Skip to main content

Advertisement

SpringerLink
Log in

Neuropsychological impairments predict the clinical course in schizophrenia

  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

To add to the open question whether cognitive impairments predict clinical outcome in schizophrenia, a sample of 125 first episode patients was assessed at the onset and over one year of controlled long-term treatment within a study of the German Research Network on Schizophrenia. No relapse according to predefined criteria occurred within the first year, but a total of 29 patients fulfilled post-hoc criteria of “clinical deterioration”. Impairments in cognitive functioning assessed by the Trail-Making Test B at the onset of long-term treatment differentiated between patients with vs. without later clinical deterioration and proved to be a significant predictor of the clinical course in a regression analysis outperforming initial clinical status as predictor. However, low sensitivity (72%) and specificity (51%) limit possibilities of a transfer to individual predictions. As a linear combination of neuropsychological and psychopathological variables obtained highest predictive validity, such a combination may improve the prediction of the course of schizophrenic disorders and may ultimately lead to a more efficient and comprehensive treatment planning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Albus M, Hubmann W, Scherer J, Dreikorn B, Hecht S, Sobizack N, Mohr F (2002) A prospective 2-year follow-up study of neurocognitive functioning in patients with first-episode schizophrenia. Eur Arch Psychiatry Clin Neurosci 252:262–267

    Article  PubMed  Google Scholar 

  2. Aster M, Neubauer A, Horn R (2006) Wechsler Intelligenztest für Erwachsene (WIE). Harcourt Test Services, Frankfurt

    Google Scholar 

  3. Bilder RM, Bates JA (1994) Neuropsychological prediction of treatment response and outcome in schizophrenia. In: Gaebel W, Awad AG (eds) Prediction of neuroleptic treatment outcome in schizophrenia: concepts and methods. Springer, New York, pp 99–110

    Google Scholar 

  4. Bowie CR, Leung WW, Reichenberg A, McClure MM, Patterson TL, Heaton RK, Harvey PD (2008) Predicting schizophrenia patients′ real world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry 63:505–511

    Article  PubMed  Google Scholar 

  5. Braff DL, Greenwood TA, Swerdlow NR, Light GA, Schork NJ (2008) Advances in endophenotyping schizophrenia. World Psychiatry 7:11–18

    PubMed  Google Scholar 

  6. Brekke JS, Long JD, Nesbitt N, Sobel E (1997) The impact of service characteristics on functional outcomes from community support programs for persons with schizophrenia: a growth curve analysis. J Consult Clin Psychol 65:464–475

    Article  PubMed  CAS  Google Scholar 

  7. Brewer WJ, Francey SM, Wood SJ, Jackson HJ, Pantelis C, Phillips LJ, Yung AR, Anderson VA, McGorry PD (2005) Memory impairments identified in people at ultra-high risk for psychosis who later develop first-episode psychosis. Am J Psychiatry 162:71–78

    Article  PubMed  Google Scholar 

  8. Buckley PF, Harvey PD, Bowie CR, Loebel A (2007) The relationship between symptomatic remission and neuropsychological improvement in schizophrenia patients switched to treatment with ziprasidone. Schizophr Res 94:99–106

    Article  PubMed  Google Scholar 

  9. Cannon TD, Zorrilla LE, Shtasel D, Gur RE, Gur RC, Marco EJ, Moberg P, Price RA (1994) Neuropsychological functioning in siblings discordant for schizophrenia and healthy volunteers. Arch Gen Psychiatry 51:651–661

    PubMed  CAS  Google Scholar 

  10. Cornblatt B, Obuchowski M, Roberts S, Pollack S, Erlenmeyer-Kimling L (1999) Cognitive and behavioral precursors of schizophrenia. Dev Psychopathol 11:487–508

    Article  PubMed  CAS  Google Scholar 

  11. Cornblatt BA, Risch NJ, Faris G, Friedman D, Erlenmeyer-Kimling L (1988) The continuous performance test, identical pairs version (CPT-IP): I new findings about sustained attention in normal families. Psychiatry Res 26:223–238

    Article  PubMed  CAS  Google Scholar 

  12. Cosway R, Byrne M, Clafferty R, Hodges A, Grant E, Abukmeil SS, Lawrie SM, Miller P, Johnstone EC (2000) Neuropsychological change in young people at high risk for schizophrenia: results from the first two neuropsychological assessments of the Edinburgh High Risk Study. Psychol Med 30:1111–1121

    Article  PubMed  CAS  Google Scholar 

  13. Csernansky JG, Mahmoud R, Brenner R (2002) A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia. N Engl J Med 346:16–22

    Article  PubMed  CAS  Google Scholar 

  14. Cuesta MJ, Peralta V, Zarzuela A (1998) Ilness duration and neuropsychological impairments in schizophrenia. Schizophr Res 33:141–150

    Article  PubMed  CAS  Google Scholar 

  15. Demily C, Franck N (2008) Cognitive remediation: a promising tool for the treatment of schizophrenia. Expert Rev Neurother 8:1029–1036

    Article  PubMed  Google Scholar 

  16. Elvevåg B, Goldberg TE (2000) Cognitive impairment in schizophrenia is the core of the disorder. Crit Rev Neurobiol 14:1–21

    PubMed  Google Scholar 

  17. Emsley R, Chiliza B, Schoeman R (2008) Predictors of long-term outcome in schizophrenia. Curr Opin Psychiatry 21:173–177

    PubMed  Google Scholar 

  18. Frances A, Pincus HA, First MB (1994) The global assessment of functioning scale (GAF). In: Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington DC, p 34

  19. Fuller R, Nopoulos P, Arndt S, O’Leary D, Ho BC, Andreasen NC (2002) Longitudinal assessment of premorbid cognitive functioning in patients with schizophrenia through examination of standardized scholastic test performance. Am J Psychiatry 159:1183–1189

    Article  PubMed  Google Scholar 

  20. Gaebel W, Jänner M, Frommann N, Pietzcker A, Köpcke W, Linden M, Müller P, Müller-Spahn F, Tegeler J (2002) First vs. multiple episode schizophrenia: two-year outcome of intermittent and maintenance medication strategies. Schizophr Res 53:145–159

    Article  PubMed  Google Scholar 

  21. Gaebel W, Möller HJ, Buchkremer G, Ohmann C, Riesbeck M, Wölwer W, Von Wilmsdorff M, Bottlender R, Klingberg S (2004) Pharmacological long-term treatment strategies in first episode schizophrenia: study design and preliminary results of an ongoing RCT within the german research network on schizophrenia. Eur Arch Psychiatry Clin Neurosci 254:129–140

    Article  PubMed  Google Scholar 

  22. Gaebel W, Riesbeck M, Wölwer W, Klimke A, Eickhoff M, von Wilmsdorff M, Jockers-Scherübl MC, Kühn KU, Lemke M, Bechdolf A, Bender S, Degner D, Schlösser R, Schmidt LG, Schmitt A, Jäger M, Buchkremer G, Falkai P, Klingberg S, Köpcke W, Maier W, Häfner H, Ohmann C, Salize HJ, Schneider F, Möller HJ, German Study Group on First-Episode Schizophrenia (2007) Maintenance treatment with risperidone or low-dose haloperidol in first-episode schizophrenia: 1-year results of a randomized controlled trial within the German research network on schizophrenia. J Clin Psychiatry 68:1763–1774

    PubMed  CAS  Google Scholar 

  23. Gold JM, Carpenter C, Randolph C, Goldberg TE, Weinberger DR (1997) Auditory working memory and Wisconsin card sorting test performance in schizophrenia. Arch Gen Psychiatry 54:159–165

    PubMed  CAS  Google Scholar 

  24. Gråwe RW, Levander S (2001) Neuropsychological impairments in patients with schizophrenia: stability and prediction of outcome. Acta Psychiatr Scand Suppl 408:60–64

    Article  PubMed  Google Scholar 

  25. Green MF (2006) Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. J Clin Psychiatry 67(Suppl 9):3–8

    PubMed  Google Scholar 

  26. Green MF, Kern RS, Braff DL, Mintz J (2000) Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophr Bull 26:119–136

    PubMed  CAS  Google Scholar 

  27. Gur RE, Calkins ME, Gur RC, Horan WP, Nuechterlein KH, Seidman LJ, Stone WS (2007) The consortium on the genetics of schizophrenia: neurocognitive endophenotypes. Schizophr Bull 33:49–68

    Article  PubMed  Google Scholar 

  28. Guy W (ed) (1976) Clinical global impression (CGI). In: ECDEU assessment manual for psychopharmacology, Rev. edn. US Department of Health, Education and Welfare, Washington, DC

  29. Harvey PD, Bertisch H, Friedman JI, Marcus S, Parrella M, White L, Davis KL (2003) The course of functional decline in geriatric patients with schizophrenia: cognitive-functional and clinical symptoms as determinants of change. Am J Geriatr Psychiatry 11:610–619

    Article  PubMed  Google Scholar 

  30. Heinrichs RW, Zakzanis KK (1998) Neurocognitive deficit in schizophrenia: a quantative review of the evidence. Neuropsychol 12:426–445

    Article  CAS  Google Scholar 

  31. Helmstaedter C, Lendt M, Lux S (2001) Verbaler Lern- und Merkfähigkeitstest. Göttingen, Hogrefe

    Google Scholar 

  32. Hoff AL, Svetina C, Shields G, Stewart J, DeLisi LE (2005) Ten year longitudinal study of neuropsychological functioning subsequent to a first episode of schizophrenia. Schizophr Res 78:27–34

    PubMed  Google Scholar 

  33. Holthausen EAE, Wiersma D, Cahn W, Kahn RS, Dingemans PM, Schene AH, van den Bosch RJ (2007) Predictive value of cognition for different domains of outcome in recent-onset schizophrenia. Psychiatry Res 149:71–80

    Article  PubMed  Google Scholar 

  34. Kay SR, Opler LA, Fiszbein A (1986) The positive and negative syndrome scale (PANSS) rating manual. Soc Behav Sci Doc 17:28–29

    Google Scholar 

  35. Keefe RS, Eesley CE, Poe MP (2005) Defining a cognitive function decrement in schizophrenia. Biol Psychiatry 57:688–691

    Article  PubMed  Google Scholar 

  36. Keefe RS, Perkins DO, Gu Hongbin Zipursky RB, Christensen BK, Lieberman JA (2006) A longitudinal study of neurocognitive function in individuals at-risk for psychosis. Schizophr Res 88:26–35

    Article  PubMed  Google Scholar 

  37. Kurtz MM (2005) Neurocognitive impairment across the lifespan in schizophrenia: an update. Schizophr Res 74:15–26

    Article  PubMed  Google Scholar 

  38. Lehrl S (2005) Mehrfachwahl-Wortschatz-Intelligenztest MWT-B. Spitta Verlag, Balingen

    Google Scholar 

  39. Lencz T, Smith CW, McLaughlin D, Auther A, Nakayama E, Hovey L, Cornblatt BA (2005) Generalized and specific neurocognitive deficits in prodromal schizophrenia. Biol Psychiatry 59:863–871

    Article  PubMed  Google Scholar 

  40. Milev P, Ho BC, Arndt S, Andreasen NC (2005) Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry 162:495–506

    Article  PubMed  Google Scholar 

  41. Moritz S, Krausz M, Gottwalz E, Lambert M, Perro C, Ganzer S, Naber D (2000) Cognitive dysfunction at baseline predicts symptomatic 1-year outcome in first-episode schizophrenics. Psychopathology 33:48–51

    Article  PubMed  CAS  Google Scholar 

  42. O’Donnell JP, Macgregor LA, Dabrowski JJ, Oestreicher JM, Romero JJ (1994) Construct validity of neuropsychological tests of conceptual and attentional abilities. J Clin Psychol 50:596–600

    Article  PubMed  CAS  Google Scholar 

  43. Petrides M, Milner B (1982) Deficits on subject-ordered tasks after frontal- and temporal-lobe lesions in man. Neuropsychologia 20:249–262

    Article  PubMed  CAS  Google Scholar 

  44. Reitan RM (1958) Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 8:271–276

    Article  Google Scholar 

  45. Robinson D, Woerner MG, Alvir JMJ, Bilder R, Goldman R, Geisler S, Koreen A, Sheitman B, Chakos M, Mayerhoff D, Lieberman JA (1999) Predictors of relapse following response form a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 56:241–247

    Article  PubMed  CAS  Google Scholar 

  46. Rund BR (1998) A review of longitudinal studies of cognitive functions in schizophrenia patients. Schizophr Bull 24:425–435

    PubMed  CAS  Google Scholar 

  47. Saykin AJ, Shtasel DL, Gur RE, Kester DB, Mozley LH, Stafiniak P, Gur RC (1994) Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia. Arch Gen Psychiatry 51:124–131

    PubMed  CAS  Google Scholar 

  48. Schüpbach D, Harris MS, Keshavan MS, Sweeney JA (2007) Die Bedeutung der Negativsymptomatik für kognitive Defizite bei Patienten mit Erstmanifestation einer Schizophrenie. Schweiz Arch Neurol Psychiatr 185:32–38

    Google Scholar 

  49. Snitz BE, MacDonald AW, Carter CS (2006) Cognitive deficits in unaffected first-degree relatives of schizophrenia patients: a meta-analytic review of putative endophenotypes. Schizophr Bull 32:179–194

    Article  PubMed  Google Scholar 

  50. Stirling J, White C, Lewis S, Hopkins R, Tantam D, Huddy A, Montague L (2003) Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort. Schizophr Res 65:75–86

    Article  PubMed  Google Scholar 

  51. Szöke A, Trandafir A, Dupont ME, Meary A, Schürhoff F, Leboyer M (2008) Longitudinal studies of cognition in schizophrenia: meta analysis. Br J Psychiatry 192:248–257

    Article  PubMed  Google Scholar 

  52. Velligan DI, Bow-Thomas CC, Mahurin RK, Miller AL, Halgunseth LC (2000) Do specific neurocognitive deficits predict specific domains of community function in schizophrenia? J Nerv Ment Dis 188:518–524

    Article  PubMed  CAS  Google Scholar 

  53. Whyte MC, Brett C, Harrison LK, Byrne M, Miller P, Lawrie SM, Johnstone EC (2006) Neuropsychological performance over time in people at high risk of developing schizophrenia and controls. Biol Psychiatry 59:730–739

    Article  PubMed  Google Scholar 

  54. Wittorf A, Wiedemann G, Buchkremer G, Klingberg S (2008) Prediction of community outcome in schizophrenia 1 year after discharge from inpatient treatment. Eur Arch Psychiatry Clin Neurosci 258:48–58

    Article  PubMed  Google Scholar 

  55. Wölwer W, Buchkremer G, Häfner H, Klosterkötter J, Maier W, Möller HJ, Gaebel W (2003) German research network on schizophrenia-bridging the gap between research and care. Eur Arch Psychiatry Clin Neurosci 253:321–329

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study is part of the German Research Network on Schizophrenia and was funded by the German Federal Ministry of Education and Research (BMBF grants 01GI9932, 01GI0232, and 01G0532). The authors are much obliged to the members of the German Study Group on First-Episode Schizophrenia for all their contributions. The German Study Group on First-Episode Schizophrenia: W.G., W.W., M.R., J.B., Martina von Wilmsdorf, Robert Krohmer (Düsseldorf, Germany); A.K. (Offenbach, Germany); Matthias Eickhoff (Warstein/Lippstadt, Germany); H.-J.M., Markus Jäger (Munich, Germany); S.K., Gerd Buchkremer, Michael Mayenberger, (Tuebingen, Germany); Paul Hoff, Frank Schneider (Aachen, Germany; recruitment until June 2002); Wolfgang Maier, Kai-Uwe Kühn, Matthias Lemke, Beate Johannwerner (Bonn, Germany); Isabella Heuser, Maria C. Jockers-Scherübl (Berlin, Germany); Joachim Klosterkötter, Andreas Bechdolf, Wolfgang Huff (Cologne, Germany); Markus Gastpar, Stefan Bender, Volker Reissner (Essen, Germany); Eckhart Rüther, Peter Falkai, Detlef Degner, Andrea Schmitt (Goettingen, Germany); Heinrich Sauer, Ralf Schlösser, Gerd Wagner (Jena, Germany); Fritz A. Henn, Heinz Häfner, Kurt Maurer, Hans J. Salize (Mannheim, Germany); Lutz G. Schmidt (Mainz, Germany; recruitment until February 2002). Conflict of interest disclosure W.G. has received consultation fees (including scientific advisory boards) from Janssen Cilag, Lilly Germany, Lundbeck GmbH, the Lundbeck Foundation, Novartis and Wyeth Pharma. W.G. has received research grants from Astra Zeneca, Bristol Myers Squibb, Eli Lilly Foundation, Janssen Cilag and Lilly Germany. W.G. is or was a member of the Speaker's Bureau of Astra Zeneca, Bristol Myers Squibb, Janssen-Cilag, Lilly Germany, Lundbeck GmbH, Lundbeck Institute, Novartis and Wyeth Pharma. H.-J. M. has received grants or is a consultant for and on the Speakership Bureaus of AstraZeneca, Bristol-Myers Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, Novartis, Organon, Pfizer, Sanofi-Aventis, Sepracor, Servier and Wyeth. A.K. is a member of the Advisory Boards for AstraZeneca and Otsuka Pharma, and is or was a member of the Speaker Bureau for AstraZeneca, Janssen-Cilag, Lilly Germany, and Novartis Pharma. W.W. was a member of the Speaker Bureau for Janssen-Cilag and Lilly Germany. J.B., M.R., L.F., M.W., and S.K. report no financial or other relationships with a commercial organization including those sponsoring or organizing the 2007 congress of the German Society of Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) that might pose a conflict of interest.

Author information

Authors and Affiliations

  1. Dept. of Psychiatry and Psychotherapy, Heinrich-Heine-University Düsseldorf-Rhineland State Clinics Düsseldorf, Bergische Landstraße 2, 40629, Düsseldorf, Germany

    Wolfgang Wölwer, Jürgen Brinkmeyer, Mathias Riesbeck, Lena Freimüller & Wolfgang Gaebel

  2. Dept. of Psychiatry and Psychotherapy, Clinical Centre Offenbach, Offenbach, Germany

    Ansgar Klimke

  3. Dept. of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany

    Michael Wagner

  4. Dept. of Psychiatry, University of Munich, Munich, Germany

    Hans-Jürgen Möller

  5. Dept. of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany

    Stefan Klingberg

Authors
  1. Wolfgang Wölwer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jürgen Brinkmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathias Riesbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lena Freimüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ansgar Klimke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hans-Jürgen Möller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefan Klingberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wolfgang Gaebel
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the German Study Group on First Episode Schizophrenia

Corresponding author

Correspondence to Wolfgang Wölwer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wölwer, W., Brinkmeyer, J., Riesbeck, M. et al. Neuropsychological impairments predict the clinical course in schizophrenia. Eur Arch Psychiatry Clin Neurosci 258 (Suppl 5), 28–34 (2008). https://doi.org/10.1007/s00406-008-5006-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-008-5006-2

Keywords

Search

Navigation