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Chan YLE, Lin WS, Lai HC, Hung CY, Huang MH. Changes in cognitive function after a 12-week POWER rehabilitation in older adults with schizophrenia and frailty. Asia Pac Psychiatry 2024; 16:e12556. [PMID: 38727090 DOI: 10.1111/appy.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/19/2024] [Accepted: 04/21/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND The effectiveness of isolated resistance training (RT) on cognitive function among older adults with schizophrenia is insufficiently investigated. This study investigated the effectiveness of 12-weeks POWER rehabilitation, a novel RT regimen, on cognitive function among older patients with schizophrenia and frailty. METHODS Thirty-two older adults with schizophrenia and frailty were enrolled and randomized to receive either a 12-week, twice weekly POWER rehabilitation, or without add-on training. Cognitive functioning was assessed using mini-mental state examination (MMSE), digit symbol substitution test, color trail task (CTT), and digit span task (DST). Physical performance was assessed by walking speed and hand grip strength. The generalized estimating equations was used to compare pre- and post-training outcome measure between groups. RESULTS Between-group analysis revealed significant improvement in CTT1 and hand grip strength in the intervention group compared to the controls. Subgroup analyses showed CTT1 performance significantly improved after 12 weeks of POWER rehabilitation in the intervention group (time, p < .001), independent of age, educational level, global cognition, depressive symptoms, and psychotropic medication use. Increased hand grip strength was significantly associated with improved performance in MMSE, CTT1, and DST forward at study endpoint. CONCLUSION A 12-week POWER rehabilitation for older patients with schizophrenia and frailty is safe and feasible, and may benefit physical and some domains of cognitive functioning.
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Affiliation(s)
- Yee-Lam E Chan
- Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Wang-Sheng Lin
- Department of Physical Medicine and Rehabilitation, Yuanshan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Chen Lai
- Department of Psychiatry, Yuanshan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
| | - Chih-Yuan Hung
- Department of Psychiatry, Yuanshan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
| | - Mao-Hsuan Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Yuanshan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
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Cai B, Zhu Y, Liu D, Li Y, Bueber M, Yang X, Luo G, Su Y, Grivel MM, Yang LH, Qian M, Stone WS, Phillips MR. Use of the Chinese version of the MATRICS Consensus Cognitive Battery to assess cognitive functioning in individuals with high risk for psychosis, first-episode schizophrenia and chronic schizophrenia: a systematic review and meta-analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:101016. [PMID: 38699289 PMCID: PMC11064724 DOI: 10.1016/j.lanwpc.2024.101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 05/05/2024]
Abstract
More than one hundred studies have used the mainland Chinese version of the MATRICS Consensus Cognitive Battery (MCCB) to assess cognition in schizophrenia, but the results of these studies, the quality of the reports, and the strength of the evidence provided in the reports have not been systematically assessed. We identified 114 studies from English-language and Chinese-language databases that used the Chinese MCCB to assess cognition in combined samples of 7394 healthy controls (HC), 392 individuals with clinical high risk for psychosis (CHR-P), 4922 with first-episode schizophrenia (FES), 1549 with chronic schizophrenia (CS), and 2925 with schizophrenia of unspecified duration. The mean difference (MD) of the composite MCCB T-score (-13.72) and T-scores of each of the seven cognitive domains assessed by MCCB (-14.27 to -7.92) were significantly lower in individuals with schizophrenia than in controls. Meta-analysis identified significantly greater cognitive impairment in FES and CS than in CHR-P in six of the seven domains and significantly greater impairment in CS than FES in the reasoning and problem-solving domain (i.e., executive functioning). The only significant covariate of overall cognitive functioning in individuals with schizophrenia was a negative association with the severity of psychotic symptoms. These results confirm the construct validity of the mainland Chinese version of MCCB. However, there were significant limitations in the strength of the evidence provided about CHR-P (small pooled sample sizes) and the social cognition domain (inconsistency of results across studies), and the quality of many reports (particularly those published in Chinese) was rated 'poor' due to failure to report sample size calculations, matching procedures or methods of handling missing data. Moreover, almost all studies were cross-sectional studies limited to persons under 60 with at least nine years of education, so longitudinal studies of under-educated, older individuals with schizophrenia are needed.
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Affiliation(s)
- Bing Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yikang Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongyang Liu
- School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Yaxi Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Marlys Bueber
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuezhi Yang
- The Fifth People's Hospital, Nanning, Guangxi, China
| | - Guoshuai Luo
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Ying Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Margaux M. Grivel
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Min Qian
- Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - William S. Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
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Sun W, Jin T, Yang H, Li J, Tian Q, Gao J, Peng R, Zhang G, Zhang X. Alterations of serum neuropeptide levels and their relationship to cognitive impairment and psychopathology in male patients with chronic schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:3. [PMID: 38172494 PMCID: PMC10851704 DOI: 10.1038/s41537-023-00425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
Serum neuropeptide levels may be linked to schizophrenia (SCZ) pathogenesis. This study aims to examine the relation between five serum neuropeptide levels and the cognition of patients with treatment-resistant schizophrenia (TRS), chronic stable schizophrenia (CSS), and in healthy controls (HC). Three groups were assessed: 29 TRS and 48 CSS patients who were hospitalized in regional psychiatric hospitals, and 53 HC. After the above participants were enrolled, we examined the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the blood serum levels of α-melanocyte stimulating hormone (α-MSH), β-endorphin (BE), neurotensin (NT), oxytocin (OT) and substance.P (S.P). Psychiatric symptoms in patients with SCZ were assessed with the Positive and Negative Syndrome Scale. SCZ patients performed worse than HC in total score and all subscales of the RBANS. The levels of the above five serum neuropeptides were significantly higher in SCZ than in HC. The levels of OT and S.P were significantly higher in CSS than in TRS patients. The α-MSH levels in TRS patients were significantly and negatively correlated with the language scores of RBANS. However, the BE and NT levels in CSS patients were significantly and positively correlated with the visuospatial/constructional scores of RBANS. Moreover, the interaction effect of NT and BE levels was positively associated with the visuospatial/constructional scores of RBANS. Therefore, abnormally increased serum neuropeptide levels may be associated with the physiology of SCZ, and may cause cognitive impairment and psychiatric symptoms, especially in patients with TRS.
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Affiliation(s)
- Wenxi Sun
- Suzhou Medical College of Soochow University, Suzhou, 215031, Jiangsu, China
- Psychiatry Department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China
| | - Tingting Jin
- Psychiatry Department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China
| | - Haidong Yang
- Department of Psychiatry, The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang, 222003, PR China
| | - Jin Li
- Psychiatry Department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China
| | - Qing Tian
- Psychiatry Department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China
| | - Ju Gao
- Psychiatry Department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China
| | - Ruijie Peng
- Suzhou Medical College of Soochow University, Suzhou, 215031, Jiangsu, China
| | - Guangya Zhang
- Psychiatry Department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China.
| | - Xiaobin Zhang
- Psychiatry Department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China.
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Zhou Y, Xia X, Zhao X, Yang R, Wu Y, Liu J, Lyu X, Li Z, Zhang G, Du X. Efficacy and safety of Transcranial Direct Current Stimulation (tDCS) on cognitive function in chronic schizophrenia with Tardive Dyskinesia (TD): a randomized, double-blind, sham-controlled, clinical trial. BMC Psychiatry 2023; 23:623. [PMID: 37620825 PMCID: PMC10464035 DOI: 10.1186/s12888-023-05112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE Previous studies have shown that transcranial direct current stimulation(tDCS) led to an improvement of cognitive function in patients with schizophrenia, but rare study has explored the effect of tDCS on long-term hospitalized chronic schizophrenia with tardive dyskinesia (TD). The present research explored if cognitive function in patients with long-term hospitalized chronic schizophrenia with TD could be improved through tDCS. METHODS This study is a randomized, double-blind, sham-controlled clinical trial. Of the 52 patients, 14 dropped out, and 38 completed the experiment. Thirty-eight patients on stable treatment regimens were randomly assigned to receive active tDCS(n = 21) or sham stimulation(n = 17) on weekdays of the first, third, and fifth weeks of treatment. Patients performed the Pattern Recognition Memory (PRM) and the Intra/Extradimensional Set Shift (IED) from the Cambridge Neuropsychological Test Automated Battery (CANTAB) at baseline and the end of week 3, week 5. Clinical symptoms were also measured at the baseline and the fifth week using the Scale for the Assessment of Negative Symptoms (SANS) and the Positive and Negative Syndrome Scale (PANSS). Side effects of tDCS were assessed with an experimenter-administered open-ended questionnaire during the whole experiment. RESULTS There were no significant differences in PRM and IED performance metrics, SANS total score and PANSS total score between active and sham tDCS groups at the end of week 5 (p > 0.05). Furthermore, there was a significant difference in the adverse effects of the tingling sensation between the two groups (p < 0.05), but there was no significant difference in other side effects (p > 0.05). CONCLUSION According to these findings, no evidence supports using anodal stimulation over the left dorsolateral prefrontal cortex to improve cognitive function in patients with long-term hospitalized chronic schizophrenia with TD.
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Affiliation(s)
- Yue Zhou
- Xuzhou Medical University, Xuzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xingzhi Xia
- Xuzhou Medical University, Xuzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruchang Yang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Medical College of Soochow University, Suzhou, China
| | - Yuxuan Wu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Medical College of Soochow University, Suzhou, China
| | - Junjun Liu
- Nanjing Meishan Hospital, Nanjing, China
| | - Xiaoli Lyu
- Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Guangya Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Xuzhou Medical University, Xuzhou, China.
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.
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Xu F, Zhang H. The application of cognitive behavioral therapy in patients with schizophrenia: A review. Medicine (Baltimore) 2023; 102:e34827. [PMID: 37565853 PMCID: PMC10419479 DOI: 10.1097/md.0000000000034827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
The aim of this review is to explore the clinical nursing application of cognitive behavioral therapy (CBT) in patients with schizophrenia. A literature search was conducted using the CINAHL and MEDLINE databases. The database search occurred during the month of December 2022. This article comprehensively summarizes the theoretical basis of CBT in improving schizophrenia in clinical nursing, its application in managing symptoms and improving social function, as well as research progress in this field. There are still inconsistencies in the research results on CBT, but overall, psychological intervention combined with drug treatment is more effective than conventional treatment alone. If social function training can be added at the same time, it is believed that it will have better effects on clinical treatment and can maintain long-lasting effectiveness. Only in this way can patients truly understand and recognize the disease, improve treatment compliance, and ultimately achieve the goal of improving prognosis and quality of life.
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Affiliation(s)
- Feifei Xu
- School of Psychology, Zhejiang Normal University, Jin Hua, China
| | - Hang Zhang
- School of Humanities and International Education Exchange, Anhui University of Chinese Medicine, HeFei, China
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Mondragón-Maya A, Flores-Medina Y, González-Sánchez D, Hernández-Echeagaray E. Similarities in cognitive impairment between recent- onset and chronic schizophrenia patients: a consideration for the neurodevelopmental hypothesis. ACTAS ESPANOLAS DE PSIQUIATRIA 2023; 51:176-183. [PMID: 37817737 PMCID: PMC10803867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/01/2023] [Indexed: 10/12/2023]
Abstract
Impairment in attention, memory, processing speed and executive functions have been described in patients with schizophrenia. Such impairments can be observed in early stages of the disease and in chronic patients; discrepancy in findings regarding the cognitive deficits at different stages of the illness keeps the debate about schizophrenia as a neurodegenerative condition which courses with continuous deterioration, or if deficits remain stable, as the neurodevelopmental hypothesis suggests.
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Affiliation(s)
| | - Yvonne Flores-Medina
- Laboratorio de Neuromodulación Instituto Nacionalde Psiquiatría Ramón de la Fuente Muñiz
| | - Daniel González-Sánchez
- Laboratorio de Neurofisiología del desarrollo y la Neurodegeneración, UBIMED, FES-I, Universidad Nacional Autónoma de México
| | - Elizabeth Hernández-Echeagaray
- Laboratorio de Neurofisiología del desarrollo y la Neurodegeneración, UBIMED, FES-I, Universidad Nacional Autónoma de México
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Haddad C, Salameh P, Sacre H, Clément JP, Calvet B. Effects of antipsychotic and anticholinergic medications on cognition in chronic patients with schizophrenia. BMC Psychiatry 2023; 23:61. [PMID: 36694187 PMCID: PMC9872384 DOI: 10.1186/s12888-023-04552-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients with psychosis frequently use a variety of psychotropic medicines, many of which have anticholinergic effects that can impair cognition. Therefore, this study aimed to evaluate whether there is an association between medications used for neuropsychological disorders/symptoms and cognition in patients with schizophrenia, focusing on their anticholinergic load and antipsychotic doses. STUDY DESIGN A cross-sectional study between July 2019 and Mars 2020 at the Psychiatric Hospital of the Cross-Lebanon enrolled 120 inpatients diagnosed with schizophrenia. The total anticholinergic burden was calculated based on the Anticholinergic Drug Scale (ADS), and the chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose. Also, the objective cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) tool. STUDY RESULTS A significantly higher BACS total score (r = -0.33, p < 0.001), higher verbal memory (r = -0.26, p = 0.004), higher working memory (r = -0.20, p = 0.03), higher motor speed (r = -0.36, p < 0.001), and higher attention and speed of information processing (r = -0.27, p = 0.003) were significantly associated with lower chlorpromazine equivalent dose. Higher ADS (Standardized Beta (SB) = -.22; p = .028), higher chlorpromazine equivalent dose (SB = -.30; p = .001), and taking mood stabilizer medications (SB = -.24; p = .004) were significantly associated with lower cognition. CONCLUSION This study confirms that the cognitive functions of chronic patients with schizophrenia may be affected by medications and their anticholinergic burden. More studies are needed to explain the role of cholinergic neurotransmission and general neurochemical mechanisms in the cognitive impairment of patients with schizophrenia.
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Affiliation(s)
- Chadia Haddad
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France. .,Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000, Limoges, France. .,Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon. .,INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon. .,School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon. .,School of Medicine, Lebanese American University, Byblos, Lebanon.
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.411323.60000 0001 2324 5973School of Medicine, Lebanese American University, Byblos, Lebanon ,grid.413056.50000 0004 0383 4764Department of Primary Care and Population Health, University of Nicosia Medical School, 2417 Nicosia, Cyprus ,grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Jean-Pierre Clément
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France ,grid.477071.20000 0000 9883 9701Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de L’Adulte, de l’Agée Et d’Addictologie, Centre Hospitalier Esquirol, 87000 Limoges, France
| | - Benjamin Calvet
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France ,grid.477071.20000 0000 9883 9701Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de L’Adulte, de l’Agée Et d’Addictologie, Centre Hospitalier Esquirol, 87000 Limoges, France
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Goonathilake P, Ediriweera D, Ruban R, Isuru A. Prevalence and correlates of cognitive impairment in schizophrenia: a cross-sectional study from a teaching hospital southern Sri Lanka. BMC Psychiatry 2022; 22:716. [PMID: 36397028 PMCID: PMC9670486 DOI: 10.1186/s12888-022-04368-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTIONS This study assessed the prevalence of cognitive impairment, the degree of impairment in individual cognitive domains and sociodemographic and clinical correlates among patients attending to psychiatry clinics at Teaching Hospital, Karapitiya, Sri Lanka. METHODS A cross-sectional study was carried out at the psychiatry outpatient clinics of Teaching Hospital, Karapitiya, Sri Lanka. Their cognitive functions were assessed using the culturally validated Sinhala version of Addenbrooke's Cognitive Examination - III (ACE-III-S). ACE-III-S score below 85.5 was considered as significant cognitive impairment. Linear regression analysis was used to assess the factors associated with cognitive impairment. A P value of 0.05 is considered significant. RESULTS One hundred forty patients with schizophrenia were assessed. Of this, 125 patients had significant cognitive impairment with a prevalence of 89.3% (95% CI:84.1-94.5). Impairment in each cognitive domain was as follows: 60% in attention, 65.7% in memory, 55% in fluency, 61.4% in language, and 63.6% in visuospatial skills. Impairment was not different between cognitive domains. Advancing age (P < 0.001), shorter duration of formal education (P = < 0.001), longer duration of illness (P = < 0.001) and not having a full-time employment (P = 0.020) showed a positive association with cognitive impairment. CONCLUSIONS Nine out of ten patients with schizophrenia experienced significant cognitive impairment. Patients showed more than 50% impairment in all cognitive domains. The cognitive domains did not show disproportionate impairment. This study highlights the importance of introducing routine cognitive assessment protocols in patients with schizophrenia.
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Affiliation(s)
| | - Dileepa Ediriweera
- grid.45202.310000 0000 8631 5388Health Data Science Unit, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Rumi Ruban
- Mental Health Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - Amila Isuru
- grid.430357.60000 0004 0433 2651Department of Psychiatry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
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Gallucci J, Pomarol-Clotet E, Voineskos AN, Guerrero-Pedraza A, Alonso-Lana S, Vieta E, Salvador R, Hawco C. Longer illness duration is associated with greater individual variability in functional brain activity in Schizophrenia, but not bipolar disorder. Neuroimage Clin 2022; 36:103269. [PMID: 36451371 PMCID: PMC9723315 DOI: 10.1016/j.nicl.2022.103269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with schizophrenia exhibit greater inter-patient variability in functional brain activity during neurocognitive task performance. Some studies have shown associations of age and illness duration with brain function; however, the association of these variables with variability in brain function activity is not known. In order to better understand the progressive effects of age and illness duration across disorders, we examined the relationship with individual variability in brain activity. METHODS Neuroimaging and behavioural data were extracted from harmonized datasets collectively including 212 control participants, 107 individuals with bipolar disorder, and 232 individuals with schizophrenia (total n = 551). Functional activity in response to an N-back working memory task (2-back vs 1-back) was examined. Individual variability was quantified via the correlational distance of fMRI activity between participants; mean correlational distance of one participant in relation to all others was defined as a 'variability score'. RESULTS Greater individual variability was found in the schizophrenia group compared to the bipolar disorder and control groups (p = 1.52e-09). Individual variability was significantly associated with aging (p = 0.027), however, this relationship was not different across diagnostic groups. In contrast, in the schizophrenia sample only, a longer illness duration was associated with increased variability (p = 0.027). CONCLUSION An increase in variability was observed in the schizophrenia group related to illness duration, beyond the effects of normal aging, implying illness-related deterioration of cognitive networks. This has clinical implications for considering long-term trajectories in schizophrenia and progressive neural and cognitive decline which may be amiable to novel treatments.
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Affiliation(s)
- Julia Gallucci
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain
| | - Aristotle N. Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amalia Guerrero-Pedraza
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain,Benito Menni Complex Assistencial en Salut Mental, Barcelona, Catalonia, Spain
| | - Silvia Alonso-Lana
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain,Research Centre and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades – Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain,Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain
| | - Colin Hawco
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Corresponding authors at: Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Spain.
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Seitz-Holland J, Wojcik JD, Cetin-Karayumak S, Lyall AE, Pasternak O, Rathi Y, Vangel M, Pearlson G, Tamminga C, Sweeney JA, Clementz BA, Schretlen DA, Viher PV, Stegmayer K, Walther S, Lee J, Crow T, James A, Voineskos A, Buchanan RW, Szeszko PR, Malhotra AK, Kelly S, Shenton ME, Keshavan MS, Mesholam-Gately RI, Kubicki M. Cognitive deficits, clinical variables, and white matter microstructure in schizophrenia: a multisite harmonization study. Mol Psychiatry 2022; 27:3719-3730. [PMID: 35982257 PMCID: PMC10538303 DOI: 10.1038/s41380-022-01731-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 02/08/2023]
Abstract
Cognitive deficits are among the best predictors of real-world functioning in schizophrenia. However, our understanding of how cognitive deficits relate to neuropathology and clinical presentation over the disease lifespan is limited. Here, we combine multi-site, harmonized cognitive, imaging, demographic, and clinical data from over 900 individuals to characterize a) cognitive deficits across the schizophrenia lifespan and b) the association between cognitive deficits, clinical presentation, and white matter (WM) microstructure. Multimodal harmonization was accomplished using T-scores for cognitive data, previously reported standardization methods for demographic and clinical data, and an established harmonization method for imaging data. We applied t-tests and correlation analysis to describe cognitive deficits in individuals with schizophrenia. We then calculated whole-brain WM fractional anisotropy (FA) and utilized regression-mediation analyses to model the association between diagnosis, FA, and cognitive deficits. We observed pronounced cognitive deficits in individuals with schizophrenia (p < 0.006), associated with more positive symptoms and medication dosage. Regression-mediation analyses showed that WM microstructure mediated the association between schizophrenia and language/processing speed/working memory/non-verbal memory. In addition, processing speed mediated the influence of diagnosis and WM microstructure on the other cognitive domains. Our study highlights the critical role of cognitive deficits in schizophrenia. We further show that WM is crucial when trying to understand the role of cognitive deficits, given that it explains the association between schizophrenia and cognitive deficits (directly and via processing speed).
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Affiliation(s)
- Johanna Seitz-Holland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Joanne D Wojcik
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Suheyla Cetin-Karayumak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda E Lyall
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Vangel
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Carol Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - John A Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Brett A Clementz
- Department of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - David A Schretlen
- Department of Psychiatry and Behavioral Sciences, Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Petra Verena Viher
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharina Stegmayer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jungsun Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tim Crow
- Department of Psychiatry, SANE POWIC, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anthony James
- Department of Psychiatry, SANE POWIC, Warneford Hospital, University of Oxford, Oxford, UK
| | - Aristotle Voineskos
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Philip R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, NY, USA
| | - Anil K Malhotra
- The Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sinead Kelly
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Marek Kubicki
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Fett AKJ, Reichenberg A, Velthorst E. Lifespan evolution of neurocognitive impairment in schizophrenia - A narrative review. Schizophr Res Cogn 2022; 28:100237. [PMID: 35242606 PMCID: PMC8861413 DOI: 10.1016/j.scog.2022.100237] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 01/28/2023]
Abstract
Cognitive impairment is a well-recognized key feature of schizophrenia. Here we review the evidence on (1) the onset and sensitive periods of change in cognitive impairment before and after the first psychotic episode, and (2) heterogeneity in neurocognitive presentations across cognitive domains between and within individuals. Overall, studies suggest that mild cognitive impairment in individuals who develop schizophrenia or related disorders is already present during early childhood. Cross-sectional studies further suggest increasing cognitive impairments from pre- to post-psychosis onset, with the greatest declines between adolescence, the prodrome, and the first psychotic episode and with some variability between domains. Longitudinal studies with more than 10 years of observation time are scarce but support mild cognitive declines after psychosis onset until late adulthood. Whether and how much this cognitive decline exceeds normal aging, proceeds further in older patients, and is specific to certain cognitive domains and subpopulations of patients remains to be investigated. Finally, studies show substantial heterogeneity in cognitive performance in schizophrenia and suggest a variety of impairment profiles. This review highlights a clear need for long-term studies that include a control group and individuals from adolescence to old age to better understand critical windows of cognitive change and their predictors. The available evidence stresses the importance of interventions that aim to counter cognitive decline during the prodromal years, as well as careful assessment of cognition in order to determine who will profit most from which cognitive training.
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Affiliation(s)
- Anne-Kathrin J Fett
- Department of Psychology, City, University of London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA.,Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA.,Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, NY, USA
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12
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Thuaire F, Rondepierre F, Vallet GT, Jalenques I, Izaute M. Executive deficits in schizophrenia: mediation by processing speed and its relationships with aging. Psychol Med 2022; 52:1126-1134. [PMID: 32840193 DOI: 10.1017/s0033291720002871] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Executive deficits are a core characteristic of schizophrenia. Yet, the origin of these impairments remains unclear as they may be caused by processing slowing. This issue is of particular interest for aging insofar as cognitive aging is also associated with a decline in executive functioning and a slowing of processing speed. As schizophrenia patients' life expectancy increases, a better understanding of the origin of older patients' cognitive deficits becomes essential so that healthcare can be adapted to suit them. This study aims to determine whether processing speed mediates how schizophrenia affects executive functions and whether these relationships are moderated by age. METHODS Sixty-two schizophrenia patients (27 women) and 62 healthy comparison subjects matched for age (range: 18-76 years), gender and education performed neurocognitive tests to evaluate their executive functions (shifting, updating, inhibition and access) and processing speed. RESULTS Processing speed mediated the effect of schizophrenia on the four specific executive functions, and age moderated this mediation for shifting, updating and access, but in different ways. Age moderated the effect of processing speed on shifting, the direct effect of schizophrenia on access, and both the effect of processing speed and the direct effect of schizophrenia on updating. CONCLUSIONS This research highlights the need to evaluate processing speed routinely during therapeutic follow-up, as it is easy and simple to assess and appears to be at the heart of the cognitive deficits in schizophrenia. Finally, processing speed abilities yield information about the evolution of cognition with aging in schizophrenia.
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Affiliation(s)
- Flavien Thuaire
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401-63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume T Vallet
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401-63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
| | - Isabelle Jalenques
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Institut de Psychiatrie-GDR 3557, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marie Izaute
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401-63001 Clermont-Ferrand Cedex 1, Clermont-Ferrand, France
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13
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Rodríguez-Sánchez JM, Setién-Suero E, Suárez-Pinilla P, Mayoral Van Son J, Vázquez-Bourgon J, Gil López P, Crespo-Facorro B, Ayesa-Arriola R. Ten-year course of cognition in first-episode non-affective psychosis patients: PAFIP cohort. Psychol Med 2022; 52:770-779. [PMID: 32686636 DOI: 10.1017/s0033291720002408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A large body of research states that cognitive impairment in schizophrenia is static. Nevertheless, most previous studies lack a control group or have small study samples or short follow-up periods. METHOD We aimed to address these limitations by studying a large epidemiological cohort of patients with first-episode schizophrenia spectrum disorders and a comparable control sample for a 10-year period. RESULTS Our results support the generalized stability of cognitive functions in schizophrenia spectrum disorders considering the entire group. However, the existence of a subgroup of patients characterized by deteriorating cognition and worse long-term clinical outcomes must be noted. Nevertheless, it was not possible to identify concomitant factors or predictors of deterioration (all Ps > 0.05). CONCLUSIONS Cognitive functions in schizophrenia spectrum disorder are stable; however, a subgroup of subjects that deteriorate can be characterized.
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Affiliation(s)
- José Manuel Rodríguez-Sánchez
- Red de Salud Mental de Bizkaia. Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12 48903, Barakaldo, Bizkaia, España
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
| | - Esther Setién-Suero
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Paula Suárez-Pinilla
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | | | - Javier Vázquez-Bourgon
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Patxi Gil López
- Red de Salud Mental de Bizkaia. Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12 48903, Barakaldo, Bizkaia, España
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Hospital universitario Virgen del Roció, IBiS, Universidad de Sevilla, Spain
| | - Rosa Ayesa-Arriola
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
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14
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Lavaud P, McMahon K, Sánchez Rico M, Hanon C, Alvarado JM, de Raykeer RP, Limosin F, Hoertel N. Long-term care utilization within older adults with schizophrenia: Associated factors in a multicenter study. Psychiatry Res 2022; 308:114339. [PMID: 34963089 DOI: 10.1016/j.psychres.2021.114339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia. In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts. METHOD We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353). RESULTS The prevalence of long-term care utilization was 35.1% of older patients with schizophrenia. Living in a long term care facility was significantly and independently associated with higher level of depression (Adjusted odds ratio (AOR) [95%CI]=1.97 [1.06-3.64]), lower cognitive (AOR [95%CI]=0.94 [0.88-0.99]) and global functioning (AOR [95%CI]=0.97 [0.95-0.99]), greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18-4.50]), not having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14-0.56]), urbanicity (AOR [95%CI]=2.81 [1.37-5.80]), and older age (AOR [95%CI]=1.08 [1.03-1.13]). DISCUSSION Older patients with schizophrenia who live in long-term care facilities appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits than older patients with schizophrenia living in other settings. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.
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Affiliation(s)
- Pierre Lavaud
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France.
| | - Kibby McMahon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27710, United States
| | - Marina Sánchez Rico
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Cécile Hanon
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Jesús M Alvarado
- Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, 28223 Pozuelo de Alarcon, Spain
| | - Rachel Pascal de Raykeer
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; Paris University, Paris, France
| | - Frédéric Limosin
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
| | - Nicolas Hoertel
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
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15
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Gebreegziabhere Y, Habatmu K, Mihretu A, Cella M, Alem A. Cognitive impairment in people with schizophrenia: an umbrella review. Eur Arch Psychiatry Clin Neurosci 2022; 272:1139-1155. [PMID: 35633394 PMCID: PMC9508017 DOI: 10.1007/s00406-022-01416-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/11/2022] [Indexed: 01/08/2023]
Abstract
Cognitive impairment is one of the core symptoms of schizophrenia. Quite a number of systematic reviews were published related to cognitive impairment in people with schizophrenia (PWS). This umbrella review, therefore, aimed at reviewing and synthesizing the findings of systematic reviews related to domains of cognition impaired and associated factors in PWS. We searched four electronic databases. Data related to domains, occurrence, and associated factors of cognitive impairment in PWS were extracted. The quality of all eligible systematic reviews was assessed using A MeaSurement Tool to Assess methodological quality of systematic Review (AMSTAR) tool. Results are summarized and presented in a narrative form. We identified 63 systematic reviews fulfilling the eligibility criteria. The included reviews showed that PWS had lower cognitive functioning compared to both healthy controls and people with affective disorders. Similar findings were reported among psychotropic free cases and people with first episode psychosis. Greater impairment of cognition was reported in processing speed, verbal memory, and working memory domains. Greater cognitive impairment was reported to be associated with worse functionality and poor insight. Cognitive impairment was also reported to be associated with childhood trauma and aggressive behaviour. According to our quality assessment, the majority of the reviews had moderate quality. We were able to find a good number of systematic reviews on cognitive impairment in PWS. The reviews showed that PWS had higher impairment in different cognitive domains compared to healthy controls and people with affective disorders. Impairment in domains of memory and processing speed were reported frequently.
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Affiliation(s)
- Yohannes Gebreegziabhere
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia. .,Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kassahun Habatmu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Awoke Mihretu
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England UK
| | - Atalay Alem
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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16
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Olfson M, Stroup TS, Huang C, Wall MM, Crystal S, Gerhard T. Suicide Risk in Medicare Patients With Schizophrenia Across the Life Span. JAMA Psychiatry 2021; 78:876-885. [PMID: 34037667 PMCID: PMC8156163 DOI: 10.1001/jamapsychiatry.2021.0841] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/15/2021] [Indexed: 11/14/2022]
Abstract
Importance Although adults with schizophrenia have an increased risk of suicide, sample size limitations of previous research have hindered characterizations of suicide risk across the life span. Objective To describe suicide mortality rates and correlates among adults with schizophrenia across the life span and standardized mortality ratios (SMRs) for suicide compared with the general US population. Design, Setting, and Participants Five national retrospective longitudinal cohorts of patients with schizophrenia in the Medicare program from January 1, 2007, to December 31, 2016, were identified by age: 18 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 years or older. Death record information was obtained from the National Death Index. The total cohort included 668 836 Medicare patients with schizophrenia, 2 997 308 years of follow-up, and 2218 suicide deaths. Data were analyzed from September 30, 2020, to March 10, 2021. Main Outcomes and Measures For each age group, suicide mortality rates per 100 000 person-years and adjusted hazard ratios (aHRs) with 95% CIs of suicide were determined. Suicide SMRs were estimated for the total cohort and by sex and age cohorts standardized to the general US population by age, sex, and race/ethnicity. Results The study population of adults 18 years and older included 668 836 Medicare recipients with schizophrenia (52.5% men, 47.5% women). The total suicide rate per 100 000 person-years was 74.00, which is 4.5 times higher than that for the general US population (SMR, 4.54; 95% CI, 4.35-4.73) and included a rate of 88.96 for men and 56.33 for women, which are 3.4 (SMR, 3.39; 95% CI, 3.22-3.57) and 8.2 (SMR, 8.16; 95% CI, 7.60-8.75) times higher, respectively, than the rates for the general US population. Suicide rates were significantly higher for men (aHR, 1.44; 95% CI, 1.29-1.61) and those with depressive (aHR, 1.32; 95% CI, 1.17-1.50), anxiety (aHR, 1.15; 95% CI, 1.02-1.30), drug use (aHR, 1.55; 95% CI, 1.36-1.76), and sleep disorders (aHR, 1.22; 95% CI, 1.07-1.39), suicidal ideation (aHR, 1.41; 95% CI, 1.22-1.63), and suicide attempts or self-injury (aHR, 2.48; 95% CI, 2.06-2.98). The adjusted hazards of suicide were lower for Hispanic patients (aHR, 0.66; 95% CI, 0.54-0.80) or Black patients (aHR, 0.29; 95% CI, 0.24-0.35) than White patients. The suicide rate declined with age, from 141.95 (SMR, 10.19; 95% CI, 9.29-11.18) for patients aged 18 to 34 years to 24.01 (SMR, 1.53; 95% CI, 1.32-1.77) for patients 65 years or older. The corresponding declines per 100 000 person-years were from 153.80 (18-34 years of age) to 34.17 (65 years or older) for men and from 115.70 (18-34 years of age) to 18.66 (65 years or older) for women. In the group aged 18 to 34 years, the adjusted hazards of suicide risk were significantly increased for patients with suicide attempt or self-injury (aHR, 2.57; 95% CI, 18.20-2.04) and with comorbid drug use disorders (aHR, 1.48; 95% CI, 1.17-1.88), but not with comorbid depressive disorders (aHR, 0.99; 95% CI, 0.38-1.26) during the year before the start of follow-up. Conclusions and Relevance In this cohort study of adult Medicare patients with schizophrenia, suicide risk was elevated, with the highest absolute and relative risk among young adults. These patterns support suicide prevention efforts with a focus on young adults with schizophrenia, especially those with suicidal symptoms and substance use.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
- Mailman School of Public Health, Columbia University, New York, New York
| | - T. Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
| | - Cecilia Huang
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
- Mailman School of Public Health, Columbia University, New York, New York
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Tobias Gerhard
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
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17
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Huo L, Zheng Z, Lu X, Wu F, Ning Y, Zhang XY. Decreased Peripheral BDNF Levels and Cognitive Impairment in Late-Life Schizophrenia. Front Psychiatry 2021; 12:641278. [PMID: 34239458 PMCID: PMC8257950 DOI: 10.3389/fpsyt.2021.641278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/14/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives: There are relatively few studies on mechanisms of cognitive deficits in late-life schizophrenia (LLS). Brain-derived neurotrophic factor (BDNF), as an important neuroplastic molecule, has been reported to be involved in neurocognitive impairment in schizophrenia. This study aimed to examine whether peripheral BDNF levels were associated with cognitive deficits in LLS, which has not been explored yet. Methods: Forty-eight LLS patients and 45 age-matched elderly controls were recruited. We measured all participants on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for cognition and serum BDNF levels. Psychopathological symptoms in patients were assessed by the Positive and Negative Syndrome Scale (PANSS). Results: The levels of BDNF in LLS patients were significantly lower than those in healthy controls (8.80 ± 2.30 vs. 12.63 ± 5.08 ng/ml, p < 0.001). The cognitive performance of LLS patients was worse than that of the controls on RBANS total score and scores of immediate memory, attention, language, and delayed memory (all p ≤ 0.005). BDNF was positively associated with attention in LLS patients (r = 0.338, p = 0.019). Conclusion: Our findings suggest that older patients with schizophrenia exhibit lower BDNF levels and more cognitive deficits than older controls, supporting the accelerated aging hypothesis of schizophrenia. Moreover, decreased BDNF is related to attention deficits, indicating that BDNF might be a candidate biomarker of cognitive impairments in LLS patients.
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Affiliation(s)
- Lijuan Huo
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhiwei Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Xiaobing Lu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiang Yang Zhang
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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18
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Potvin S, Giguère CÉ, Mendrek A. Functional Connectivity During Visuospatial Processing in Schizophrenia: A Classification Study Using Lasso Regression. Neuropsychiatr Dis Treat 2021; 17:1077-1087. [PMID: 33888984 PMCID: PMC8055358 DOI: 10.2147/ndt.s304434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Robust evidence shows that schizophrenia is associated with significant cognitive impairments, including deficits in visuospatial abilities. While other cognitive domains have sparked several functional neuroimaging studies in schizophrenia, only a few brain activation studies have examined the neural correlates of visuospatial abilities in schizophrenia. PURPOSE Here, we propose to perform a functional connectivity study on visuospatial processing in schizophrenia, and to determine the classification accuracy of the observed alterations. METHODS Thirty-nine schizophrenia patients and 42 healthy controls were scanned using functional magnetic resonance imaging while performing a mental rotation task. Task-based functional connectivity was examined using a region-of-interest (ROI) to ROI approach, as implemented in the CONN Toolbox. ROIs were selected from a previous meta-analysis on mental rotation. Logistic regression with Lasso regularization was performed, using train-test cross-validation. RESULTS Schizophrenia was associated with a complex pattern of dysconnectivity between the superior, middle and inferior frontal gyrus, the precentral gyrus, the superior parietal lobule (SPL) and the inferior lateral occipital cortex. The classification accuracy was 86.1%. Mental rotation performance was predicted by the dysconnectivity between the right and left superior frontal gyrus (SFG), as well as between the left SFG and left SPL. CONCLUSION The results of the current study highlight that visuospatial processing is useful for examining the widespread dysconnectivity between executive, motor and visual brain regions in schizophrenia. We also demonstrate that very good classification accuracy can be achieved using visuospatial-related functional connectivity data.
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Affiliation(s)
- Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Charles-Édouard Giguère
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Adrianna Mendrek
- Department of Psychology, Bishop's University, Lennoxville, Quebec, Canada
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19
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Hatzipantelis C, Langiu M, Vandekolk TH, Pierce TL, Nithianantharajah J, Stewart GD, Langmead CJ. Translation-Focused Approaches to GPCR Drug Discovery for Cognitive Impairments Associated with Schizophrenia. ACS Pharmacol Transl Sci 2020; 3:1042-1062. [PMID: 33344888 PMCID: PMC7737210 DOI: 10.1021/acsptsci.0c00117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Indexed: 01/07/2023]
Abstract
There are no effective therapeutics for cognitive impairments associated with schizophrenia (CIAS), which includes deficits in executive functions (working memory and cognitive flexibility) and episodic memory. Compounds that have entered clinical trials are inadequate in terms of efficacy and/or tolerability, highlighting a clear translational bottleneck and a need for a cohesive preclinical drug development strategy. In this review we propose hippocampal-prefrontal-cortical (HPC-PFC) circuitry underlying CIAS-relevant cognitive processes across mammalian species as a target source to guide the translation-focused discovery and development of novel, procognitive agents. We highlight several G protein-coupled receptors (GPCRs) enriched within HPC-PFC circuitry as therapeutic targets of interest, including noncanonical approaches (biased agonism and allosteric modulation) to conventional clinical targets, such as dopamine and muscarinic acetylcholine receptors, along with prospective novel targets, including the orphan receptors GPR52 and GPR139. We also describe the translational limitations of popular preclinical cognition tests and suggest touchscreen-based assays that probe cognitive functions reliant on HPC-PFC circuitry and reflect tests used in the clinic, as tests of greater translational relevance. Combining pharmacological and behavioral testing strategies based in HPC-PFC circuit function creates a cohesive, translation-focused approach to preclinical drug development that may improve the translational bottleneck currently hindering the development of treatments for CIAS.
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Affiliation(s)
- Cassandra
J. Hatzipantelis
- Drug
Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Monica Langiu
- Drug
Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Teresa H. Vandekolk
- Drug
Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Tracie L. Pierce
- Drug
Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Jess Nithianantharajah
- Florey
Institute of Neuroscience
and Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Gregory D. Stewart
- Drug
Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Christopher J. Langmead
- Drug
Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
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20
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Zhang X, Yang M, Du X, Liao W, Chen D, Fan F, Xiu M, Jia Q, Ning Y, Huang X, Wu F, Soares JC, Cao B, Wang L, Chen H. Glucose disturbances, cognitive deficits and white matter abnormalities in first-episode drug-naive schizophrenia. Mol Psychiatry 2020; 25:3220-3230. [PMID: 31409883 DOI: 10.1038/s41380-019-0478-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/13/2022]
Abstract
Disturbance of glucose metabolism may be implicated in cognitive deficits of schizophrenia in its early phases. Many studies have reported the important role of widespread disruption of white matter (WM) connectivity in pathogenesis, cognitive deficit and psychopathology of schizophrenia. However, no study has investigated their inter-relationships in drug-naive first episode (DNFE) patients with schizophrenia. Glucose metabolism parameters including fasting glucose, insulin and homeostasis model of assessment-insulin resistance (HOMA-IR) index, cognitive performance on the MATRICS Consensus Cognitive Battery (MCCB) and the voxel-wised WM fractional anisotropy (FA) values were examined using DTI in 39 DNFE schizophrenia and 31 control subjects. The Positive and Negative Syndrome Scale was utilized for clinical symptoms. The patients showed significantly greater fasting plasma levels of glucose and insulin and HOMA-IR, and poorer cognitive scores, together with widespread reduced FA values in five brain areas, including left and right corpus callosum, superior longitudinal fasciculus, posterior thalamic radiation, and corona radiata (all p < 0.05). Association analysis showed that glucose level was positively associated with Digital Sequence Test and Continuous Performance Test, but negatively with FA values in posterior thalamic radiation and left corpus callosum in patients (all p < 0.05). Furthermore, multiple regression analysis revealed that the interactions of glucose × FA in left corpus callosum, longitudinal fasciculus and corona radiata were independent contributors to the Brief Visuospatial Memory Test (BVMT) of MCCB, while the interaction of glucose × FA in left corpus callosum, or in longitudinal fasciculus was associated with MCCB mazes and Trail Making A Test, respectively. Therefore, abnormal glucose metabolism, cognitive impairment and widespread disruption of WM structure occur in an early course of schizophrenia onset. An interaction between glucose metabolism abnormality and the WM dysconnectivity may lead to cognitive impairment.
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Affiliation(s)
- Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China. .,The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Mi Yang
- Department of Stomatology, the Fourth People's Hospital of Chengdu, Chengdu, China.,Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiangdong Du
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Wei Liao
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Dachun Chen
- Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Fengmei Fan
- Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Meihong Xiu
- Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Qiufang Jia
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xingbing Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Bo Cao
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Huafu Chen
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.
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21
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Fujii K, Yoshihara Y, Matsumoto Y, Tose K, Takeuchi H, Isobe M, Mizuta H, Maniwa D, Okamura T, Murai T, Kawahara Y, Takahashi H. Cognition and interpersonal coordination of patients with schizophrenia who have sports habits. PLoS One 2020; 15:e0241863. [PMID: 33166326 PMCID: PMC7652240 DOI: 10.1371/journal.pone.0241863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
Team sports activities are effective for improving the negative symptoms and cognitive functions in patients with schizophrenia. However, the interpersonal coordination during the sports and visual cognition of patients with schizophrenia who have team sports habits are unknown. The main objectives of this study were to test two hypotheses: first, patients with schizophrenia perform the skill requiring ball passing and receiving worse than healthy controls; and second, the patients will be impaired in these functionings in accordance with the previous studies regarding schizophrenia in general. Twelve patients with schizophrenia and 15 healthy controls, who had habits in football, participated in this study. The participants performed three conventional cognitive tests and a 3-vs-1 ball possession task to evaluate their interpersonal coordination. The results showed that in the 3-vs-1 possession task, the displacement in the pass angle for the patients was significantly smaller than that for the control. The recall in the complex figure test, the performance in the trail making test, and that in the five-choice reaction task for the patients were worse than those for the control. Moreover, we found the significant partial correlations in the patients between the extradimensional shift error and the pass angle as well as between the time in the trail making test and the displacement in the pass angle, whereas there was no significant correlation in the control group. This study clarified the impaired interpersonal coordination during team sports and the visual cognition of patients with schizophrenia who have team sports habits.
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Affiliation(s)
- Keisuke Fujii
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
| | - Yujiro Yoshihara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukiko Matsumoto
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Kyoto, Japan
| | - Keima Tose
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideaki Takeuchi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Kyoto, Japan
| | - Masanori Isobe
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroto Mizuta
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Maniwa
- Takatsuki Sports Club for Mental Illness, Takatsuki, Japan
| | | | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinobu Kawahara
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
- Institute of Mathematics for Industry, Kyushu University, Fukuoka, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Kyoto, Japan
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22
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Atagun MI, Drukker M, Hall MH, Altun IK, Tatli SZ, Guloksuz S, van Os J, van Amelsvoort T. Meta-analysis of auditory P50 sensory gating in schizophrenia and bipolar disorder. Psychiatry Res Neuroimaging 2020; 300:111078. [PMID: 32361172 DOI: 10.1016/j.pscychresns.2020.111078] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/15/2022]
Abstract
The ability of the brain to reduce the amount of trivial or redundant sensory inputs is called gating function. Dysfunction of sensory gating may lead to cognitive fragmentation and poor real-world functioning. The auditory dual-click paradigm is a pertinent neurophysiological measure of sensory gating function. This meta-analysis aimed to examine the subcomponents of abnormal P50 waveforms in bipolar disorder and schizophrenia to assess P50 sensory gating deficits and examine effects of diagnoses, illness states (first-episode psychosis vs. schizophrenia, remission vs. episodes in bipolar disorder), and treatment status (medication-free vs. medicated). Literature search of PubMed between Jan 1st 1980 and March 31st 2019 identified 2091 records for schizophrenia, 362 for bipolar disorder. 115 studies in schizophrenia (4932 patients), 16 in bipolar disorder (975 patients) and 10 in first-degree relatives (848 subjects) met the inclusion criteria. P50 sensory gating ratio (S2/S1) and S1-S2 difference were significantly altered in schizophrenia, bipolar disorder and their first-degree relatives. First-episode psychosis did not differ from schizophrenia, however episodes altered P50 sensory gating in bipolar disorder. Medications improve P50 sensory gating alterations in schizophrenia significantly and at trend level in bipolar disorder. Future studies should examine longitudinal course of P50 sensory gating in schizophrenia and bipolar disorder.
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Affiliation(s)
- Murat Ilhan Atagun
- Department of Psychiatry, Ankara Yildirim Beyazit University Medical School, Universities Region, Ihsan Dogramaci Boulevard. No: 6, Bilkent, Cankaya, Ankara Turkey.
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, Maastricht University School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - Mei Hua Hall
- Psychosis Neurobiology Laboratory, Harvard Medical School, McLean Hospital, Belmont, Massachusetts, USA
| | - Ilkay Keles Altun
- Department of Psychiatry, Bursa Higher Education Training and Education Hospital, Bursa, Turkey
| | | | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, Maastricht University School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, Maastricht University School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; King's Health Partners Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, United Kingdom; Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
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23
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Cai X, Xie D, Madsen KH, Wang Y, Bögemann SA, Cheung EFC, Møller A, Chan RCK. Generalizability of machine learning for classification of schizophrenia based on resting-state functional MRI data. Hum Brain Mapp 2020; 41:172-184. [PMID: 31571320 PMCID: PMC7268030 DOI: 10.1002/hbm.24797] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022] Open
Abstract
Machine learning has increasingly been applied to classification of schizophrenia in neuroimaging research. However, direct replication studies and studies seeking to investigate generalizability are scarce. To address these issues, we assessed within-site and between-site generalizability of a machine learning classification framework which achieved excellent performance in a previous study using two independent resting-state functional magnetic resonance imaging data sets collected from different sites and scanners. We established within-site generalizability of the classification framework in the main data set using cross-validation. Then, we trained a model in the main data set and investigated between-site generalization in the validated data set using external validation. Finally, recognizing the poor between-site generalization performance, we updated the unsupervised algorithm to investigate if transfer learning using additional unlabeled data were able to improve between-site classification performance. Cross-validation showed that the published classification procedure achieved an accuracy of 0.73 using majority voting across all selected components. External validation found a classification accuracy of 0.55 (not significant) and 0.70 (significant) using the direct and transfer learning procedures, respectively. The failure of direct generalization from one site to another demonstrates the limitation of within-site cross-validation and points toward the need to incorporate efforts to facilitate application of machine learning across multiple data sets. The improvement in performance with transfer learning highlights the importance of taking into account the properties of data when constructing predictive models across samples and sites. Our findings suggest that machine learning classification result based on a single study should be interpreted cautiously.
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Affiliation(s)
- Xin‐Lu Cai
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental HealthInstitute of PsychologyBeijingChina
- Sino‐Danish College, University of Chinese Academy of SciencesBeijingChina
- Sino‐Danish Center for Education and ResearchBeijingChina
| | - Dong‐Jie Xie
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental HealthInstitute of PsychologyBeijingChina
- Hangzhou College of Preschool Teacher EducationZhejiang Normal UniversityHangzhouChina
| | - Kristoffer H. Madsen
- Sino‐Danish Center for Education and ResearchBeijingChina
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreCopenhagenDenmark
- Department of Applied Mathematics and Computer ScienceTechnical University of DenmarkKongens LyngbyDenmark
| | - Yong‐Ming Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental HealthInstitute of PsychologyBeijingChina
- Sino‐Danish College, University of Chinese Academy of SciencesBeijingChina
- Sino‐Danish Center for Education and ResearchBeijingChina
| | - Sophie Alida Bögemann
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental HealthInstitute of PsychologyBeijingChina
- Sino‐Danish College, University of Chinese Academy of SciencesBeijingChina
- Sino‐Danish Center for Education and ResearchBeijingChina
| | | | - Arne Møller
- Sino‐Danish Center for Education and ResearchBeijingChina
- Department of Nuclear Medicine and PET CentreAarhus University HospitalAarhusDenmark
| | - Raymond C. K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental HealthInstitute of PsychologyBeijingChina
- Sino‐Danish College, University of Chinese Academy of SciencesBeijingChina
- Sino‐Danish Center for Education and ResearchBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
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24
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Thuaire F, Rondepierre F, Bacon E, Vallet GT, Jalenques I, Izaute M. Executive functions in schizophrenia aging: Differential effects of age within specific executive functions. Cortex 2019; 125:109-121. [PMID: 31981891 DOI: 10.1016/j.cortex.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/19/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022]
Abstract
There are common cognitive and brain abnormalities in schizophrenia and healthy aging which may cumulate in schizophrenia aging. However, the course of executive deficits in late-life schizophrenia is still controversial as it remains unclear whether schizophrenia patients show accelerated aging. The use of specific models of executive functions might help to shed new lights on this issue. The aim of this study was then to determine how each of the four specific executive functions (shifting, updating, inhibition and access to long-term memory) is affected by aging in schizophrenia compared to healthy aging. 20 younger (age 18-34), 17 middle-aged (age 35-49) and 25 older (age 59-76) schizophrenia patients and 62 healthy comparison participants matched for gender, age and education performed a neurocognitive battery evaluating the four specific executive functions. Schizophrenia patients performed worse than comparison participants on shifting, updating and access, whereas inhibition appeared preserved. Age affected the four functions with increased degradation of shifting and access in schizophrenia patients, whereas updating and inhibition showed a normal decline with age. These results suggest a vulnerability of prefrontal and cingulate cortexes in schizophrenia aging. Moreover, as age affected the specific executive functions differently, remediation programs should be adapted to older patients. Models of specific executive functions are useful for understanding the complexity of cognition in schizophrenia and its course during later life so that healthcare can be adapted accordingly.
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Affiliation(s)
- Flavien Thuaire
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
| | - Fabien Rondepierre
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - Elisabeth Bacon
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), CHU de Strasbourg, Université de Strasbourg, France.
| | - Guillaume T Vallet
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
| | - Isabelle Jalenques
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Institut de Psychiatrie-GDR 3557, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - Marie Izaute
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
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25
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Simón-Expósito M, Felipe-Castaño E. Effects of Metacognitive Training on Cognitive Insight in a Sample of Patients with Schizophrenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224541. [PMID: 31744146 PMCID: PMC6888430 DOI: 10.3390/ijerph16224541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 12/04/2022]
Abstract
Metacognitive training (MCT) is a group intervention that addresses cognitive biases and distortions that could help maintain delusions and hallucinations in people with schizophrenia. This program has proven its effectiveness in reducing the symptoms, but its impact on cognitive insight has scarcely been investigated. Therefore, the aim of the study was to assess the program’s impact on cognitive insight in patients with long-term schizophrenia. A sample of 22 patients with schizophrenia was divided into two groups: one received 16 sessions of MCT (n = 11), while the other received the usual treatment (n = 11). They were assessed using the Beck Cognitive Insight Scale which measures two components, self-reflection and self-certainty, and the Positive and Negative Syndrome Scale (PANSS). The experimental group showed high levels of adherence, an increase in self-reflection, and a decrease in self-assurance levels as hypothesized. We found statistically significant differences between the control and experimental groups in excitation, hostility, positive symptomatology total score, hallucinatory behavior, and suspicion. In the usual treatment group, a non-significant decrease in positive symptoms was also observed. The findings showed that the implementation of the MCT program in real clinical settings can contribute to an improvement in the metacognitive ability and symptomatology of people with schizophrenia.
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Affiliation(s)
- Miguel Simón-Expósito
- Clinical Psychologist, SESPE, Regional Government of Extremadura, 1003 Cáceres, Spain;
| | - Elena Felipe-Castaño
- Lecturer in Psychological Treatment, Evaluation & Personality, University of Extremadura, 1003 Cáceres, Spain
- Correspondence: ; Tel.: +34-605-468-088
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26
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Van Haren NEM, Van Dam DS, Stellato RK. Change in IQ in schizophrenia patients and their siblings: a controlled longitudinal study. Psychol Med 2019; 49:2573-2581. [PMID: 30674361 DOI: 10.1017/s0033291718003537] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lower intelligence quotient (IQ) has frequently been reported in patients with schizophrenia. However, it is unclear whether IQ declines (further) after illness onset and what the familial contribution is to this change. Therefore, we investigate IQ changes during the course of illness in patients with non-affective psychosis, their siblings and controls. METHODS Data are part of the longitudinal Genetic Risk and Outcome of Psychosis (GROUP) study in the Netherlands and Belgium. Participants underwent three measurements, each approximately 3 years apart. A total of 1022 patients with non-affective psychosis [illness duration: 4.34 (s.d. = 4.50) years], 977 of their siblings, and 565 controls had at least one measure of IQ (estimated from four subtests of the WAIS-III). RESULTS At baseline, IQ was significantly lower in patients (IQ = 97.8) and siblings (IQ = 108.2; p < 0.0001) than in controls (IQ = 113.0; p < 0.0001), and in patients as compared with siblings (p < 0.0001). Over time, IQ increased in all groups. In siblings, improvement in IQ was significantly more pronounced (+0.7 points/year) than in patients (+0.5 points/year; p < 0.0001) and controls (+0.3 points/year; p < 0.0001). IQ increase was not significantly correlated with improvement in (sub)clinical outcome in any of the groups. CONCLUSIONS During the first 10 years of the illness, IQ increases to a similar (and subtle) extent in a relatively high-functioning group of schizophrenia patients and controls, despite the lower IQ in patients at baseline. In addition, the siblings' IQ was intermediate at baseline, but over time the increase in IQ was more pronounced.
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Affiliation(s)
- N E M Van Haren
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D S Van Dam
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R K Stellato
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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27
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Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study. J Affect Disord 2019; 256:164-175. [PMID: 31176189 DOI: 10.1016/j.jad.2019.05.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/14/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder. METHODS We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder. RESULTS Depression and cognitive impairment were positively associated (r = 0.24, p < 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p < 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively. LIMITATIONS Because of the cross-sectional design of this study, measures of association do not imply causal associations. CONCLUSIONS Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.
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Heitz U, Papmeyer M, Studerus E, Egloff L, Ittig S, Andreou C, Vogel T, Borgwardt S, Graf M, Eckert A, Riecher-Rössler A. Plasma and serum brain-derived neurotrophic factor (BDNF) levels and their association with neurocognition in at-risk mental state, first episode psychosis and chronic schizophrenia patients. World J Biol Psychiatry 2019; 20:545-554. [PMID: 29938562 DOI: 10.1080/15622975.2018.1462532] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Brain-derived neurotrophic factor (BDNF) is involved in numerous cognitive processes. Since cognitive deficits are a core feature of psychotic disorders, the investigation of BDNF levels in psychosis and their correlation with cognition has received increased attention. However, there are no studies investigating BDNF levels in individuals with an at-risk mental state (ARMS) for psychosis. Hence, the aims of the present study were: (1) assessing peripheral BDNF levels across different (potential) stages of psychosis; (2) investigating their association with cognition.Methods: Plasma and serum BDNF levels and neuropsychological performance were assessed in 16 ARMS, six first-episode psychosis (FEP), and 11 chronic schizophrenia (CS) patients. Neuropsychological assessment covered intelligence, verbal memory, working memory, attention and executive functioning.Results: Both plasma and serum BDNF levels were highest in CS, intermediate in FEP and lowest in ARMS. Multiple regression analysis revealed a significant positive association of plasma BDNF levels with planning ability across all groups.Conclusions: The lower peripheral BDNF levels in ARMS compared to FEP and CS might point towards an important drop of this neurotrophin prior to the onset of frank psychosis. The associations of peripheral BDNF with planning-abilities match previous findings.
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Affiliation(s)
- Ulrike Heitz
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Martina Papmeyer
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Laura Egloff
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Tobias Vogel
- Department of Forensic Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Marc Graf
- Department of Forensic Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Anne Eckert
- Neurobiology Laboratory for Brain Aging and Mental Health, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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McCleery A, Nuechterlein KH. Cognitive impairment in psychotic illness: prevalence, profile of impairment, developmental course, and treatment considerations
. DIALOGUES IN CLINICAL NEUROSCIENCE 2019; 21:239-248. [PMID: 31749648 PMCID: PMC6829172 DOI: 10.31887/dcns.2019.21.3/amccleery] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Despite effective pharmacological treatments for psychotic symptoms (eg, hallucinations, delusions), functional outcomes for people with psychotic disorders are often disappointing. Although it is not included in the diagnostic criteria for psychotic disorders, cognitive impairment is one of the strongest determinants of community functioning in this clinical population, and thus it is an important target for intervention. In this review, we discuss the major areas of research regarding impaired cognition in psychotic illness. The specific topics covered include: (i) the prevalence of cognitive impairment in psychotic disorders; (ii) the profile and magnitude of cognitive impairment in psychotic disorders; (iii) the developmental course of cognitive impairment; (iv) the longitudinal stability of cognitive impairment; and (v) treatment approaches to improve cognitive performance in people with psychotic disorders.
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Affiliation(s)
- Amanda McCleery
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, US; VA Greater Los Angeles, VISN 22 MIRECC, Los Angeles, California, US
| | - Keith H Nuechterlein
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, US; UCLA Department of Psychology, Los Angeles, California, US
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30
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Xie T, Li Q, Luo X, Tian L, Wang Z, Tan S, Chen S, Yang G, An H, Yang F, Tan Y. Plasma total antioxidant status and cognitive impairments in first-episode drug-naïve patients with schizophrenia. Cogn Neurodyn 2019; 13:357-365. [PMID: 31354881 DOI: 10.1007/s11571-019-09530-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022] Open
Abstract
Accumulating evidence suggest that excessive reactive oxygen species-induced oxidative damage may underlie neurodegeneration and cognitive impairment in several disorders including schizophrenia. In this study we examined the association of oxidative stress with cognitive deficits in first-episode drug-naïve (FEDN) patients with schizophrenia. We recruited 54 FEDN patients and 50 age- and sex-matched healthy controls and examined the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus cognitive Battery (MCCB) and plasma total antioxidant status (TAS). Psychopathological symptoms were assessed using the Positive and Negative Syndrome Scale. The results showed that plasma TAS levels were significantly lower in the patients than those in the healthy subjects (94.7 ± 25.0 U/ml vs 156.6 ± 46.7 U/ml, p < 0.0001). The patients scored lower than healthy controls on the MCCB total score, speed of processing, attention/vigilance and managing emotion test index and STROOP test. For the patients, TAS was associated with some domains of cognitive deficits in schizophrenia, such as speed of processing, attention/vigilance and emotion managing. Our results suggested that oxidative stress may be involved in the pathophysiology of schizophrenia at the early of stage and its cognitive impairment.
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Affiliation(s)
- Ting Xie
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
| | - Qiongwei Li
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
| | - Xingguang Luo
- 2Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Li Tian
- 3Neuroscience Center, University of Helsinki, Viikinkaari 4, 00014 Helsinki, Finland
| | - Zhiren Wang
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
| | - Shuping Tan
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
| | - Song Chen
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
| | - Guigang Yang
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
| | - Huimei An
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
| | - Fude Yang
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
| | - Yunlong Tan
- 1Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096 People's Republic of China
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31
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Valsdottir V, Haraldsson M, Gylfason HF, Sigurdsson E, Magnusdottir BB. Schizophrenia, cognition, and aging: cognitive deficits and the relationship between test performance and aging. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:40-51. [PMID: 30707655 DOI: 10.1080/13825585.2019.1572100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Most measures of cognitive function decline with age during adulthood. Research indicates that people with schizophrenia experience considerable cognitive deficits. These deficits appear to become more troublesome with increasing age, but this has been debated. The aim of this research was to better understand the age related cognitive deficits of Icelandic subjects with schizophrenia in comparison to healthy individuals. Cognition of individuals 18 to 64 years of age was evaluated with 10 neuropsychological tests. People with schizophrenia performed significantly worse on all tests, as expected, indicating widespread cognitive deficits compared to healthy individuals, independent of age. Furthermore, the results suggest that people with schizophrenia follow a similar age-related trajectory of cognitive decline as healthy individuals. Overall, we conclude that the cognitive difficulties often experienced by older people with schizophrenia are better explained by lower cognitive function at the time of diagnosis than by faster cognitive decline with increasing age.
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Affiliation(s)
| | - Magnus Haraldsson
- School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Department of Psychiatry, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Engilbert Sigurdsson
- School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Department of Psychiatry, Landspitali University Hospital, Reykjavik, Iceland
| | - Brynja Bjork Magnusdottir
- Psychology, Reykjavik University, Reykjavik, Iceland.,Department of Psychiatry, Landspitali University Hospital, Reykjavik, Iceland
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DNA methylation in the human frontal cortex reveals a putative mechanism for age-by-disease interactions. Transl Psychiatry 2019; 9:39. [PMID: 30696804 PMCID: PMC6351569 DOI: 10.1038/s41398-019-0372-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 12/02/2018] [Accepted: 12/09/2018] [Indexed: 12/19/2022] Open
Abstract
A consistent gene set undergoes age-associated expression changes in the human cerebral cortex, and our Age-by-Disease Model posits that these changes contribute to psychiatric diseases by "pushing" the expression of disease-associated genes in disease-promoting directions. DNA methylation (DNAm) is an attractive candidate mechanism for age-associated gene expression changes. We used the Illumina HumanMethylation450 array to characterize genome-wide DNAm in the postmortem orbital frontal cortex from 20 younger (<42 years) and 19 older (>60 years) subjects. DNAm data were integrated with existing normal brain aging expression data and sets of psychiatric disease risk genes to test the hypothesis that age-associated DNAm changes contribute to age-associated gene expression changes and, by extension, susceptibility to psychiatric diseases. We found that age-associated differentially methylated regions (aDMRs) are common, robust, bidirectional, concentrated in CpG island shelves and sea, depleted in CpG islands, and enriched among genes undergoing age-associated expression changes (OR = 2.30, p = 1.69 × 10-27). We found the aDMRs are enriched among genetic association-based risk genes for schizophrenia, Alzheimer's disease (AD), and major depressive disorder (MDD) (OR = 2.51, p = 0.00015; OR = 2.38, p = 0.036; and OR = 3.08, p = 0.018, respectively) as well as expression-based MDD-associated genes (OR = 1.48, p = 0.00012). Similar patterns of enrichment were found for aDMRs that correlate with local gene expression. These results were replicated in a large publically-available dataset, and confirmed by meta-analysis of the two datasets. Our findings suggest DNAm is a molecular mechanism for age-associated gene expression changes and support a role for DNAm in age-by-disease interactions through preferential targeting of disease-associated genes.
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Kelly S, Guimond S, Lyall A, Stone WS, Shenton ME, Keshavan M, Seidman LJ. Neural correlates of cognitive deficits across developmental phases of schizophrenia. Neurobiol Dis 2018; 131:104353. [PMID: 30582983 DOI: 10.1016/j.nbd.2018.12.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 11/21/2018] [Accepted: 12/20/2018] [Indexed: 12/28/2022] Open
Abstract
Schizophrenia is associated with cognitive deficits across all stages of the illness (i.e., high risk, first episode, early and chronic phases). Identifying the underlying neurobiological mechanisms of these deficits is an important area of scientific inquiry. Here, we selectively review evidence regarding the pattern of deficits across the developmental trajectory of schizophrenia using the five cognitive domains identified by the Research Domain Criteria (RDoC) initiative. We also report associated findings from neuroimaging studies. We suggest that most cognitive domains are affected across the developmental trajectory, with corresponding brain structural and/or functional differences. The idea of a common mechanism driving these deficits is discussed, along with implications for cognitive treatment in schizophrenia.
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Affiliation(s)
- Sinead Kelly
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Synthia Guimond
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Amanda Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William S Stone
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Matcheri Keshavan
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Larry J Seidman
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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34
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MacKenzie NE, Kowalchuk C, Agarwal SM, Costa-Dookhan KA, Caravaggio F, Gerretsen P, Chintoh A, Remington GJ, Taylor VH, Müeller DJ, Graff-Guerrero A, Hahn MK. Antipsychotics, Metabolic Adverse Effects, and Cognitive Function in Schizophrenia. Front Psychiatry 2018; 9:622. [PMID: 30568606 PMCID: PMC6290646 DOI: 10.3389/fpsyt.2018.00622] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/05/2018] [Indexed: 01/09/2023] Open
Abstract
Cognitive impairment is a core symptom domain of schizophrenia. The effect of antipsychotics, the cornerstone of treatment in schizophrenia, on this domain is not fully clear. There is some evidence suggesting that antipsychotics may partially improve cognitive function, and that this improvement may vary depending on the specific cognitive domain. However, this research is confounded by various factors, such as age, duration/stage of illness, medication adherence, and extrapyramidal side effects that complicate the relationship between antipsychotics and cognitive improvement. Furthermore, antipsychotics-particularly the second generation, or "atypical" antipsychotics-can induce serious metabolic side effects, such as obesity, dyslipidemia and type 2 diabetes, illnesses which themselves have been linked to impairments in cognition. Thus, the inter-relationships between cognition and metabolic side effects are complex, and this review aims to examine them in the context of schizophrenia and antipsychotic treatment. The review also speculates on potential mechanisms underlying cognitive functioning and metabolic risk in schizophrenia. We conclude that the available literature examining the inter-section of antipsychotics, cognition, and metabolic effects in schizophrenia is sparse, but suggests a relationship between metabolic comorbidity and worse cognitive function in patients with schizophrenia. Further research is required to determine if there is a causal connection between the well-recognized metabolic adverse effects of antipsychotics and cognitive deficits over the course of the illness of schizophrenia, as well as, to determine underlying mechanisms. In addition, findings from this review highlight the importance of monitoring metabolic disturbances in parallel with cognition, as well as, the importance of interventions to minimize metabolic abnormalities for both physical and cognitive health.
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Affiliation(s)
| | - Chantel Kowalchuk
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kenya A. Costa-Dookhan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fernando Caravaggio
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Philip Gerretsen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Araba Chintoh
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gary J. Remington
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Daniel J. Müeller
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Margaret K. Hahn
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Islam MA, Habtewold TD, van Es FD, Quee PJ, van den Heuvel ER, Alizadeh BZ, Bruggeman R. Long-term cognitive trajectories and heterogeneity in patients with schizophrenia and their unaffected siblings. Acta Psychiatr Scand 2018; 138:591-604. [PMID: 30242827 PMCID: PMC6220939 DOI: 10.1111/acps.12961] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed to assess the heterogeneity and stability of cognition in patients with a non-affective psychotic disorder and their unaffected siblings. In addition, we aimed to predict the cognitive subtypes of siblings by their probands. METHOD Assessments were conducted at baseline, 3 and 6 years in 1119 patients, 1059 siblings and 586 controls from the Genetic Risk and Outcome of Psychosis (GROUP) study. Group-based trajectory modeling was applied to identify trajectories and clustered multinomial logistic regression analysis was used for prediction modeling. A composite score of eight neurocognitive tests was used to measure cognitive performance. RESULTS Five stable cognitive trajectories ranging from severely altered to high cognitive performance were identified in patients. Likewise, four stable trajectories ranging from moderately altered to high performance were found in siblings. Siblings had a higher risk of cognitive alteration when patients' alteration was mild (OR = 2.21), moderate (OR = 5.70), and severe (OR = 10.07) compared with patients with intact cognitive function. The familial correlation coefficient between pairs of index patients and their siblings was 0.27 (P = 0.003). CONCLUSIONS The cognitive profiles identified in the current study might be suitable as endophenotypes and could be used in future genetic studies and predicting functional and clinical outcomes.
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Affiliation(s)
- Md. A. Islam
- University of GroningenUniversity Medical Center GroningenUniversity Center for PsychiatryRob Giel Research CenterGroningenThe Netherlands
- University of GroningenUniversity Medical Center GroningenDepartment of EpidemiologyGroningenThe Netherlands
- Department of StatisticsShahjalal University of Science and TechnologySylhetBangladesh
| | - T. D. Habtewold
- University of GroningenUniversity Medical Center GroningenUniversity Center for PsychiatryRob Giel Research CenterGroningenThe Netherlands
- University of GroningenUniversity Medical Center GroningenDepartment of EpidemiologyGroningenThe Netherlands
| | - F. D. van Es
- University of GroningenUniversity Medical Center GroningenUniversity Center for PsychiatryRob Giel Research CenterGroningenThe Netherlands
| | - P. J. Quee
- University of GroningenUniversity Medical Center GroningenUniversity Center for PsychiatryRob Giel Research CenterGroningenThe Netherlands
- University Psychiatric Centre (UPC)KU LeuvenLeuvenBelgium
| | - E. R. van den Heuvel
- University of GroningenUniversity Medical Center GroningenDepartment of EpidemiologyGroningenThe Netherlands
- Department of Mathematics and Computer ScienceEindhoven University of TechnologyEindhovenThe Netherlands
| | - B. Z. Alizadeh
- University of GroningenUniversity Medical Center GroningenUniversity Center for PsychiatryRob Giel Research CenterGroningenThe Netherlands
- University of GroningenUniversity Medical Center GroningenDepartment of EpidemiologyGroningenThe Netherlands
| | - R. Bruggeman
- University of GroningenUniversity Medical Center GroningenUniversity Center for PsychiatryRob Giel Research CenterGroningenThe Netherlands
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
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Kurtz MM, Gopal S, John S, Thara R. Cognition, social cognition and functional disability in early-stage schizophrenia: A study from southern India. Psychiatry Res 2018; 265:231-237. [PMID: 29753255 DOI: 10.1016/j.psychres.2018.03.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 03/18/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
In high-income countries a wealth of studies has revealed cognitive and social cognitive deficits in schizophrenia and a close relationship of these deficits to psychosocial functioning. Studies examining these illness features in middle and low-income countries are rare, particularly in early-stage samples. Sixty adult participants within 5 years of diagnosis with schizophrenia and 53 matched, healthy control were assessed with the MATRICS Consensus Cognitive Battery and the PEAT emotion identification task at study entry, and the WHODAS functioning scale one year later. Deficits on cognitive instruments ranged from d = 0.64-1.04 and were consistent with those reported in Western samples. Negative symptoms were linked to function longitudinally. Deficits in social cognitive skills and longitudinal links between cognition and functioning were not evident. These findings suggest a highly consistent magnitude of neurocognitive deficits in people with schizophrenia across widely varying cultures, but with limited evidence of social cognitive skill deficits using Western-based instruments. There was little evidence of a relationship between cognition and psychosocial disability in people with early-stage schizophrenia in this sample.
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Affiliation(s)
- Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, 207 High Street, Middletown, CT, USA.
| | | | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - R Thara
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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Cohen CI, Murante T. A prospective analysis of the role of cognition in three models of aging and schizophrenia. Schizophr Res 2018; 196:22-28. [PMID: 28679478 DOI: 10.1016/j.schres.2017.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study uses longitudinal data from a sample of older adults with schizophrenia spectrum disorder (OAS) to examine the role of cognition in 3 models of aging and schizophrenia-accelerated aging, paradoxical aging, and heterogeneity of course-and their clinical relevance. METHODS The sample consisted of 103 community-dwelling persons aged 55 and over (mean=61years) with early-onset schizophrenia. Mean follow-up was 52.5months (range: 12-116months); 55% were men; 55% were white. We identified 21 potential predictor variables and used the Dementia Rating Scale (DRS) to assess cognition. RESULTS There were no significant differences in the DRS at baseline (T1) and follow-up (T2). However, 20%, 22% and 58% of persons exhibited >0.5 effect size increase or decrease, or no change in their DRS scores, respectively; 19% were rapid decliners (>-2.11pts/year) and 19% were rapid improvers (>+2.11pts/year). In multivariable analysis, there were 3 predictors of higher DRS (T2): DRS (T1), decline in anxiety score, and race (white). CONCLUSIONS The heterogeneity model best characterized the trajectory of cognition in later life. The accelerated aging model did not represent typical cognitive trajectories since most individuals were stable or improved. The heterogeneous trajectories made it difficult to generalize about cognition's role in the paradoxical aging model. Despite the paucity of predictors, our findings suggested that it may be clinically productive to enlist remediation strategies that target anxiety and cognition, and direct more attention to non-white OAS.
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Affiliation(s)
- Carl I Cohen
- SUNY Downstate Medical Center, Brooklyn, NY, United States.
| | - Tessa Murante
- SUNY Downstate Medical Center, Brooklyn, NY, United States
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Accelerated aging in schizophrenia and related disorders: Future research. Schizophr Res 2018; 196:4-8. [PMID: 28689755 DOI: 10.1016/j.schres.2017.06.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 01/17/2023]
Abstract
Several lines of evidence suggest schizophrenia is a segmental progeria, that is, some but not all aspects of accelerated aging may be present. However, the evidence has not been consistent. Problems with matching and confounding may account for some of these discrepancies. Given the etiopathophysiological heterogeneity of schizophrenia, it is possible that only a specific pathophysiological group within schizophrenia is associated with progeroid features, while others are not, or that one group is associated with a particular segment of aging features, while other progeroid features are found in another pathophysiological subgroup. In the aging research field, significant progress has been made in identifying the molecular pathways that confer aging: epigenetic changes, inflammation, proteostasis, adult stem cell function, metabolic changes, and adaptation to stress, and macromolecular damage. In addition to replication and clarification of existing kinds of evidence, examining these aging pathways would improve our understanding of progeria in schizophrenia.
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Man L, Lv X, Du XD, Yin G, Zhu X, Zhang Y, Soares JC, Yang XN, Chen X, Zhang XY. Cognitive impairments and low BDNF serum levels in first-episode drug-naive patients with schizophrenia. Psychiatry Res 2018; 263:1-6. [PMID: 29482040 DOI: 10.1016/j.psychres.2018.02.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/24/2018] [Accepted: 02/14/2018] [Indexed: 12/12/2022]
Abstract
Evidence shows that BDNF may regulate activity-dependent forms of synaptic plasticity underlying learning and memory. Previous studies reported low BDNF levels and cognitive impairment in the early stage of schizophrenia. Our current study aimed to explore the association between serum BDNF and cognitive functions in first-episode drug-naïve (FEDN) patients with schizophrenia, which has been under-investigated. We recruited 80 FEDN patients and 80 healthy controls and examined the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and serum BDNF in both groups. Patient psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). BDNF levels were significantly lower in patients compared to controls (p < 0.001). The RBANS total score and nearly all indexes (all p < 0.001) except for visuospatial/constructional index (p > 0.05) were significantly lower in patients than controls. No significant correlation was found between BDNF and any index or total scores of RBANS in either patients or healthy controls (all p > 0.05). However, the PANSS negative subscale score were negatively associated with both the immediate memory and language indexes (both p < 0.005). Our findings suggest that excessive cognitive impairments are present in the early stage of schizophrenia. Low BDNF may contribute to the pathogenesis of schizophrenia, but maybe not to its cognitive impairments.
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Affiliation(s)
- Lijuan Man
- The First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China
| | - Xiaoli Lv
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, 286 Guangji Rd 21500, Suzhou Shi 215008, Jiangsu Province, China
| | - Xiang-Dong Du
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, 286 Guangji Rd 21500, Suzhou Shi 215008, Jiangsu Province, China
| | - Guangzhong Yin
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, 286 Guangji Rd 21500, Suzhou Shi 215008, Jiangsu Province, China
| | - Xiaomin Zhu
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, 286 Guangji Rd 21500, Suzhou Shi 215008, Jiangsu Province, China
| | - Yingyang Zhang
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, 286 Guangji Rd 21500, Suzhou Shi 215008, Jiangsu Province, China
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, USA
| | - Xu-Na Yang
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, 286 Guangji Rd 21500, Suzhou Shi 215008, Jiangsu Province, China.
| | - Xingshi Chen
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, 286 Guangji Rd 21500, Suzhou Shi 215008, Jiangsu Province, China.
| | - Xiang Yang Zhang
- The First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, USA.
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Abstract
In recent years there has been growing interest in early intervention in psychotic disorders and a number of clinical and research programmes have been developed. The clinical staging model has been an essential part of early intervention as it provides the rationale of existing programmes. In medicine, clinical staging is a valuable approach in disorders where primary pathology is progressive in nature. However, the clinical staging model of psychosis has been proposed without establishing first that schizophrenia is a primarily progressive disorder. In reviewing existing evidence, this current paper argues that cross-sectional data interpreted as supportive of clinical staging data does not consider the effects of sampling bias, problems in reliability in assessing 'soft symptoms', or false positives. Longitudinal neurobiological studies do not provide a convincing case for primarily progressive pathology in schizophrenia. Clinical progression in schizophrenia can be better conceptualised as neuroplastic changes in response to interaction between core developmental pathology and environmental stimuli. An alternative rationale for early and continuous intervention targeting neurodevelopmental abnormality and neuroplastic changes, as well as medical and psychological comorbidities, is proposed in this paper.
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Affiliation(s)
- E Bora
- Department of Psychiatry,Faculty of Medicine,Dokuz Eylül University,Izmir,Turkey
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41
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Croca M, Lagodka A, Gadel R, Bourdel MC, Bendjemaa N, Gaillard R, Olié JP, Champagne-Lavau M, Krebs MO, Amado I. Theory of mind and schizophrenia in young and middle-aged patients: Influence of executive functions. Psychiatry Res 2018; 259:532-537. [PMID: 29156426 DOI: 10.1016/j.psychres.2017.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/13/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
Theory of Mind (ToM) is compromised in schizophrenia, and responsible for social disability. We aim to study the correlation between ToM deficits and Executive Functions (EF), using the Faux Pas Test (FPT) for ToM evaluation, Behavioral Assessment of the Dysexecutive Syndrome (BADS) and Wisconsin Card Sorting Test (WCST) for EF assessment. Two groups of patients with schizophrenia were included: 22 young (18-35 years-old) and 18 middle-aged (>50 years-old) Patients, compared to age-matched Controls. We found worst FPT performances in both groups of patients, but with a more generalized pattern of dysfunction in the middle-aged patient group. This group had worse EF scores than both controls and younger patients. The association of EF with FPT items was uneven. In young patients only empathy (Q6) remained significant after controlling for EF and level of education, while in middle-aged patients faux pas explanation (Q4), false belief (Q5) and total scores remained significant. In young patients only affective TOM was impaired. No correlation was found with clinical symptoms, nor age at onset of the disease. We conclude that ToM deficit arises early during the course of the illness (already present in young patients), increases in middle-aged patients, and relates only partially with EF.
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Affiliation(s)
- Marta Croca
- Mental Health and Psychiatry Department, Hospital de Santa Maria - CHLN, Lisbon, Portugal; Faculdade de Medicina de Lisboa - University of Lisbon, Portugal
| | - Aurèlie Lagodka
- Centre de remédiation cognitive et réhabilitation psychosociale - C3RP, Service Hospitalo-Universitaire de santé mentale et thérapeutique, Hôpital Sainte-Anne, 1 Rue Cabanis, 75014 Paris, France; Inserm U 894, Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Remi Gadel
- Centre de remédiation cognitive et réhabilitation psychosociale - C3RP, Service Hospitalo-Universitaire de santé mentale et thérapeutique, Hôpital Sainte-Anne, 1 Rue Cabanis, 75014 Paris, France; Inserm U 894, Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Marie Chantal Bourdel
- Centre de remédiation cognitive et réhabilitation psychosociale - C3RP, Service Hospitalo-Universitaire de santé mentale et thérapeutique, Hôpital Sainte-Anne, 1 Rue Cabanis, 75014 Paris, France; Inserm U 894, Université Paris Descartes, Paris Sorbonne Cité, Paris, France; Inserm U 894, Psychiatry and Neuroscience center, France
| | - Narjes Bendjemaa
- Centre de remédiation cognitive et réhabilitation psychosociale - C3RP, Service Hospitalo-Universitaire de santé mentale et thérapeutique, Hôpital Sainte-Anne, 1 Rue Cabanis, 75014 Paris, France; Inserm U 894, Université Paris Descartes, Paris Sorbonne Cité, Paris, France; Inserm U 894, Psychiatry and Neuroscience center, France
| | - Raphael Gaillard
- Centre de remédiation cognitive et réhabilitation psychosociale - C3RP, Service Hospitalo-Universitaire de santé mentale et thérapeutique, Hôpital Sainte-Anne, 1 Rue Cabanis, 75014 Paris, France; Inserm U 894, Université Paris Descartes, Paris Sorbonne Cité, Paris, France; Inserm U 894, Psychiatry and Neuroscience center, France
| | - Jean Pierre Olié
- Centre de remédiation cognitive et réhabilitation psychosociale - C3RP, Service Hospitalo-Universitaire de santé mentale et thérapeutique, Hôpital Sainte-Anne, 1 Rue Cabanis, 75014 Paris, France; Inserm U 894, Université Paris Descartes, Paris Sorbonne Cité, Paris, France; Inserm U 894, Psychiatry and Neuroscience center, France
| | - M Champagne-Lavau
- Aix-Marseille University, CNRS, LPL UMR 7309, 13100 Aix-en-Provence, France
| | - Marie Odile Krebs
- Centre de remédiation cognitive et réhabilitation psychosociale - C3RP, Service Hospitalo-Universitaire de santé mentale et thérapeutique, Hôpital Sainte-Anne, 1 Rue Cabanis, 75014 Paris, France; Inserm U 894, Université Paris Descartes, Paris Sorbonne Cité, Paris, France; Inserm U 894, Psychiatry and Neuroscience center, France
| | - Isabelle Amado
- Centre de remédiation cognitive et réhabilitation psychosociale - C3RP, Service Hospitalo-Universitaire de santé mentale et thérapeutique, Hôpital Sainte-Anne, 1 Rue Cabanis, 75014 Paris, France; Inserm U 894, Université Paris Descartes, Paris Sorbonne Cité, Paris, France; Inserm U 894, Psychiatry and Neuroscience center, France.
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42
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Czepielewski LS, Massuda R, Panizzutti B, Grun LK, Barbé-Tuana FM, Teixeira AL, Barch DM, Gama CS. Telomere Length and CCL11 Levels are Associated With Gray Matter Volume and Episodic Memory Performance in Schizophrenia: Evidence of Pathological Accelerated Aging. Schizophr Bull 2018; 44:158-167. [PMID: 28338779 PMCID: PMC5767949 DOI: 10.1093/schbul/sbx015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Schizophrenia (SZ) is associated with increased somatic morbidity and mortality, in addition to cognitive impairments similar to those seen in normal aging, which may suggest that pathological accelerated aging occurs in SZ. Therefore, we aim to evaluate the relationships of age, telomere length (TL), and CCL11 (aging and inflammatory biomarkers, respectively), gray matter (GM) volume and episodic memory performance in individuals with SZ compared to healthy controls (HC). One hundred twelve participants (48 SZ and 64 HC) underwent clinical and memory assessments, structural MRI, and had their peripheral blood drawn for biomarkers analysis. Comparisons of group means and correlations were performed. Participants with SZ had decreased TL and GM volume, increased CCL11, and worse memory performance compared to HC. In SZ, shorter TL was related to increased CCL11, and both biomarkers were related to reduced GM volume, all of which were related to worse memory performance. Older age was only associated with reduced GM, but longer duration of illness was related with all the aforementioned variables. Younger age of disease onset was associated with increased CCL11 levels and worse memory performance. In HC, there were no significant correlations except between memory and GM. Our results are consistent with the hypothesis of accelerated aging in SZ. These results may indicate that it is not age itself, but the impact of the disease associated with a pathological accelerated aging that leads to impaired outcomes in SZ.
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Affiliation(s)
- Leticia Sanguinetti Czepielewski
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Raffael Massuda
- Departamento de Psiquiatria, Universidade Federal do Paraná, Curitiba, Brazil
| | - Bruna Panizzutti
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Kich Grun
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Florencia María Barbé-Tuana
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Antonio Lucio Teixeira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, MO,Department of Psychiatry and Radiology, Washington University in St Louis, St Louis, MO
| | - Clarissa S Gama
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,To whom correspondence should be addressed; Hospital de Clínicas de Porto Alegre/CPE, Molecular Psychiatry Laboratory, Rua Ramiro Barcelos, 2350, Prédio Anexo, 90035-903 Porto Alegre, Brazil; tel: +55-51-33598845, fax: +55-51-33598846, e-mail:
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Van Assche L, Morrens M, Luyten P, Van de Ven L, Vandenbulcke M. The neuropsychology and neurobiology of late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: A critical review. Neurosci Biobehav Rev 2017; 83:604-621. [DOI: 10.1016/j.neubiorev.2017.08.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 01/20/2023]
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44
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Lahera G, Ruiz A, Brañas A, Vicens M, Orozco A. Tiempo de reacción, velocidad de procesamiento y atención sostenida en esquizofrenia: impacto sobre el funcionamiento social. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 10:197-205. [DOI: 10.1016/j.rpsm.2017.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 02/21/2017] [Accepted: 04/12/2017] [Indexed: 01/27/2023]
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45
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Ishøy PL, Fagerlund B, Broberg BV, Bak N, Knop FK, Glenthøj BY, Ebdrup BH. No cognitive-enhancing effect of GLP-1 receptor agonism in antipsychotic-treated, obese patients with schizophrenia. Acta Psychiatr Scand 2017; 136:52-62. [PMID: 28260235 DOI: 10.1111/acps.12711] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Schizophrenia is associated with profound cognitive and psychosocial impairments. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used for diabetes and obesity treatment, and animal studies have indicated cognitive-enhancing effects. In this investigator-initiated, double-blind, randomized, placebo-controlled trial, we tested non-metabolic effects of exenatide once-weekly (Bydureon™) in obese, antipsychotic-treated patients with schizohrenia spectrum disorder. METHOD Before and after 3 months of exenatide (N = 20) or placebo (N = 20) treatment, patients were assessed with the following: Brief Assessment of Cognition in Schizophrenia (BACS), Rey-Osterreith complex figure test (REY), Short-Form Health Survey (SF-36), Personal and Social Performance Scale (PSP) and the Positive and Negative Syndrome Scale (PANSS). We used BACS composite score as the main outcome measure. RESULTS Repeated measures analysis of variance on BACS composite score showed significant effect of 'Time' (P < 0.001), no effect of 'Group' (P = 0.64) and no 'Time*Group' interaction (P = 0.77). For REY, SF-36, PSP and PANSS, only significant 'Time' effects were found. CONCLUSION The non-significant results of this first clinical trial exploring non-metabolic effects of a long-acting GLP-1RA in patients with schizophrenia could reflect a general problem of translating cognitive-enhancing effects of GLP-1RAs from animals to humans or be explained by factors specifically related to schizophrenia spectrum patients with obesity such as antipsychotic treatment.
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Affiliation(s)
- P L Ishøy
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B Fagerlund
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B V Broberg
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - N Bak
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - F K Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,The Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B Y Glenthøj
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
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46
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Lifetime use of psychiatric medications and cognition at 43years of age in schizophrenia in the Northern Finland Birth Cohort 1966. Eur Psychiatry 2017; 45:50-58. [PMID: 28728095 DOI: 10.1016/j.eurpsy.2017.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/07/2017] [Accepted: 06/11/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Higher lifetime antipsychotic exposure has been associated with poorer cognition in schizophrenia. The cognitive effects of adjunctive psychiatric medications and lifetime trends of antipsychotic use remain largely unclear. We aimed to study how lifetime and current benzodiazepine and antidepressant medications, lifetime trends of antipsychotic use and antipsychotic polypharmacy are associated with cognitive performance in midlife schizophrenia. METHODS Sixty participants with DSM-IV schizophrenia from the Northern Finland Birth Cohort 1966 were examined at 43years of age with an extensive cognitive test battery. Cumulative lifetime and current use of psychiatric medications were collected from medical records and interviews. The associations between medication and principal component analysis-based cognitive composite score were analysed using linear regression. RESULTS Lifetime cumulative DDD years of benzodiazepine and antidepressant medications were not significantly associated with global cognition. Being without antipsychotic medication (for minimum 11months) before the cognitive examination was associated with better cognitive performance (P=0.007) and higher lifetime cumulative DDD years of antipsychotics with poorer cognition (P=0.020), when adjusted for gender, onset age and lifetime hospital treatment days. Other lifetime trends of antipsychotic use, such as a long antipsychotic-free period earlier in the treatment history, and antipsychotic polypharmacy, were not significantly associated with cognition. CONCLUSIONS Based on these naturalistic data, low exposure to adjunctive benzodiazepine and antidepressant medications does not seem to affect cognition nor explain the possible negative effects of high dose long-term antipsychotic medication on cognition in schizophrenia.
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Herold CJ, Schmid LA, Lässer MM, Seidl U, Schröder J. Cognitive Performance in Patients with Chronic Schizophrenia Across the Lifespan. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2017. [DOI: 10.1024/1662-9647/a000164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Chronic schizophrenia involves neuropsychological deficits that primarily strike executive functions and episodic memory. Our study investigated these deficits throughout the lifespan in patients with chronic schizophrenia and in healthy controls. Important neuropsychological functions were tested in 94 patients and 66 healthy controls, who were assigned to three age groups. Compared with the healthy controls, patients performed significantly poorer on all tests applied. Significant age effects occurred on all tests except the digit span forward, with older subjects scoring well below the younger ones. With respect to cognitive flexibility, age effects were more pronounced in the patients. These findings underline the importance of cognitive deficits in chronic schizophrenia and indicate that diminished cognitive flexibility shows age-associated differences.
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Affiliation(s)
- Christina Josefa Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Lena Anna Schmid
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marc Montgomery Lässer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Institute of Gerontology, University of Heidelberg, Heidelberg, Germany
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48
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Baandrup L, Fagerlund B, Glenthoj B. Neurocognitive performance, subjective well-being, and psychosocial functioning after benzodiazepine withdrawal in patients with schizophrenia or bipolar disorder: a randomized clinical trial of add-on melatonin versus placebo. Eur Arch Psychiatry Clin Neurosci 2017; 267:163-171. [PMID: 27400927 DOI: 10.1007/s00406-016-0711-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 06/30/2016] [Indexed: 12/22/2022]
Abstract
Chronic benzodiazepine use is common in patients with mental illness and is associated with cognitive impairment. It is unclear whether benzodiazepine-induced cognitive impairment is reversible. Amelioration of cognitive dysfunction may be facilitated during benzodiazepine tapering by add-on melatonin due to its anti-inflammatory and neuroprotective properties. We examined how melatonin and benzodiazepine withdrawal affect cognition, subjective well-being, and psychosocial functioning. Eighty patients with schizophrenia or bipolar disorder were randomized to add-on treatment once daily with either prolonged-release melatonin or placebo in a 24-week, double-blind clinical trial. All participants gradually tapered usual benzodiazepine dosage in a closely monitored treatment setting. We used the Brief Assessment of Cognition in Schizophrenia (BACS) to assess neurocognitive performance with additional assessments of subjective well-being and psychosocial functioning. BACS composite and subscale scores (except motor speed) significantly improved in parallel with benzodiazepine dose reduction, but there was no additional effect of melatonin. Cognitive performance was still markedly impaired post-tapering compared with normative data. Neither benzodiazepine withdrawal nor treatment group affected subjective well-being or psychosocial functioning. In conclusion, add-on melatonin does not seem to affect cognition, well-being, or psychosocial functioning in patients with severe mental illness. The observed improvement in cognitive performance could not be distinguished from retest effects, which may in turn have been facilitated by the benzodiazepine tapering.
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Affiliation(s)
- Lone Baandrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Center Glostrup, Mental Health Services - Capital Region of Denmark, Glostrup, Denmark.
| | - Birgitte Fagerlund
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Center Glostrup, Mental Health Services - Capital Region of Denmark, Glostrup, Denmark
| | - Birte Glenthoj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Center Glostrup, Mental Health Services - Capital Region of Denmark, Glostrup, Denmark
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49
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Murante T, Cohen CI. Cognitive Functioning in Older Adults With Schizophrenia. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:26-34. [PMID: 31975837 DOI: 10.1176/appi.focus.20160032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cognitive deficits are thought to be a core feature in schizophrenia and have been found to be strongly associated with impairments in functioning. It is estimated that more than 70% of patients with schizophrenia have cognitive impairment. The aim of this article is to critically review the emerging literature on cognition in older adults with schizophrenia. Specifically, we address the following questions: Are there differences in cognitive functioning between older adults with schizophrenia and their healthy age peers as well as with younger people with schizophrenia? What are the factors associated with cognitive deficits and their interaction over time? What are the life course trajectories of cognitive deficits, especially in later life? Are older adults with schizophrenia more likely to develop dementia, and, if so, does it differ from other dementias? Are there pharmacological and psychosocial interventions that can successfully treat cognitive deficits in older adults with schizophrenia?
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Affiliation(s)
- Tessa Murante
- Dr. Murante is with the Psychiatric Residency Training Program and Dr. Cohen is with the Division of Geriatric Psychiatry, SUNY Downstate Medical College, Brooklyn, New York. Send correspondence to Dr. Cohen (e-mail: )
| | - Carl I Cohen
- Dr. Murante is with the Psychiatric Residency Training Program and Dr. Cohen is with the Division of Geriatric Psychiatry, SUNY Downstate Medical College, Brooklyn, New York. Send correspondence to Dr. Cohen (e-mail: )
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50
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Lifetime antipsychotic medication and cognitive performance in schizophrenia at age 43 years in a general population birth cohort. Psychiatry Res 2017; 247:130-138. [PMID: 27888683 PMCID: PMC5241225 DOI: 10.1016/j.psychres.2016.10.085] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 09/30/2016] [Accepted: 10/30/2016] [Indexed: 11/23/2022]
Abstract
This naturalistic study analysed the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia after an average of 16.5 years of illness. Sixty participants with schizophrenia and 191 controls from the Northern Finland Birth Cohort 1966 were assessed at age 43 years with a neurocognitive test battery. Cumulative lifetime antipsychotic dose-years were collected from medical records and interviews. The association between antipsychotic dose-years and a cognitive composite score based on principal component analysis was analysed using linear regression. Higher lifetime antipsychotic dose-years were significantly associated with poorer cognitive composite score, when adjusted for gender, onset age and lifetime hospital treatment days. The effects of typical and atypical antipsychotics did not differ. This is the first report of an association between cumulative lifetime antipsychotic dose and global cognition in midlife schizophrenia. Based on these data, higher lifetime antipsychotic dose-years may be associated with poorer cognitive performance at age 43 years. Potential biases related to the naturalistic design may partly explain the results; nonetheless, it is possible that large antipsychotic doses harm cognition in schizophrenia in the long-term.
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