This article is more than 5 years old. Information may no longer be current.

No evidence of deteriorating cognitive control in recent-onset schizophrenia

Findings from a longitudinal, functional MRI study indicated that young patients with recent-onset schizophrenia exhibited developmental trends in behavioral performance and brain function throughout adolescence and early adulthood similar to age-matched healthy controls.

The researchers found no evidence of differential impairment related to earlier age at onset or deterioration of cognitive control processes in youth with recent-onset schizophrenia.

“The utility of [functional] MRI in elucidating age-related changes in brain function in [schizophrenia] has not been fully explored,” Tara A. Niendam, PhD, from the department of psychiatry and behavioral sciences, University of California, Davis, and colleagues wrote in JAMA Psychiatry. “Larger-scale longitudinal studies following up young individuals through the earliest phases of illness — compared with age-matched healthy controls — are needed to determine the age-related factors associated with early illness course and outcome.”

Using functional MRI data, the investigators examined the connection between age at onset and subsequent longitudinal course of prefrontal activity in young patients with schizophrenia during the first 2 years of illness and healthy controls.

Participants aged 12 to 25 years completed clinical assessments and the AX Continuous Performance Task during functional MRI at baseline and at 6-, 12-, and 24-month follow-up. Researchers performed analyses of whole-brain, voxel-wise, and an a priori dorsolateral prefrontal cortex (DLPFC) region of interest to measure group differences in developmental trajectories at baseline and across the age span via behavioral performance and cognitive control-associated brain activity. They also examined whether antipsychotics influenced behavioral performance and DLPFC activity.

Analysis revealed that 87 participants with schizophrenia showed impaired performance compared with 93 healthy controls across the age span (estimated difference = –0.571; P < .001). At baseline, patients with schizophrenia also demonstrated decreased activation in the DLPFC and parietal cortex (P < .05) compared with healthy control participants under conditions of high cognitive control.

According to region-of-interest analysis, patients with schizophrenia showed lower activation in the DLPFC bilaterally, with a trajectory that paralleled that of healthy control patients across the age span (left DLPFC beta estimates = 0.409 for the healthy control group vs. –0.285 for the schizophrenia group [P = .03]; right DLPFC beta estimates = 0.35 for the healthy control group vs. –0.469 for the schizophrenia group [P = .003]). Niendam and colleagues also found that antipsychotic drugs, clinical symptoms and global functioning were linked to schizophrenia performance.

“The observed pattern of performance for [schizophrenia] across the age span suggests that these patients continue to benefit from ongoing brain maturation during the critical period of development from adolescence into young adulthood,” the researchers wrote. “Future research should examine the effects of specific interventions (eg, cognitive remediation, psychotherapy, medication, supported education, and employment) on the trajectory of cognitive control deficits in psychotic illness.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.