Stanley Research Program, Sheppard Pratt, Baltimore, Maryland.
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
JAMA Netw Open. 2024 Sep 3;7(9):e2432401. doi: 10.1001/jamanetworkopen.2024.32401.
Schizophrenia is associated with premature mortality from mostly natural causes. Decreased cognitive functioning has been identified as a determinant of mortality in the general population. However, there have been few prospective studies of this issue in persons with schizophrenia.
To examine whether lower cognitive functioning is a risk factor for natural cause mortality in schizophrenia.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included persons with schizophrenia or schizoaffective disorder enrolled between February 1, 1999, and December 31, 2022, at a nonprofit psychiatric system in Baltimore, Maryland. Participants were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and other clinical measures.
Natural cause mortality.
Associations of cognitive function, obesity, tobacco smoking, and medical conditions with natural cause mortality were evaluated using Cox proportional hazards regression models.
Of the 844 participants enrolled (mean [SD] age, 39.6 [12.1] years; 533 male [63.2%]), 158 (18.7%) died of natural causes during a median follow-up of 14.4 years (range, 7.0 days to 23.9 years). The most significant factor associated with mortality was lower cognitive functioning as measured by the RBANS (Cox coefficient, -0.04; 95% CI, -0.05 to -0.03; z = -5.72; adjusted P < .001). Additional factors independently associated with mortality included the diagnosis of an autoimmune disorder (hazard ratio [HR], 2.86; 95% CI, 1.83-4.47; z = 4.62; adjusted P < .001), tobacco smoking (HR, 2.26; 95% CI, 1.55-3.30; z = 4.23; adjusted P < .001), diagnosis of chronic obstructive pulmonary disease (HR, 3.31; 95% CI, 1.69-6.49; z = 3.48; adjusted P = .006), body mass index as a continuous variable (HR, 1.06; 95% CI, 1.02-1.09; z = 3.30; adjusted P = .01), diagnosis of a cardiac rhythm disorder (HR, 2.56; 95% CI, 1.40-4.69; z = 3.06; adjusted P = .02), and being divorced or separated (HR, 1.80; 95% CI, 1.22-2.65; z = 2.97; adjusted P = .02). An RBANS score below the 50th percentile displayed a joint association with being a smoker, having an elevated body mass index, and having a diagnosis of an autoimmune or a cardiac rhythm disorder.
In this prospective cohort study, lower cognitive functioning was a risk factor for natural cause mortality in schizophrenia. Efforts should be directed at methods to improve cognitive functioning, particularly among individuals with additional risk factors.
精神分裂症与大多数自然原因导致的过早死亡有关。认知功能下降已被确定为普通人群死亡率的决定因素。然而，在精神分裂症患者中，很少有前瞻性研究这一问题。
研究认知功能下降是否是精神分裂症自然原因死亡的风险因素。
设计、地点和参与者：这是一项前瞻性队列研究，纳入了 1999 年 2 月 1 日至 2022 年 12 月 31 日期间在马里兰州巴尔的摩市非营利性精神科系统就诊的精神分裂症或分裂情感障碍患者。参与者使用重复神经心理状态评估量表（RBANS）和其他临床测量方法进行评估。
自然原因死亡。
使用 Cox 比例风险回归模型评估认知功能、肥胖、吸烟和医疗状况与自然原因死亡的相关性。
在 844 名入组的参与者中（平均[标准差]年龄 39.6[12.1]岁；533 名男性[63.2%]），中位随访 14.4 年（范围 7.0 天至 23.9 年）期间有 158 人（18.7%）死于自然原因。与死亡率最显著相关的因素是 RBANS 测量的较低认知功能（Cox 系数，-0.04；95%CI，-0.05 至-0.03；z=−5.72；调整后的 P<.001）。与死亡率独立相关的其他因素包括自身免疫性疾病诊断（HR，2.86；95%CI，1.83-4.47；z=4.62；调整后的 P<.001）、吸烟（HR，2.26；95%CI，1.55-3.30；z=4.23；调整后的 P<.001）、慢性阻塞性肺疾病诊断（HR，3.31；95%CI，1.69-6.49；z=3.48；调整后的 P=0.006）、体重指数作为连续变量（HR，1.06；95%CI，1.02-1.09；z=3.30；调整后的 P=0.01）、心律失常诊断（HR，2.56；95%CI，1.40-4.69；z=3.06；调整后的 P=0.02）以及离婚或分居（HR，1.80；95%CI，1.22-2.65；z=2.97；调整后的 P=0.02）。RBANS 评分低于第 50 百分位数与吸烟者、体重指数升高和自身免疫或心律失常诊断具有联合相关性。
在这项前瞻性队列研究中，认知功能下降是精神分裂症自然原因死亡的风险因素。应努力寻找改善认知功能的方法，特别是针对那些有额外风险因素的人。
