Neurocognitive Functioning in Individuals at Clinical High Risk for Psychosis

Abstract

IMPORTANCE Neurocognitive functioning is a potential biomarker to advance detection, prognosis, and preventive care for individuals at clinical high risk for psychosis (CHR-P). The current consistency and magnitude of neurocognitive functioning in individuals at CHR-P are undetermined.OBJECTIVE To provide an updated synthesis of evidence on the consistency and magnitude of neurocognitive functioning in individuals at CHR-P. DATA SOURCES Web of Science database, Cochrane Central Register of Reviews, and Ovid/PsycINFO and trial registries up to July 1, 2020. STUDY SELECTION Multistep literature search compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology performed by independent researchers to identify original studies reporting on neurocognitive functioning in individuals at CHR-P. DATA EXTRACTION AND SYNTHESIS Independent researchers extracted the data, clustering the neurocognitive tasks according to 7 Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains and 8 CHR-P domains. Random-effect model meta-analyses, assessment of publication biases and study quality, and meta-regressions were conducted. MAIN OUTCOMES AND MEASURES The primary effect size measure was Hedges g of neurocognitive functioning in individuals at CHR-P (1) compared with healthy control (HC) individuals or (2) compared with individuals with first-episode psychosis (FEP) or (3) stratified for the longitudinal transition to psychosis. RESULTS A total of 78 independent studies were included, consisting of 5162 individuals at CHR-P (mean [SD; range] age, 20.2 [3.3; 12.0-29.0] years; 2529 [49.0%] were female), 2865 HC individuals (mean [SD; range] age, 21.1 [3.6; 12.6-29.2] years; 1490 [52.0%] were female), and 486 individuals with FEP (mean [SD; range] age, 23.0 [2.0; 19.1-26.4] years; 267 [55.9%] were female). Compared with HC individuals, individuals at CHR-P showed medium to large deficits on the Stroop color word reading task (g = −1.17; 95% CI, −1.86 to −0.48), Hopkins Verbal Learning Test-Revised (g = −0.86; 95% CI, −1.43 to −0.28), digit symbol coding test (g = −0.74; 95% CI, −1.19 to −0.29), Brief Assessment of Cognition Scale Symbol Coding (g = −0.67; 95% CI, −0.95 to −0.39), University of Pennsylvania Smell Identification Test (g = −0.55; 95% CI, −0.97 to −0.12), Hinting Task (g = −0.53; 95% CI, −0.77 to −0.28), Rey Auditory Verbal Learning Test (g = −0.50; 95% CI, −0.78 to −0.21), California Verbal Learning Test (CVLT) (g = −0.50; 95% CI, −0.64 to −0.36), and National Adult Reading Test (g = −0.52; 95% CI, −1.01 to −0.03). Individuals at CHR-P were less impaired than individuals with FEP. Longitudinal transition to psychosis from a CHR-P state was associated with medium to large deficits in the CVLT task (g = −0.58; 95% CI, −1.12 to −0.05). Meta-regressions found significant effects for age and education on processing speed.CONCLUSIONS AND RELEVANCE Findings from this meta-analysis support neurocognitive dysfunction...

A systematic review of premorbid cognitive functioning and its timing of onset in schizophrenia spectrum disorders

“…Increasingly, specific cognitive domains have been studied. A recent meta-analysis found significant differences between those at high-risk for psychosis and healthy controls on specific tests of cognition, identifying cognitive dysfunction as a potential marker for diagnosis and prognosis ( Catalan et al, 2021 ).…”

Prevalence of Individuals at Clinical High-Risk of Psychosis in the General Population and Clinical Samples: Systematic Review and Meta-Analysis

“…The clinical high-risk for psychosis (CHR-P) paradigm aims to improve the course of psychotic disorders through prevention in a subgroup of individuals with early symptoms or antecedent features (i.e., indicated prevention) [ 1 , 2 ]. Accordingly, CHR-P individuals are mostly defined by the presence of attenuated psychotic symptoms [ 3 , 4 ], in addition to functional impairment [ 5 ] and an accumulation of numerous risk factors for psychosis [ 6 , 7 ]. Because of these problems, such individuals typically display help-seeking behaviours and access specialised CHR-P when available [ 8 ].…”

“…The characterisation and designation of a CHR-P state are essential to guide the subsequent preventive interventions [ 2 ], which have the potential to improve clinical outcomes [ 8 ]. Briefly, CHR-P individuals present with subtle attenuated psychotic symptoms lasting on average for more than a year [ 5 ], frequently in association with comorbid conditions [ 3 ], impairments in cognition, and social cognition [ 6 ]. Because of these issues, their quality of life may be impaired [ 7 ].…”

Impact of smoking behavior on cognitive functioning in persons at risk for psychosis and healthy controls: A longitudinal study

“…Moreover, smoking prevalence in individuals who are at risk for psychosis—also known as ultra-high risk (UHR) individuals—exceeds three times the prevalence rate found in age-matched controls [2,3]. In individuals with a psychotic disorder and also in UHR individuals, a widespread impairment of neurocognitive functioning has been observed [4]. Deficits in verbal learning, visual memory, processing speed, attention/vigilance, and intelligence contribute to the prediction of later transition to psychotic disorder [4].…”

“…In individuals with a psychotic disorder and also in UHR individuals, a widespread impairment of neurocognitive functioning has been observed [4]. Deficits in verbal learning, visual memory, processing speed, attention/vigilance, and intelligence contribute to the prediction of later transition to psychotic disorder [4].…”