“The Course of General Cognitive Ability in Individuals With Psychotic Disorders”, 2022-05-18 ():
Question: When do major cognitive deficits emerge among individuals with schizophrenia and other psychotic disorders, and how do they change over the course of illness?
Results: This cohort study traced general cognitive ability in 428 individuals with psychotic disorders, for whom 1,619 estimates of general cognitive ability spanning from childhood to old age were available. Cognitive decline began 14 years before the onset of psychosis and was more rapid in those with schizophrenia than in those with other psychotic disorders until 22 years after psychosis onset, at which point cognitive decline accelerated in both groups.
Meaning: In this study, the trajectory of general cognitive ability in schizophrenia was consistent with both a neurodevelopmental and neurodegenerative disorder.
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, & 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 & Measures: Preadmission cognitive scores were extracted from school and medical records. Post-onset 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. 3 phases of cognitive change were observed: normative, declining, and deteriorating. In the first phase, cognition was stable. 14 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 < 0.001), a statistically-significantly faster decline than those with other psychotic disorders (0.15 IQ points per year; 95% CI, 0.08–0.22, p < 0.001). 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 < 0.001).
Conclusions & 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.