Poor premorbid school performance, but not severity of illness, predicts cognitive decline in schizophrenia in midlife

Rannikko, Irina; Murray, Graham K.; Juola, Pauliina; Salo, Henri; Haapea, Marianne; Miettunen, Jouko; Veijola, Juha; Barnett, Jennifer H.; Husa, Anja P.; Jones, Peter B.; Järvelin, Marjo‐Riitta; Isohanni, Matti; Jääskeläinen, Erika

doi:10.1016/j.scog.2015.08.001

Cited by 10 publications

(8 citation statements)

References 43 publications

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“…This suggests a general continuity of cognitive functioning over time, such that better premorbid cognitive ability (estimated premorbid IQ) is associated with higher levels of education and better overall cognitive function (MCCB performance) after psychosis onset. This also aligns with evidence that reduced educational success is related to poorer cognitive function (Lee et al, 2017) and longitudinal work reporting that lower school scores at age 16 and lower education at age 34 predicted greater cognitive decline in schizophrenia (Rannikko et al, 2015). Different cognitive clusters do not appear to be associated with current age, gender, age of illness onset or current medication dosage.…”

Section: Discussionsupporting

confidence: 85%

“…This mirrors and extends our current findings with years of education by demonstrating that it is not only duration but also relative educational achievement/success during the developmental period, even as early as childhood, that relates to future cognitive function. It also extends the findings of Rannikko et al (2015) by demonstrating the added relevance of scholastic performance in childhood and early adolescence, in addition to late adolescence, to future cognitive functioning in schizophrenia. Educational opportunities are curtailed by the earlier onset of psychotic symptoms in schizophrenia (Hakulinen et al, 2019), which may have contributed to the relationship to the late adolescent scholastic performance observed here; however, our conclusions are strengthened by the fact that age of onset does not differ between the resultant clusters in the current study.…”

Section: Discussionsupporting

confidence: 84%

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Cognitive heterogeneity in first-episode psychosis and its relationship with premorbid developmental adjustment

et al. 2021

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Background Patients with schizophrenia spectrum disorders have been increasingly recognised to form cognitive subgroups with differential levels of impairment. Using cluster analytical techniques, this study sought to identify cognitive clusters in a sample of first-episode psychosis (FEP) patients and examine clinical and developmental differences across the resultant groups. Methods In total, 105 FEP patients in the University of California Los Angeles Aftercare Research Program were assessed for cognition, symptoms and premorbid developmental adjustment. Hierarchical cluster analysis with Ward's method and squared Euclidean distance was conducted, confirmed by discriminant function analysis and optimised with k-means clustering. The stability of the solution was evaluated through split-sample (random, 80 and 70% samples) and alternate method (average linkage method) replication via Cohen's κ analysis. Controlling for multiple comparisons, one-way analysis of variances examined group differences in symptom severity and premorbid adjustment. Results Three groups were identified: severely impaired (n = 27), moderately impaired (n = 41) and relatively intact (n = 37). There were no significant differences in symptom severity across the groups. Significant differences were observed for scholastic performance at three different developmental stages: childhood, early adolescence and late adolescence, with the relatively intact group demonstrating significantly better scholastic performance at all three stages than both the moderately impaired and severely impaired groups (who did not significantly differ from each other). Conclusions The findings add to growing evidence that cognitive clusters in FEP mirror that of later-stage schizophrenia. They also suggest that premorbid scholastic performance may not just be a risk factor for developing schizophrenia, but is also related to cognitive impairment severity and potentially to prognosis.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 84%

Cognitive heterogeneity in first-episode psychosis and its relationship with premorbid developmental adjustment

et al. 2021

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“…Disorganisation symptoms, such as stereotyped thinking, poor attention, disorientation, conceptual disorganisation and difficulty in abstraction (van der Gaag et al, 2006), in fact are clinical manifestations of cognitive deficits and inversely correlate with cognition (Minor and Lysaker, 2014). Premorbid school performance is associated with cognitive functioning at first-episode (Fuller et al, 2002) and poorer premorbid school performance predicts cognitive decline in midlife schizophrenia (Rannikko et al, 2015). In our data both disorganisation symptoms and school marks had significant and strong correlations with cognition.…”

Section: Discussionmentioning

confidence: 99%

Lifetime antipsychotic medication and cognitive performance in schizophrenia at age 43 years in a general population birth cohort

Husa

Moilanen

Murray

et al. 2017

Psychiatry Research

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This naturalistic study analysed the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia after an average of 16.5 years of illness. Sixty participants with schizophrenia and 191 controls from the Northern Finland Birth Cohort 1966 were assessed at age 43 years with a neurocognitive test battery. Cumulative lifetime antipsychotic dose-years were collected from medical records and interviews. The association between antipsychotic dose-years and a cognitive composite score based on principal component analysis was analysed using linear regression. Higher lifetime antipsychotic dose-years were significantly associated with poorer cognitive composite score, when adjusted for gender, onset age and lifetime hospital treatment days. The effects of typical and atypical antipsychotics did not differ. This is the first report of an association between cumulative lifetime antipsychotic dose and global cognition in midlife schizophrenia. Based on these data, higher lifetime antipsychotic dose-years may be associated with poorer cognitive performance at age 43 years. Potential biases related to the naturalistic design may partly explain the results; nonetheless, it is possible that large antipsychotic doses harm cognition in schizophrenia in the long-term.

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“… 31 , 32 This has also been shown to be applicable in schizophrenia, where lower education predicted more cognitive decline and years of education showed a positive correlation. 33 Murray et al postulated that better premorbid educational attainment may compensate for deficits that occur as a result of the illness. 34 This matches with the findings of the present study, where years of education had a positive correlation with all tests of EF, and the relationship was significant in the case of lexical fluency.…”

Section: Discussionmentioning

confidence: 99%

Nature and Correlates of Executive Dysfunction in Schizophrenia: An Exploratory Study

Noel

Viswanathan

Kuruvilla

2020

Indian Journal of Psychological Medicine

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Background: Executive function (EF) impairment has been demonstrated in patients with schizophrenia. This study attempted to examine the clinical and demographic correlates associated with the different components of EF in these patients using a comprehensive battery of neuropsychological tests. Materials and Methods: Consecutive inpatients with schizophrenia in remission were recruited. The following instruments were administered: (a) Positive and Negative Syndrome Scale (PANSS), (b)World Health Organization Disability Assessment Schedule 2.0, (c) Tower of London, (d) Stroop Test, (e) Controlled Oral Word Association Test, (f) Animal Names Test, and (g) Verbal N-Back Test. Sociodemographic and clinical details were also recorded. Data was analyzed using standard bivariate and multivariate statistics. Results: A total of 50 patients were recruited. The mean age of the population was 30 years (standard deviation [SD]: 7.74). The majority were male, literate, single, from a rural background, from a middle socioeconomic background, and unemployed. The mean dose of antipsychotic medication was 618.57 mg (SD: 282.08) of chlorpromazine equivalents per day. Impairment was found in the different sub-components of EF. On multivariate analysis, factors significantly associated with executive dysfunction were lower education, unemployment, lower income, positive PANSS score, higher antipsychotic dose, and history of treatment with electroconvulsive therapy. Conclusion: EFs encompass a wide range of cognitive processes that influence an individual’s ability to adapt and function in the society. These are often impaired in patients with schizophrenia. Clinicians need to be aware of these deficits and factors associated with them, to plan appropriate and effective remedial measures.

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Poor premorbid school performance, but not severity of illness, predicts cognitive decline in schizophrenia in midlife

Cited by 10 publications

References 43 publications

Cognitive heterogeneity in first-episode psychosis and its relationship with premorbid developmental adjustment

Cognitive heterogeneity in first-episode psychosis and its relationship with premorbid developmental adjustment

Lifetime antipsychotic medication and cognitive performance in schizophrenia at age 43 years in a general population birth cohort

Nature and Correlates of Executive Dysfunction in Schizophrenia: An Exploratory Study

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