Abstract
To investigate whether changes in serum lipids are associated with cognitive performance in first episode psychosis (FEP) patients during their first year of antipsychotic drug treatment. One hundred and thirty-two antipsychotic-treated FEP patients were included through the TOP study along with 83 age- and gender-matched healthy controls (HC). Information regarding cognitive performance, psychotic symptoms, lifestyle, body mass index, serum lipids [total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and triglycerides] and antipsychotic treatment was obtained at baseline and after 1 year. The cognitive test battery is comprised of assessments for verbal learning, processing speed, working memory, verbal fluency, and inhibition. Mixed-effects models were used to study the relationship between changes over time in serum lipids and cognitive domains, controlling for potential confounders. There was a significant group by HDL interaction effect for verbal learning (F = 11.12, p = 0.001), where an increase in HDL levels was associated with improvement in verbal learning in FEP patients but not in HC. Practice effects, lifestyle, and psychotic symptoms did not significantly affect this relationship. Antipsychotic-treated FEP patients who increased in HDL levels during the first year of follow-up exhibited better verbal learning capacity. Further investigations are needed to clarify the underlying mechanisms.
Highlights
More than 70% of patients with schizophrenia are estimated to experience cognitive impairments [1]
We further investigated the possible influence of lifestyle, metabolic measures connected to serum lipids, improvements in clinical symptomatology secondary to antipsychotic drug treatment, and other illness-related factors on the relationship between serum lipids and cognition in the patient group
During the follow-up, there were no significant changes in mean levels of serum lipids among the first episode psychosis (FEP) patients when compared to the healthy controls (HC) at the group level (Table 3)
Summary
More than 70% of patients with schizophrenia are estimated to experience cognitive impairments [1]. For several cognitive domains—including verbal learning and memory, attention, perception, and processing speed—the impairment may be as prominent as two standard deviations below healthy controls [2] indicating a clinically relevant decrease or deficits in cognitive functioning. In a cross-sectional study, Lancon et al [18] found low HDL levels (along with hypertriglyceridemia, and abdominal obesity) to be related to impairment in verbal learning and memory Another cross-sectional study [19] demonstrated that patients with schizophrenia and co-morbid metabolic syndrome exhibited impairments in processing speed, attention/vigilance, working memory and problem solving, compared to those without metabolic syndrome. There are other studies in schizophrenia that have failed to show any associations between serum lipids and cognition [21, 22], and some have even found negative associations between serum lipids and cognitive performance [23]
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