Two-Month Cognitive Changes Enhance Prediction of Nonremission in Clinical High-Risk Individuals

Longitudinal changes in cognitive function may be crucial in predicting clinical outcomes in clinical high-risk (CHR) individuals. In this study, we aimed to investigate the predictive value of baseline cognitive impairment and short-term cognitive changes for nonremission and conversion to psychosis in individuals at CHR for psychosis compared with healthy control individuals (HCs).

This study used a multiple-group prospective design with a 3-year follow-up. CHR individuals and HCs were assessed at baseline and at a 2-month follow-up. Neuropsychological performance was evaluated using the Chinese version of the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery.

The study included 310 CHR individuals and 93 HCs. Significant improvements in predicting nonremission in CHR individuals were observed when incorporating cognitive changes over 2 months (area under the receiver operating characteristic curve [AUC] for baseline cognition, 0.690; AUC for changes, 0.819; z = 3.365, p < .001). Key predictors included the Hopkins Verbal Learning Test-Revised (β = 0.083, p = .003), Wechsler Memory Scale-III spatial span (β = 0.330, p < .001), and Brief Visuospatial Memory Test-Revised (β = 0.127, p < .001). Conversely, predicting conversion to psychosis showed no significant difference between baseline and 2-month cognitive changes (AUC for baseline cognition, 0.667; AUC for changes, 0.666; z = 0.021, p = .242).

The findings underscore the importance of dynamic cognitive monitoring in CHR individuals. Short-term cognitive changes significantly enhanced the prediction of nonremission but did not add predictive value for conversion to psychosis beyond baseline assessments. Specific cognitive domains, such as verbal learning and working memory, were particularly valuable for predicting clinical outcomes.