The Course of General Cognitive Ability in Individuals With Psychotic Disorders

精神分裂症(面向对象编程) 认知 精神科 精神病 心理学 神经心理学 智商 精神分裂症 队列 认知功能衰退 临床心理学 儿科 医学 分裂情感障碍 痴呆 疾病 病理 内科学
作者
Katherine Jonas,Wenxuan Lian,Jennifer L. Callahan,Camilo J. Ruggero,Sean Clouston,Avraham Reichenberg,Gabrielle A. Carlson,Evelyn J. Bromet,Roman Kotov
出处
期刊:JAMA Psychiatry [American Medical Association]
卷期号:79 (7): 659-659 被引量:51
标识
DOI:10.1001/jamapsychiatry.2022.1142
摘要

Importance

Schizophrenia is associated with major cognitive deficits and has been conceptualized as both a neurodevelopmental and a neurodegenerative disorder. However, when deficits develop and how they change over the course of illness is uncertain.

Objective

To trace cognition from elementary school to old age to test neurodevelopmental and neurodegenerative theories of psychotic disorders.

Design, Setting, and Participants

Data were taken from the Suffolk County Mental Health Project, a first-admission longitudinal cohort study of individuals with psychotic disorders. Participants were recruited from all 12 inpatient psychiatric facilities in Suffolk County, New York. This analysis concerns the 428 participants with at least 2 estimates of general cognitive ability. Data were collected between September 1989 and October 2019, and data were analyzed from January 2020 to October 2021.

Exposures

Psychiatric hospitalization for psychosis.

Main Outcomes and Measures

Preadmission cognitive scores were extracted from school and medical records. Postonset cognitive scores were based on neuropsychological testing at 6-month, 24-month, 20-year, and 25-year follow-ups.

Results

Of the 428 included individuals (212 with schizophrenia and 216 with other psychotic disorders), 254 (59.6%) were male, and the mean (SD) age at psychosis onset was 27 (9) years. Three phases of cognitive change were observed: normative, declining, and deteriorating. In the first phase, cognition was stable. Fourteen years before psychosis onset, those with schizophrenia began to experience cognitive decline at a rate of 0.35 intelligence quotient (IQ) points per year (95% CI, 0.29-0.42;P < .001), a significantly faster decline than those with other psychotic disorders (0.15 IQ points per year; 95% CI, 0.08-0.22,P < .001). At 22 years after onset, both groups declined at a rate of 0.59 IQ points per year (95% CI, 0.25-0.94;P < .001).

Conclusions and Relevance

In this cohort study, cognitive trajectories in schizophrenia were consistent with both a neurodevelopmental and neurodegenerative pattern, resulting in a loss of 16 IQ points over the period of observation. Cognitive decline began long prior to psychosis onset, suggesting the window for primary prevention is earlier than previously thought. A window for secondary prevention emerges in the third decade of illness, when cognitive declines accelerate in individuals with schizophrenia and other psychotic disorders.
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