Developmental trajectories of premorbid functioning predict cognitive remediation treatment response in first-episode schizophrenia.
Developmental trajectories of premorbid functioning predict cognitive remediation treatment response in first-episode schizophrenia.
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DOI：
10.1017/s0033291722003312
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发表时间：
2023-10
影响因子：
6.9
通讯作者：
Nuechterlein, Keith H.
中科院分区：
文献类型：
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作者：
Kuo, Susan S.;Ventura, Joseph;Forsyth, Jennifer K.;Subotnik, Kenneth L.;Turner, Luana R.;Nuechterlein, Keith H.
关键词：
精神分裂症发作后的认知发展可以通过认知补救等干预措施来塑造，但到目前为止还没有研究调查早期行为发展的模式是否可以预测干预后的认知变化。因此，我们调查了精神分裂症患者病前调整轨迹预测认知补救效果的程度。在总共215名参与者(170名首发精神分裂症参与者和45名对照组)中，我们使用Cannon-Spoke病前调整量表对从儿童到青春期晚期的病前功能轨迹进行了分类。对于62名接受了为期6个月的计算机辅助、自下而上的认知补救干预的精神分裂症参与者，我们确定了参与者在干预后表现出平均变化的Matrics Consensus Cognitive Battery分数，然后评估发展轨迹是否预测了这些变化。增长混合模型支持疾病前的三种运行轨迹：稳定-良好、恶化和稳定-不良调整。精神分裂症参与者在处理速度、语言学习和整体认知方面显示出显著的认知补救收获。值得注意的是，与轨迹恶化的参与者相比，轨迹稳定-较差的参与者在处理速度方面表现出了更大的改善。这是我们所知的第一项表征病前功能轨迹与精神分裂症发作后认知修复收益之间关系的研究，表明6个月的自下而上的认知修复似乎足以为患有早期、持久功能障碍的个人在处理速度方面产生完整的标准差收益。我们的发现突出了精神分裂症病前和病后功能轨迹之间的联系，并强调了考虑寿命发展过程在个性化治疗干预中的作用。
Cognitive development after schizophrenia onset can be shaped by interventions such as cognitive remediation, yet no study to date has investigated whether patterns of early behavioral development may predict later cognitive changes following intervention. We therefore investigated the extent to which premorbid adjustment trajectories predict cognitive remediation gains in schizophrenia. In a total sample of 215 participants (170 first-episode schizophrenia participants and 45 controls), we classified premorbid functioning trajectories from childhood through late adolescence using the Cannon-Spoor Premorbid Adjustment Scale. For the 62 schizophrenia participants who underwent 6 months of computer-assisted, bottom-up cognitive remediation interventions, we identified MATRICS Consensus Cognitive Battery scores for which participants demonstrated mean changes after intervention, then evaluated whether developmental trajectories predicted these changes. Growth mixture models supported three premorbid functioning trajectories: stable-good, deteriorating, and stable-poor adjustment. Schizophrenia participants demonstrated significant cognitive remediation gains in processing speed, verbal learning, and overall cognition. Notably, participants with stable-poor trajectories demonstrated significantly greater improvements in processing speed compared to participants with deteriorating trajectories. This is the first study to our knowledge to characterize the associations between premorbid functioning trajectories and cognitive remediation gains after schizophrenia onset, indicating that 6 months of bottom-up cognitive remediation appears to be sufficient to yield a full standard deviation gain in processing speed for individuals with early, enduring functioning difficulties. Our findings highlight the connection between trajectories of premorbid and postmorbid functioning in schizophrenia and emphasize the utility of considering the lifespan developmental course in personalizing therapeutic interventions.