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. 2022 Jul 1;79(7):659-666.
doi: 10.1001/jamapsychiatry.2022.1142.

The Course of General Cognitive Ability in Individuals With Psychotic Disorders

Katherine Jonas  1 , Wenxuan Lian  2 , Jennifer Callahan  3 , Camilo J Ruggero  3 , Sean Clouston  4 , Avraham Reichenberg  5 , Gabrielle A Carlson  6 , Evelyn J Bromet  1 , Roman Kotov  1
Affiliations

The Course of General Cognitive Ability in Individuals With Psychotic Disorders

Katherine Jonas et al. JAMA Psychiatry. .

Abstract

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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Jonas has received grants from National Institute of Mental Health during the conduct of the study. Dr Carlson has received grants from the National Institute of Mental Health during the conduct of the study. Dr Kotov has received grants from the National Institute of Mental Health during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Overview of Study Design and Data Completed at Each Time Point
Figure 2.
Figure 2.. Locally Estimated Scatterplot Smoothed Plot of General Cognitive Ability as a Function of Age, Stratified by Diagnosis
Cognitive trajectories expressed relative to age, rather than time since psychosis onset. The shaded areas indicate the 95% CIs.
Figure 3.
Figure 3.. Trajectories of General Cognitive Ability in Individuals With Schizophrenia and Other Psychotic Disorders
Lines depict model-implied trajectories.
See this image and copyright information in PMC

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