Long-term Changes in Cognitive Functioning in Individuals With Psychotic Disorders Findings From the Suffolk County Mental Health Project
Long-term Changes in Cognitive Functioning in Individuals With Psychotic Disorders Findings From the Suffolk County Mental Health Project
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DOI：
10.1001/jamapsychiatry.2019.3993
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发表时间：
2020-04-01
期刊：
影响因子：
25.8
通讯作者：
Kotov, Roman
中科院分区：
文献类型：
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作者：
Fett, Anne-Kathrin J.;Velthorst, Eva;Kotov, Roman
这项队列研究检查了精神障碍患者的长期认知变化，并比较了精神障碍患者和从未患过精神障碍的人之间与年龄相关的认知表现差异。 重要性 目前尚不确定精神障碍患者在首次住院后是否会经历进行性认知衰退或正常的认知衰老。这些信息对于临床环境中的预测、认知补救的部署和公共卫生政策至关重要。目的 检查精神障碍患者的长期认知变化，并比较精神障碍患者和匹配对照个体（即从未患有精神障碍的个体）之间与年龄相关的认知表现差异。设计、设置和参与者 萨福克县心理健康项目是一项针对首次入院的精神病患者的初始队列研究。 2 年后和 20 年后对认知功能进行评估。患者是从纽约州萨福克县的 12 个住院机构招募的。 20 岁时，通过随机数字拨号招募对照组，并在邮政编码和人口统计方面与临床队列进行匹配。数据收集于 1991 年 9 月至 2015 年 7 月之间。分析于 2016 年 1 月开始。主要结果和测量 6 个领域的认知功能变化：言语知识（韦克斯勒成人智力量表修订词汇测试）、言语陈述性记忆（言语配对测试 I 和 II）、视觉陈述性记忆（视觉再现测试 I 和 II）、注意力和处理速度（符号数字模态测试书面和口头；轨迹制作测试 [TMT]-A）、抽象执行功能（Trenerry Stroop 色词测试；TMT-B）和言语流畅性（受控口语关联测试）。结果 共有 705 名参与者参与分析（平均 [SD] 年龄为 20 岁，49.4 [10.1] 岁）：445 人 (63.1%) 患有精神障碍（211 人患有精神分裂症谱系 [138 (65%) 男性]；164 人患有情感性精神病 [76 (46%) 男性]；70 人患有其他精神病 [43 (61%)男]);对照组有 260 人 (36.9%)（50.5 [9.0] 岁；134 人 [51.5%] 男性）。除 2 项测试外，精神障碍患者的认知能力均下降（平均下降：d = 0.31；范围，0.17-0.54；所有 P < .001）。认知能力下降与职业功能恶化（视觉再现测试 II：r = 0.20；符号数字模态测试书写：r = 0.25；Stroop：r = 0.24；P < .009）和恶化的阴性症状（厌恶：符号数字模态测试书写：r = -0.24；TMT-A：r = -0.21；Stroop：r = -0.21；所有P < .009；无表达性：斯特鲁普：r = -0.22；P < .009）。与对照个体相比，精神病患者在语言知识、流畅性和抽象执行功能方面表现出年龄依赖性缺陷（词汇：beta = -0.32；对照口语联想测试：beta = -0.32；TMT-B：beta = 0.23；所有 P < .05），其中 50 岁或以上参与者的差距最大。结论和相关性 在患有精神障碍的个体中，大多数认知功能在首次住院后 20 年内出现下降。观察到的下降具有临床意义。由于正常衰老，一些下降幅度超出预期，表明该人群某些领域的认知衰老可能会加速。如果得到证实，这些发现将凸显认知作为精神疾病后期研究和治疗的重要目标。问题 首次因精神障碍住院后，个体认知功能的长期进展如何？结果 在这项对 445 名精神障碍患者进行的研究中，大多数领域的认知能力都下降了，而且由于正常衰老，其中一些变化比预期的要大。各种精神障碍的下降都是一致的，并且与功能恶化和阴性症状有关；此外，精神障碍患者在所有认知测试中的表现都比对照组 (n = 260) 更差，尤其是在 50 岁之后。意味着在某些认知领域，精神障碍患者的认知衰老可能比普通人群更快。
This cohort study examines long-term cognitive changes in individuals with psychotic disorders and compares age-related differences in cognitive performance between people with psychotic disorders and people who have never had psychotic disorders.Importance It remains uncertain whether people with psychotic disorders experience progressive cognitive decline or normal cognitive aging after first hospitalization. This information is essential for prognostication in clinical settings, deployment of cognitive remediation, and public health policy. Objective To examine long-term cognitive changes in individuals with psychotic disorders and to compare age-related differences in cognitive performance between people with psychotic disorders and matched control individuals (ie, individuals who had never had psychotic disorders). Design, Setting, and Participants The Suffolk County Mental Health Project is an inception cohort study of first-admission patients with psychosis. Cognitive functioning was assessed 2 and 20 years later. Patients were recruited from the 12 inpatient facilities of Suffolk County, New York. At year 20, the control group was recruited by random digit dialing and matched to the clinical cohort on zip code and demographics. Data were collected between September 1991 and July 2015. Analysis began January 2016. Main Outcomes and Measures Change in cognitive functioning in 6 domains: verbal knowledge (Wechsler Adult Intelligence Scale-Revised vocabulary test), verbal declarative memory (Verbal Paired Associates test I and II), visual declarative memory (Visual Reproduction test I and II), attention and processing speed (Symbol Digit Modalities Test-written and oral; Trail Making Test [TMT]-A), abstraction-executive function (Trenerry Stroop Color Word Test; TMT-B), and verbal fluency (Controlled Oral Word Association Test). Results A total of 705 participants were included in the analyses (mean [SD] age at year 20, 49.4 [10.1] years): 445 individuals (63.1%) had psychotic disorders (211 with schizophrenia spectrum [138 (65%) male]; 164 with affective psychoses [76 (46%) male]; 70 with other psychoses [43 (61%) male]); and 260 individuals (36.9%) in the control group (50.5 [9.0] years; 134 [51.5%] male). Cognition in individuals with a psychotic disorder declined on all but 2 tests (average decline: d = 0.31; range, 0.17-0.54; all P < .001). Cognitive declines were associated with worsening vocational functioning (Visual Reproduction test II: r = 0.20; Symbol Digit Modalities Test-written: r = 0.25; Stroop: r = 0.24; P < .009) and worsening negative symptoms (avolition: Symbol Digit Modalities Test-written: r = -0.24; TMT-A: r = -0.21; Stroop: r = -0.21; all P < .009; inexpressivity: Stroop: r = -0.22; P < .009). Compared with control individuals, people with psychotic disrders showed age-dependent deficits in verbal knowledge, fluency, and abstraction-executive function (vocabulary: beta = -0.32; Controlled Oral Word Association Test: beta = -0.32; TMT-B: beta = 0.23; all P < .05), with the largest gap among participants 50 years or older. Conclusions and Relevance In individuals with psychotic disorders, most cognitive functions declined over 2 decades after first hospitalization. Observed declines were clinically significant. Some declines were larger than expected due to normal aging, suggesting that cognitive aging in some domains may be accelerated in this population. If confirmed, these findings would highlight cognition as an important target for research and treatment during later phases of psychotic illness.Question What is the long-term progression of cognitive functioning in individuals after first hospitalization with a psychotic disorder? Findings In this study of 445 people with psychotic disorders, cognitive performance declined in most domains and some of these changes were larger than expected owing to normal aging. Declines were consistent across psychotic disorders and were associated with worsening functioning and negative symptoms; also, people with psychotic disorders performed worse on all cognitive tests than control individuals (n = 260), especially after age 50 years. Meaning Cognitive aging may be more rapid in individuals with psychotic disorders than in the general population for some cognitive domains.