Divergent age-related cognitive impairments in first-episode psychosis

Cognitive impairment is a core feature of first-episode psychosis (FEP), but its age-associated cognitive patterns remain unclear. Prior studies suggest FEP is associated with baseline cognitive deficits and accelerated decline, yet inconsistencies exist regarding whether cognitive aging in FEP mirrors or diverges from healthy aging.

We compared 378 drug-naive FEP patients and 477 healthy controls (HC) using the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Clinical symptoms were evaluated via the Positive and Negative Syndrome Scale (PANSS). Age-correlations with cognitive domains were analyzed via Pearson's coefficients and Fisher's z-transformation.

FEP patients showed significant deficits across all cognitive domains (all p < 0.001) and disrupted age-associated cognitive patterns. In HC, age was associated with gradual declines in memory (e.g., HVLT-R r = -0.304, p < 0.001), working memory (r = -0.168, p < 0.001), and learning functions, aligning with normative aging. FEP patients showed a complex pattern: while some executive functions (e.g., Trail Making A) mirrored HC's negative age correlations, social cognition (r = 0.174, p < 0.001), attention (r = 0.125, p = 0.015), and specific learning domains exhibited positive age associations. Group comparisons revealed significant differences in age-cognition relationships for verbal memory, working memory, and overall cognitive composites (all p < 0.0028 after Bonferroni correction), indicating disrupted cognitive aging in FEP.

FEP disrupts normative cognitive aging patterns, characterized by atypical decline and compensatory improvements. These findings highlight the need for longitudinal studies to clarify mechanisms and inform age-adapted interventions.