Ten year neurocognitive trajectories in first-episode psychosis

Abstract

Objective: Neurocognitive impairment is commonly reported at onset of psychotic disorders. However, the long-term neurocognitive course remains largely uninvestigated in first episode psychosis (FEP) and the relationship to clinically significant subgroups even more so. We report 10 year longitudinal neurocognitive development in a sample of FEP patients, and explore whether the trajectories of cognitive course are related to presence of relapse to psychosis, especially within the first year, with a focus on the course of verbal memory.Method: Forty-three FEP subjects (51% male, 28 ± 9 years) were followed-up neurocognitively over five assessments spanning 10 years. The test battery was divided into four neurocognitive indices; Executive Function, Verbal Learning, Motor Speed, and Verbal Fluency. The sample was grouped into those relapsing or not within the first, second and fifth year.Results: The four neurocognitive indices showed overall stability over the 10 year period. Significant relapse by index interactions were found for all indices except Executive Function. Follow-up analyses identified a larger significant decrease over time for the encoding measure within Verbal Memory for patients with psychotic relapse in the first year [F(4, 38) = 5.8, p = 0.001, η2 = 0.40].Conclusions: Main findings are long-term stability in neurocognitive functioning in FEP patients, with the exception of verbal memory in patients with psychotic relapse or non-remission early in the course of illness. We conclude that worsening of specific parts of cognitive function may be expected for patients with on-going psychosis, but that the majority of patients do not show significant change in cognitive performance during the first 10 years after being diagnosed.

The research evidence for schizophrenia as a neurodevelopmental disorder

“…A majority of the studies reported a relatively high degree of stability in cognitive functioning, with the exception of the study by Oie et al . (), and to some degree Barder and associates (), where a certain decline was found for verbal learning and memory.…”

Cognitive intervention in early psychosis — preserving abilities versus remediating deficits

“…This would suggest that although slight improvement may occur, individuals experiencing a psychotic illness fail to make normal gains in cognitive development (neurodevelopmental arrest), or even show evidence of deterioration (neuroprogression). Indeed, the available evidence indicates that a number of cognitive domains, such as language, processing speed and working memory, are impaired at psychosis onset, and remain stably impaired over the course of the illness [12,29,30 ]. However, there is evidence that other areas of cognition may be preserved at psychosis onset, with deterioration occurring as the illness progresses [12].…”

Cognitive functioning in first-episode schizophrenia: MATRICS Consensus Cognitive Battery (MCCB) Profile of Impairment

“…Among patients with chronic schizophrenia (CSz), cognitive impairment is diffuse and pervasive, with deficits typically 1 to 2 standard deviations below non-psychiatric control samples across various cognitive domains (Gold, 2004; Green, 2006; Heinrichs and Zakzanis, 1998). Cognitive impairment appears to be a relatively stable feature of schizophrenia (Barder et al, 2013b; Hoff et al, 2005), even across acute vs. remitted states (Nuechterlein et al, 1992), with limited response to antipsychotic treatment (Keefe et al, 2007; Rund, 1998). Cognitive impairment is present in first-episode schizophrenia (FESz; (Addington and Addington, 2002; Barder et al, 2013a; Gold et al, 1999; Hoff et al, 1999; Mohamed et al, 1999), and likely precedes the onset of illness in an attenuated form (Cornblatt et al, 1999; Hawkins et al, 2004; Lencz et al, 2006; Lewandowski et al, 2011; Seidman et al, 2010; Simon et al, 2007).…”