20-year neurocognitive development following a schizophrenia spectrum disorder and associations with symptom severity and functional outcomes

Marie Starzer*, Helene Gjervig Hansen, Carsten Hjorthøj, Nikolai Albert, Kathryn E. Lewandowski, Louise Birkedal Glenthøj, Merete Nordentoft

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background Cognitive deficits are a core feature of schizophrenia and are closely associated with poor functional outcomes. It remains unclear if cognitive deficits progress over time or remain stable. Determining patients at increased risk of progressive worsening might help targeted neurocognitive remediation approaches. Methods This 20-year follow-up study examined neurocognitive outcomes of 156 participants from the OPUS I trial. Neurocognition was assessed using the brief assessment of cognition in schizophrenia at the 10- and 20-year follow-up, allowing us to examine changes in neurocognition over ten years. Results We found that 30.5% of patients had a declining course of neurocognition, 49.2% had a stable course of neurocognition and 20.3% experienced improvements in neurocognition. Good cognitive functioning at the 20-year follow-up was significantly associated with higher levels of social functioning (B 6.86, CI 4.71-9.02, p < 0.001) while increasing experiential negative symptoms were significantly correlated to cognitive worsening (PC-0.231, p = 0.029). Younger age at inclusion (B: 0.23 per 10-years, CI 0.00-0.045, p = 0.047) and low level of education (below ten years) (mean difference: -0.346, CI -0.616 to -0.076, p = 0.012) predicted declining neurocognition. Conclusion Our findings support the notion of different schizophrenia subtypes with varying trajectories. Neurocognitive impairment at the 20-year follow-up was associated with other poor outcomes, highlighting the importance of treatments aimed at improving neurocognition in patients with schizophrenia spectrum disorders.

Original languageEnglish
JournalPsychological Medicine
Volume54
Issue number9
Number of pages11
ISSN0033-2917
DOIs
Publication statusPublished - 2024

Bibliographical note

Publisher Copyright:
Copyright © The Author(s), 2024. Published by Cambridge University Press.

Keywords

  • cognitive function
  • early specialized intervention services
  • first-episode psychosis
  • long-term follow-up studies
  • longitudinal study
  • OPUS
  • schizophrenia

Cite this