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Cognitive development in schizophrenia: follow-back from the first episode
Robert M Bilder1, Gail Reiter, Jay Bates
1Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA. rbilder@mednet.ucla.edu
Journal of Clinical and Experimental Neuropsychology
|February 18, 2006
Summary
Schizophrenia patients show cognitive deficits by first grade, with the gap widening by twelfth grade. Further cognitive decline occurs with the initial illness episode.
Area of Science:
- Neuroscience
- Developmental Psychology
- Psychiatry
Background:
- Schizophrenia is recognized as a neurodevelopmental disorder with cognitive deficits.
- Objective data on the developmental trajectory of cognitive function in schizophrenia are limited.
Purpose of the Study:
- To investigate the developmental course of cognitive performance in individuals who later develop schizophrenia.
- To identify cognitive differences from early academic performance through the initial illness episode.
Main Methods:
- A follow-back study design comparing individuals with first-episode schizophrenia/schizoaffective disorder to matched healthy controls.
- Analysis of school records (1st-12th grade achievement tests) and Scholastic Aptitude Test (SAT) scores.
- Examination of cognitive trajectories and decline relative to illness onset.
Main Results:
- Significant academic achievement differences were observed as early as first grade (0.8-1.1 grade equivalents behind peers).
- This cognitive gap increased to 1.5-1.8 grade equivalents by twelfth grade.
- Patients showed an 11.5-point drop in IQ from predicted levels based on SAT scores during their initial illness episode.
Conclusions:
- Schizophrenia is associated with early and significant cognitive deficits apparent from first grade.
- Subtle cognitive decline may precede the overt onset of psychotic symptoms.
- The initial episode of schizophrenia is accompanied by a further substantial decline in cognitive abilities.
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