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Cognitive Decline May Be Accelerated in Adults With Psychotic Disorders

January 13, 2020

Cognitive aging appears to occur more rapidly in people with psychotic disorders, compared with peers without such disorders, according to a study that followed 445 people for 2 decades after their first psychotic disorder hospitalization.

Researchers published their findings online in JAMA Psychiatry.

“Our study provides the first comprehensive picture of long-term cognitive changes and associated clinical and functional outcomes in psychotic disorders, and is an important step toward providing clarity on what challenges people with these disorders face in the community,” said researcher Anne-Kathrin Fett, PhD, psychology senior lecturer at City, University of London, in the United Kingdom.

Quiz: How Often Does Schizophrenia Follow Cannabis-Induced Psychosis?

Participants were from the Suffolk County Mental Health Project, which recruited first-admission patients with psychosis from 12 inpatient facilities in Suffolk County, New York. Participants completed cognitive testing at 2 and 20 years after their initial admission. Testing measured various aspects of cognitive functioning, including verbal knowledge, verbal declarative memory, visual declarative memory, attention and processing speed, abstraction-executive function, and verbal fluency.

Twenty years after their first admission, cognitive performance significantly declined on all but 2 tests, researchers reported. Compared with a control group of participants matched for age and gender, cognitive decline was greater in participants with psychotic disorders. The gap between the groups was most notable after age 50.

Across psychotic disorders—which included schizophrenia spectrum, affective psychoses, and other psychoses—cognitive declines were consistent, according to the study. Furthermore, cognitive declines were linked with worsening vocational functioning as well as worsening negative symptoms.

“However, it is important to note that while there was a general downward trend, participants varied in terms of cognitive changes and some also achieved improvement over the follow-up period,” Dr. Fett pointed out. “We need to find out what can influence cognitive functioning positively. We do not yet have medication, but lifestyle changes may be able to improve cognition long-term to some extent.”

—Jolynn Tumolo


Fett AJ, Velthorst E, Reichenberg A, et al. Long-term changes in cognitive functioning in individuals with psychotic disorders: findings from the Suffolk County Mental Health Project. JAMA Psychiatry. 2019 December 11;[Epub ahead of print].

Having a psychotic disorder may increase decline of some areas of cognition over adulthood [press release]. London, United Kingdom: City, University of London; December 17, 2019.

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