Allott Kelly, Schmidt Stefanie J, Yuen Hok Pan, Wood Stephen J, Nelson Barnaby, Markulev Connie, Lavoie Suzie, Brewer Warrick J, Schäfer Miriam R, Mossaheb Nilufar, Schlögelhofer Monika, Smesny Stefan, Hickie Ian B, Berger Gregor Emanuel, Chen Eric Y H, de Haan Lieuwe, Nieman Dorien H, Nordentoft Merete, Riecher-Rössler Anita, Verma Swapna, Thompson Andrew, Yung Alison R, Amminger Paul, McGorry Patrick D, Hartmann Jessica
Orygen, Parkville, Australia.
Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
Schizophr Bull Open. 2022 Jan 13;3(1):sgac008. doi: 10.1093/schizbullopen/sgac008. eCollection 2022 Jan.
Understanding longitudinal cognitive performance in individuals at ultra-high risk for psychosis (UHR) is important for informing theoretical models and treatment. A vital step in this endeavor is to determine whether there are UHR subgroups that have similar patterns of cognitive change over time. The aims were to: i) identify latent class trajectories of cognitive performance over 12-months in UHR individuals, ii) identify baseline demographic and clinical predictors of the resulting classes, and iii) determine whether trajectory classes were associated with transition to psychosis or functional outcomes. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline, 6- and 12-months ( = 288). Using Growth Mixture Modeling, a single unimpaired improving trajectory class was observed for motor function, speed of processing, verbal fluency, and BACS composite. A two-class solution was observed for executive function and working memory, showing one unimpaired and a second impaired class. A three-class solution was found for verbal learning and memory: unimpaired, mildly impaired, and initially extremely impaired, but improved ("caught up") to the level of the mildly impaired. IQ, omega-3 index, and premorbid adjustment were associated with class membership, whereas clinical variables (symptoms, substance use), including transition to psychosis, were not. Working memory and verbal learning and memory trajectory class membership was associated with functioning outcomes. These findings suggest there is no short-term progressive cognitive decline in help-seeking UHR individuals, including those who transition to psychosis. Screening of cognitive performance may be useful for identifying UHR individuals who may benefit from targeted cognitive interventions.
了解超高危精神病个体（UHR）的纵向认知表现对于完善理论模型和治疗方法具有重要意义。这一工作的关键步骤是确定是否存在随时间推移认知变化模式相似的UHR亚组。目的是：i）识别UHR个体在12个月内认知表现的潜在类别轨迹，ii）识别所得类别的基线人口统计学和临床预测因素，iii）确定轨迹类别是否与精神病转变或功能结局相关。在基线、6个月和12个月时使用精神分裂症认知简短评估量表（BACS）评估认知（n = 288）。使用生长混合模型，观察到运动功能、加工速度、言语流畅性和BACS综合得分呈现单一未受损且改善的轨迹类别。执行功能和工作记忆观察到两类解决方案，显示一类未受损，另一类受损。言语学习和记忆发现三类解决方案：未受损、轻度受损和最初极度受损但有所改善（“赶上”）至轻度受损水平。智商、ω-3指数和病前适应与类别归属相关，而临床变量（症状、物质使用），包括向精神病的转变，则无关。工作记忆以及言语学习和记忆轨迹类别归属与功能结局相关。这些发现表明，寻求帮助的UHR个体，包括那些转变为精神病的个体，短期内不存在进行性认知衰退。筛查认知表现可能有助于识别可能从针对性认知干预中获益的UHR个体。
