Patients with psychosis may experience significant cognitive decline with age
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Cognitive performance declined over the two decades following first hospitalization for patients with psychotic disorders, according to study results published in JAMA Psychiatry.
“Periodic neuropsychological testing every 5 years or even every 10 years is a good idea,” Roman Kotov, PhD, of the department of psychiatry at Stony Brook University in New York, told Healio Psychiatry. “The provider may not realize how impaired a given patient has become, which has consequences for many spheres from medication management to employment prospects.”
According to Kotov and colleagues, previous research did not reach a definitive conclusion on whether individuals with psychotic disorders experience normal cognitive aging or progressive cognitive decline after first hospitalization. To examine long-term changes in this patient population, the researchers included 445 individuals with psychotic disorders who participated in the Suffolk County Mental Health Project — an inception cohort study of first-admission patients with psychosis, they noted. They recruited participants from 12 inpatient facilities and at year 20, they recruited 260 individuals who had never had psychotic disorders as the control group.
The researchers found that individuals with a psychotic disorder exhibited a decline in cognition on four of six domains tested. Declines were associated with worsening vocational functioning and worsening negative symptoms. Those with psychotic disorders showed age-dependent deficits in verbal knowledge, fluency and abstraction-executive function, with those aged 50 years or older having experienced the largest gap.
“There is not much one can do for cognitive change, but physical activity and social engagement are known to help,” Kotov said. “Such resources are limited in the community, but asking social workers to help is a good first step as they can help to identify those at risk and get patients going.” – by Joe Gramigna
Disclosures: Kotov reports grants from the National Institute of Mental Health. Please see the study for all other authors’ relevant financial disclosures.