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Cognitive clusters in first-episode psychosis.

Silvia Amoretti1, Francisco Diego Rabelo-da-Ponte2, Adriane Ribeiro Rosa3

  • 1Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Institute of Neurosciences, University of Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.

Schizophrenia Research
|September 4, 2021
PubMed
Summary

Cognitive deficits in first-episode psychosis (FEP) can improve over time. Higher cognitive reserve (CR) and later age of onset at baseline predict better cognitive outcomes in schizophrenia spectrum disorders.

Keywords:
CognitionCognitive reserveEarly interventionFirst episodeNeuropsychology

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Cognitive Psychology

Background:

  • Cognitive impairments are common in first-episode psychosis (FEP) and can emerge during the prodromal stage.
  • The long-term trajectory of these cognitive deficits in FEP remains unclear.
  • Understanding cognitive heterogeneity is crucial for targeted interventions.

Purpose of the Study:

  • To identify distinct cognitive subgroups in patients with schizophrenia spectrum disorders over a two-year period.
  • To compare the sociodemographic, clinical, and functional profiles of these cognitive subgroups.
  • To identify baseline predictors of cognitive impairment at follow-up.

Main Methods:

  • Partition Around Medoids algorithm applied to cognitive variables from 114 patients with schizophrenia spectrum disorders.
  • Assessment included psychiatric scales and eight neuropsychological tests at baseline and two-year follow-up.
  • Logistic regression used to identify predictors of cognitive clusters at follow-up.

Main Results:

  • Two distinct cognitive subgroups were identified: one with significant impairment and another with relatively intact cognition.
  • Over 54% of patients with baseline cognitive deficits showed improvement by the two-year follow-up.
  • Intact cognition at follow-up was associated with higher socioeconomic status, later age of onset, fewer negative symptoms, and greater baseline cognitive reserve (CR).

Conclusions:

  • Cognitive impairment in schizophrenia spectrum disorders is heterogeneous, with a notable proportion improving within two years.
  • Baseline cognitive reserve and age of onset are significant predictors of cognitive impairment.
  • Enhancing cognitive reserve may be a viable strategy to improve illness course and outcomes in FEP.