: Lithium treatment appears to have only few and minor negative effects on cognition.
机译：背景：双相情感障碍患者对认知障碍的认识不足，不仅可能代表疾病的影响，还可能代表治疗的不利影响。其中，锂是研究最多的情绪稳定剂。由于其认知效果参差不齐且不为人所知，我们评估了锂对认知表现的影响。数据来源：MEDLINE，PsycINFO和EMBASE数据库（1950年至2008年12月）使用以下关键词查询：锂，认知*，神经认知*，神经心理*，心理*，注意力，注意力，处理速度，记忆力，执行力和学习能力。数据库搜索通过手工参考书目交叉引用得到补充。文献检索由2008年8月至9月的2位作者（A.P.W.和T.S.W.）独立进行，有关他们之间适当收录或排除的问题已通过协商解决。研究选择：在最初被确定为潜在兴趣的586份报告中，有539名受试者中有12名符合我们的纳入标准：（1）服用锂的受试者与未服用锂的可比较受试者之间的认知表现;可比性通过以下方式得到保证：（2）具有相同情感障碍的患者被诊断为正常或缓解状态的患者或健康志愿者; （3）年龄和性别相近的群体; （4）类似的智力，教育或职业; （5）其他并发精神药物的分布相似; （6）通过基于绩效的评估来评估认知能力（结果）。数据提取：在每项研究中，针对认知任务计算了经校正的小样本偏倚（Hedges'g）的标准均差效应大小（ES）。将ES估计值转换为正值，表明锂治疗对象的表现较差。通常，如果未提供均值和标准差，则根据报告的t，F或z检验值估算ES。为了进行分析，将类似的神经认知测试根据他们旨在评估的认知领域进行先验分组。数据综合：我们确定了12项研究，涉及276个锂治疗的受试者和263个无锂相似或相同的受试者。情感障碍患者服用锂的平均持续时间为3.9年，健康志愿者接受锂的平均持续时间为2.5周，平均日谷血药浓度为0.80 mEq / L。总体而言，锂治疗与即时口语学习和记忆（ES = 0.24; 95％CI，0.05-0.43）和创造力（ES = 0.33; 95％CI，0.02-0.64）的轻微但显着损害相关，而言语延迟出现，视觉记忆，注意力，执行功能，处理速度和精神运动表现均未受到明显影响。选择性地，在326例情感障碍患者中，除了这些总体障碍之外，长期的锂治疗还与精神运动表现的更大障碍相关（ES = 0.62; 95％CI，0.27-0.97），没有证据表明认知改善。结论：锂治疗似乎对认知只有极少的负面影响。

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