Associations of cognitive test performance with self-reported mental health, cognition, and quality of life in adults with functional seizures: A systematic review and meta-analysis

Objective: People with functional seizures (FS) have frequent and disabling cognitive dysfunction and mental health symptoms, with low quality of life. However, interrelationships among these constructs are poorly understood. In this meta-analysis, we examined associations between objective (i.e. performance-based) cognitive testing and self-reported (i) mental health, (ii) cognition, and (iii) quality of life in FS. Method: We searched MEDLINE, Embase, PsycINFO, and Web of Science, with the final search on June 10, 2024. Inclusion criteria were studies documenting relationships between objective cognitive test scores and self-reported (i.e. subjective) mental health, cognition, and/or quality of life in adults with FS. Exclusion criteria were mixed FS/epilepsy samples. A modified Newcastle-Ottawa Scale evaluated risk of bias. This project is registered as CRD42023392385 in PROSPERO. Results: Initially, 4,054 unique reports were identified, with the final sample including 24 articles of 1,173 people with FS. Mean age was 35.9 (SD = 3.9), mean education was 12.6 (SD = 1.3), and proportion of women was 73.9%. Risk of bias was moderate, due in part to inconsistent reporting of confounding demographic variables. Significant relationships were found between global objective cognition and global self-reported mental health (k = 21, Z = −0.23 [0.04], 95% CI = −0.30, −0.16), depression (k = 11, Z = −0.13 [0.05], 95% CI = −0.21, −0.04), cognition (k = 5, Z = −0.16 [0.05], 95% CI = −0.26, −0.06), and quality of life (k = 5, Z = −0.17 [0.05], 95% CI = −0.24, −0.10). Exploratory analyses showed associations between select cognitive and mental health constructs. Conclusions: Objective cognition is reliably associated with self-reported mental health, cognition, and quality of life in people with FS. Scientific and clinical implications are discussed.研究目的：功能性发作（functional seizures, FS）患者常出现频发且致残的认知功能障碍与精神健康症状，且生活质量低下，但目前学界对上述各类心理构念间的内在关联仍知之甚少。本项元分析旨在探讨功能性发作患者的客观（即基于操作表现的）认知测试结果与三项自我报告指标的关联：(i) 精神健康状况、(ii) 认知功能、(iii) 生活质量。 研究方法：我们检索了MEDLINE、Embase、PsycINFO及Web of Science四大学术数据库，最终检索完成时间为2024年6月10日。纳入标准为：针对成年功能性发作患者，报道客观认知测试得分与自我报告（即主观）精神健康、认知功能及/或生活质量之间关联的研究。排除标准为：混合功能性发作与癫痫的样本队列。采用改良纽卡斯尔-渥太华量表（modified Newcastle-Ottawa Scale）评估研究偏倚风险。本项目已在PROSPERO国际前瞻性系统评价注册平台完成注册，注册号为CRD42023392385。 研究结果：初步检索共识别出4054篇独立文献，最终纳入24项研究，涉及1173名功能性发作患者。受试者平均年龄为35.9岁（标准差SD=3.9），平均受教育年限为12.6年（SD=1.3），女性占比73.9%。由于人口统计学混淆变量的报告存在不一致，整体研究偏倚风险为中等水平。分析显示，整体客观认知功能与整体自我报告精神健康（k=21，Z=-0.23[0.04]，95%置信区间CI=-0.30~-0.16）、抑郁症状（k=11，Z=-0.13[0.05]，95%置信区间CI=-0.21~-0.04）、认知功能（k=5，Z=-0.16[0.05]，95%置信区间CI=-0.26~-0.06）及生活质量（k=5，Z=-0.17[0.05]，95%置信区间CI=-0.24~-0.10）均存在显著关联。探索性分析显示，特定认知维度与精神健康维度间存在关联。 研究结论：功能性发作患者的客观认知功能与自我报告的精神健康、认知功能及生活质量存在可靠关联。本文还就该发现的科学与临床意义展开了讨论。