Abstract
It remains unclear whether the onset of psychosis is associated with deterioration in cognitive performance. The aim of this study was to examine the course of cognitive performance in an ultrahigh risk (UHR) cohort, and whether change in cognition is associated with transition to psychosis and change in functioning. Consecutive admissions to Personal Assessment and Crisis Evaluation (PACE) Clinic between May 1994 and July 2000 who had completed a comprehensive cognitive assessment at baseline and follow-up were eligible (N = 80). Follow-up ranged from 7.3 to 13.4 years (M = 10.4 years; SD = 1.5). In the whole sample, significant improvements were observed on the Similarities (P = .03), Information (P < .01), Digit Symbol Coding (P < .01), and Trail Making Test-B (P = .01) tasks, whereas performance on the Rey Auditory Verbal Learning Test (Trials 1-3) declined significantly (P < .01) over the follow-up period. Change in performance on cognitive measures was not significantly associated with transition status. Taking time to transition into account, those who transitioned after 1 year showed significant decline on Digit Symbol Coding, whereas those who did not transition improved on this measure (P = .01; effect size [ES] = 0.85). Small positive correlations were observed between improvements in functioning and improvements in performance on Digit Symbol Coding and Arithmetic (0.24, P = .03 and 0.28, P = .01, respectively). In summary, the onset of psychosis was not associated with deterioration in cognitive ability. However, specific findings suggest that immediate verbal learning and memory, and processing speed may be relevant domains for future risk models and early intervention research in UHR individuals.
Highlights
Considerable evidence suggests that cognitive impairments emerge early and are markers of vulnerability for psychosis
Given our long follow-up period and evidence from longitudinal cohort studies, we hypothesised that significantly greater cognitive decline would be evident in ultra-high risk (UHR) individuals who transitioned to psychosis, relative to those individuals who did not transition to psychosis over a 10-year period
Cognitive functioning over a mean of 10 years was examined in 80 UHR individuals, with a focus on whether an association existed between change in cognition and transition to psychosis and change in functioning over this period
Summary
Considerable evidence suggests that cognitive impairments emerge early and are markers of vulnerability for psychosis. Cohort studies have shown that lower cognitive function in childhood and adolescence is associated with the later development of psychosis[6,7,8,9,10,11,12] While these findings suggest neurodevelopmental vulnerability expressed as cognitive difficulties is associated with psychotic disorder, the course of cognition from pre- to post-psychosis onset remains unclear. Assessment of the same individuals longitudinally, before and after the development of psychotic disorder, is necessary to determine whether progressive cognitive changes occur in association with psychosis onset. A significant decline in IQ was only observed in the schizophrenia group, with the main drop occurring between ages 13 and 38
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