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Neurocognitive Assessments Are More Important Among Adolescents Than Adults for Predicting Psychosis in Clinical High Risk

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Abstract

Background

Few studies have examined the effects of age on neurocognition to predict conversion to psychosis in individuals at clinical high risk (CHR). This study aimed to compare the extent and predictive performance of cognitive deficits between adolescents and adults at CHR.

Methods

A comprehensive neuropsychological battery was performed on 325 CHR individuals and 365 healthy control (HC) subjects. The subjects were first divided into 189 CHR adolescents (age 12−17 years), 136 CHR adults (age 18−45 years), 88 HC adolescents, and 277 HC adults. CHR subjects were then divided into converters (CHR-Cs) (adolescents, n = 43; adults, n = 34) and nonconverters (CHR-NCs) (adolescents, n = 146; adults, n = 102) based on their 2-year follow-up clinical status.

Results

The adolescents and adults at CHR performed significantly worse than their control groups on all neurocognitive tests, except for performance on the continuous performance test in adolescents. In the comparison between adolescents and adults, patterns of neurocognitive deficits seemed to vary in HC subjects rather than in CHR subjects. In the comparison between CHR and HC subjects, the rank order of effect sizes across the neurocognitive tests was similar for the top two tests of symbol coding and verbal learning. Comparison between CHR-Cs and CHR-NCs revealed that adolescent CHR-Cs performed significantly worse than CHR-NCs on seven of eight neurocognitive tests; however, adult CHR-Cs performed significantly worse than CHR-NCs only in the visuospatial memory test.

Conclusions

The role of neurocognitive dysfunction may have different patterns and weights during the onset of psychosis in adolescents and adults at CHR, implicating the development of specific strategies that could monitor and improve cognitive function in CHR adolescents.

Section snippets

Participants and Procedures

A total of 447 participants at CHR and 365 HC subjects aged 12 to 45 years were recruited through the extended phase of ShangHai At Risk for Psychosis (SHARP-extended) between 2016 and 2019. Of all individuals at CHR, 76 did not complete baseline neurocognitive tests, while 46 were lost to follow-up by the 2-year follow-up visit. The remaining 325 CHR participants completed neurocognitive assessments using the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB) (18, 19, 20) at

Demographic, Clinical, and Cognitive Characteristics

Within the HC group, adolescents performed significantly worse than the adult group on category fluency and CPT-IP but significantly better on WMS-3 spatial span and BVMT-R (Table 1). Within the CHR group, adults performed significantly worse than the adolescent group on the BVMT-R test.

Neuropsychological Profile and Comparisons Between CHR Participants and HC Subjects

Both the CHR adolescents and CHR adults demonstrated significantly poorer performances than the HC subjects on all eight neurocognitive tests (Figure 1), except for performance on the CPT-IP test in adolescents (

Discussion

Although neurocognitive deficits have been widely used to predict psychosis from CHR status, very few studies have been conducted specifically for comparisons of cognitive performance between adolescents and adults at CHR. To our knowledge, this study is one of the largest sample sizes in which both the adolescent and adult CHR groups were matched to adolescent and adult HC groups, respectively. This study was based on a drug-naive CHR cohort sample at their first contact with mental health

Acknowledgments and Disclosures

This study was supported by the Ministry of Science and Technology of China, National Key R&D Program of China (Grant No. 2016YFC1306800), Science and Technology Commission of Shanghai Municipality (Grant Nos. 19441907800, 19ZR1445200, 17411953100, 16JC1420200, 2018SHZDZX01, 19410710800, 19411969100, and 19411950800), Shanghai Clinical Research Center for Mental Health (Grant No. 19MC1911100) and the Clinical Research Center at Shanghai Mental Health Center (Grant Nos. CRC2018ZD01 and

References (49)

  • K. Allott et al.

    Cognition at illness onset as a predictor of later functional outcome in early psychosis: Systematic review and methodological critique

    Schizophr Res

    (2011)
  • R.E. Carrión et al.

    From the psychosis prodrome to the first-episode of psychosis: No evidence of a cognitive decline

    J Psychiatr Res

    (2018)
  • M. Bang et al.

    Neurocognitive impairments in individuals at ultra-high risk for psychosis: Who will really convert?

    Aust N Z J Psychiatry

    (2015)
  • T. Zhang et al.

    Correlation of social cognition and neurocognition on psychotic outcome: A naturalistic follow-up study of subjects with attenuated psychosis syndrome

    Sci Rep

    (2016)
  • E. Bora et al.

    Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: Do the cognitive deficits progress over, or after, the onset of psychosis?

    Schizophr Bull

    (2014)
  • A.J. Giuliano et al.

    Neurocognition in the psychosis risk syndrome: A quantitative and qualitative review

    Curr Pharm Des

    (2012)
  • A. Tuulio-Henriksson et al.

    Age at onset and cognitive functioning in schizophrenia

    Br J Psychiatry

    (2004)
  • T.C. Manschreck et al.

    Earlier age of first diagnosis in schizophrenia is related to impaired motor control

    Schizophr Bull

    (2004)
  • T.H. Zhang et al.

    Two-year follow-up of a Chinese sample at clinical high risk for psychosis: Timeline of symptoms, help-seeking and conversion

    Epidemiol Psychiatr Sci

    (2017)
  • H.J. Ferguson et al.

    The developmental trajectories of executive function from adolescence to old age

    Sci Rep

    (2021)
  • J.R. Best et al.

    A developmental perspective on executive function

    Child Dev

    (2010)
  • C. Pantelis et al.

    Early and late neurodevelopmental disturbances in schizophrenia and their functional consequences

    Aust N Z J Psychiatry

    (2003)
  • B. Fagerlund et al.

    Differential effects of age at illness onset on verbal memory functions in antipsychotic-naive schizophrenia patients aged 12-43 years

    Psychol Med.

    (2021)
  • T.K. Rajji et al.

    Age at onset and cognition in schizophrenia: Meta-analysis

    Br J Psychiatry

    (2009)
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