Cognitive functioning in psychotic disorders

What is it about?

Knowledge is limited regarding the long-term course of cognitive functioning in individuals with psychotic disorders. We thus investigated cognitive functioning at 2- and 20-years follow-up in an epidemiological cohort of first admissions with psychotic disorders. Data came from the prospective Suffolk County Mental Health Project (SCMHP). Cognitive tests were administered 2-years and 20-years after baseline assessment. A comparison group having no history of psychosis was assessed at year 20. Individuals with schizophrenia spectrum disorders showed poorer cognitive functioning overall than those with affective and other psychoses. SCMHP participants declined on most tests, with comparable slopes across diagnoses. Longer duration of untreated psychosis and low premorbid IQ were significantly associated with clinically relevant declines in vocabulary and processing speed but not in other areas. Cross-sectional comparisons showed that compared to controls, the SCMHP cohort with psychosis functioned more poorly and showed greater age-specific impairments in vocabulary knowledge, verbal fluency, and abstraction-executive functioning after age 40. Cognitive decline is neither specific to nor more pronounced in schizophrenia than in other psychotic disorders. In psychotic disorders, impairments in some key cognitive domains relative to never-psychotic individuals seem to increase from middle age onwards, possibly suggesting premature aging or neuro-degeneration. Our findings stress the potential of cognitive interventions that can reduce and/or slow declines in cognitive function that precede or exceed normal aging.

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