Hostname: page-component-669899f699-tpknm Total loading time: 0 Render date: 2025-04-27T01:58:15.774Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive reserve as a moderator of outcomes in five clusters of first episode psychosis patients: a 10-year follow-up study of the PAFIP cohort

Published online by Cambridge University Press:  10 September 2021

Rosa Ayesa-Arriola Open the ORCID record for Rosa Ayesa-Arriola [Opens in a new window] ,
Victor Ortiz-García de la Foz ,
Nancy Murillo-García ,
Javier Vázquez-Bourgon ,
María Juncal-Ruiz ,
Marcos Gómez-Revuelta ,
Paula Suárez-Pinilla ,
Esther Setién-Suero  and
Benedicto Crespo-Facorro
Rosa Ayesa-Arriola*
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
Victor Ortiz-García de la Foz
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
Nancy Murillo-García
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
Javier Vázquez-Bourgon
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
María Juncal-Ruiz
Affiliation:
Department of Psychiatry, Sierrallana Hospital, IDIVAL, School of Medicine, University of Cantabria, Torrelavega, Spain
Marcos Gómez-Revuelta
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
Paula Suárez-Pinilla
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
Esther Setién-Suero
Affiliation:
Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country, Spain
Benedicto Crespo-Facorro
Affiliation:
Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain Department of Psychiatry, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain Instituto de Investigación Sanitaria de Sevilla, IBiS, Sevilla, Spain
*
Author for correspondence: Rosa Ayesa Arriola, E-mail: rayesa@humv.es
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Cognitive reserve (CR) has been associated with the development and prognosis of psychosis. Different proxies have been used to estimate CR among individuals. A composite score of these proxies could elucidate the role of CR at illness onset on the variability of clinical and neurocognitive outcomes.

Methods

Premorbid intelligence quotient (IQ), years of education and premorbid adjustment were explored as proxies of CR in a large sample (N = 424) of first-episode psychosis (FEP) non-affective patients. Clusters of patients were identified and compared based on premorbid, clinical and neurocognitive variables at baseline. Additionally, the clusters were compared at 3-year (N = 362) and 10-year (N = 150) follow-ups.

Results

The FEP patients were grouped into five CR clusters: C1 (low premorbid IQ, low education and poor premorbid) 14%; C2 (low premorbid IQ, low education and good premorbid adjustment) 29%; C3 (normal premorbid IQ, low education and poor premorbid adjustment) 17%; C4 (normal premorbid IQ, medium education and good premorbid adjustment) 25%; and C5 (normal premorbid IQ, higher education and good premorbid adjustment) 15%. In general, positive and negative symptoms were more severe in the FEP patients with the lowest CR at baseline and follow-up assessments, while those with high CR presented and maintained higher levels of cognitive functioning.

Conclusions

CR could be considered a key factor at illness onset and a moderator of outcomes in FEP patients. A high CR could function as a protective factor against cognitive impairment and severe symptomatology. Clinical interventions focused on increasing CR and documenting long-term benefits are interesting and desirable.

Keywords

Cognitive reservefirst episode psychosislong-term outcomeneurocognition
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 5 , April 2023 , pp. 1891 - 1905
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

*

Joint first authors

References

Addington, D., Addington, J., & Maticka-Tyndale, E. (1993). Assessing depression in schizophrenia: The Calgary Depression Scale. British Journal of Psychiatry. Supplementary, 22, 39–44.CrossRefGoogle Scholar
Amoretti, S., Bernardo, M., Bonnin, C. M., Bioque, M., Cabrera, B., Mezquida, G., … Torrent, C. (2016). The impact of cognitive reserve in the outcome of first-episode psychoses: 2-year follow-up study. European Neuropsychopharmacology 26, 1638–1648.CrossRefGoogle ScholarPubMed
Amoretti, S., Cabrera, B., Torrent, C., Bonnin, C. D. M., Mezquida, G., Garriga, M., … Bernardo, M. (2019). Cognitive reserve assessment scale in health (CRASH): Its validity and reliability. Journal of Clinical Medicine 8(5), 586.CrossRefGoogle ScholarPubMed
Amoretti, S., Cabrera, B., Torrent, C., Mezquida, G., Lobo, A., & Gonzalez-Pinto, A., … PepsGroup (2018). Cognitive reserve as an outcome predictor: First-episode affective versus non-affective psychosis. Acta Psychiatrica Scandinavica 138, 441–455.CrossRefGoogle ScholarPubMed
Amoretti, S., Rosa, A. R., Mezquida, G., Cabrera, B., Ribeiro, M., Molina, M., … Group, P. E. (2020). The impact of cognitive reserve, cognition and clinical symptoms on psychosocial functioning in first-episode psychoses. Psychological Medicine, 1–12.Google ScholarPubMed
Anderson, K. K., Voineskos, A., Mulsant, B. H., George, T. P., & McKenzie, K. J. (2014). The role of untreated psychosis in neurodegeneration: A review of hypothesized mechanisms of neurotoxicity in first-episode psychosis. Canadian Journal of Psychiatry 59, 513–517.CrossRefGoogle ScholarPubMed
Andreasen, N. (1983). Scale for the assessment of negative symptoms (SANS). Iowa City: University of Iowa.Google Scholar
Andreasen, N. (1984). Scale for the assessment of positive symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
Ayesa-Arriola, R., de la Foz, V. O., Setien-Suero, E., Ramirez-Bonilla, M. L., Suarez-Pinilla, P., Son, J. M., … Crespo-Facorro, B. (2020). Understanding sex differences in long-term outcomes after a first episode of psychosis. NPJ Schizophrenia 6, 33.CrossRefGoogle ScholarPubMed
Ayesa-Arriola, R., Miguel-Corredera, M., de la Foz, V. O., Neergaard, K. D., Correa-Ghisays, P., Setien-Suero, E., & Crespo-Facorro, B. (2021). Education and long-term outcomes in first episode psychosis: 10-year follow-up study of the PAFIP cohort. Psychological Medicine, 1–12.Google Scholar
Ayesa-Arriola, R., Ortiz-Garcia de la Foz, V., Martinez-Garcia, O., Setien-Suero, E., Ramirez, M. L., Suarez-Pinilla, P., … Crespo-Facorro, B. (2019). Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: A 10-year follow-up study in the PAFIP cohort. Psychological Medicine, 51(2), 264–277.CrossRefGoogle Scholar
Ayesa-Arriola, R., Setien-Suero, E., Neergaard, K. D., Belzunces, A. A., Contreras, F., van Haren, N. E. M., & Crespo-Facorro, B. (2018). Premorbid IQ subgroups in first episode non affective psychosis patients: Long-term sex differences in function and neurocognition. Schizophrenia Research 197, 370–377.CrossRefGoogle ScholarPubMed
Barnett, J. H., Salmond, C. H., Jones, P. B., & Sahakian, B. J. (2006). Cognitive reserve in neuropsychiatry. Psychological Medicine 36, 1053–1064.CrossRefGoogle ScholarPubMed
Boyle, R., Knight, S. P., De Looze, C., Carey, D., Scarlett, S., Stern, Y., … Whelan, R. (2021). Verbal intelligence is a more robust cross-sectional measure of cognitive reserve than level of education in healthy older adults. Alzheimers Research & Therapy, 13, 128.CrossRefGoogle Scholar
Buonocore, M., Bechi, M., Uberti, P., Spangaro, M., Cocchi, F., Guglielmino, C., … Cavallaro, R. (2018). Cognitive reserve profiles in chronic schizophrenia: Effects on theory of mind performance and improvement after training. Journal of the International Neuropsychological Society 24, 563–571.CrossRefGoogle ScholarPubMed
Camprodon-Boadas, P., de la Serna, E., Baeza, I., Puig, O., Ilzarbe, D., Sugranyes, G., … Castro-Fornieles, J. (2020). Cognitive reserve in patients with first-episode psychosis as outcome predictor at 5-year follow-up. European Child & Adolescent Psychiatry.Google ScholarPubMed
Cannon-Spoor, H. E., Potkin, S. G., & Wyatt, R. J. (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.CrossRefGoogle ScholarPubMed
Cegalis, J., & Bowlin, J. (1991). VIGIL: Software for the assessment of attention. Nashua, NH: Forthought.Google Scholar
Cocchi, A., Cerati, G., Lora, A., Meneghelli, A., Monzani, E., Percudani, M., … Preti, A. (2013). Patients with first-episode psychosis are not a homogeneous population: Implications for treatment. Clinical Practice & Epidemiology in Mental Health 10, 1–8.CrossRefGoogle Scholar
Crespo-Facorro, B., Gonzalez-Blanch, C., & Pelayo-Teran, J. M. Eds. (2005). Programa asistencial para las fases iniciales de psicosis de Cantabria (PAFIP). Barcelona: Masson.Google Scholar
Crespo-Facorro, B., Pelayo-Teran, J. M., Perez-Iglesias, R., Ramirez-Bonilla, M., Martinez-Garcia, O., Pardo-Garcia, G., & Vazquez-Barquero, J. L. (2007). Predictors of acute treatment response in patients with a first episode of non-affective psychosis: Sociodemographics, premorbid and clinical variables. Journal of Psychiatric Research 41, 659–666.CrossRefGoogle ScholarPubMed
Crespo-Facorro, B., Perez-Iglesias, R., Ramirez-Bonilla, M., Martinez-Garcia, O., Llorca, J., & Luis Vazquez-Barquero, J. (2006). A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. The Journal of Clinical Psychiatry 67, 1511–1521.CrossRefGoogle ScholarPubMed
Cuesta, M. J., Sanchez-Torres, A. M., Cabrera, B., Bioque, M., Merchan-Naranjo, J., Corripio, I., … Group, P. E. (2015). Premorbid adjustment and clinical correlates of cognitive impairment in first-episode psychosis. The PEPsCog study. Schizophrenia Research 164, 65–73.CrossRefGoogle ScholarPubMed
de la Serna, E., Andres-Perpina, S., Puig, O., Baeza, I., Bombin, I., Bartres-Faz, D., … Castro-Fornieles, J. (2013). Cognitive reserve as a predictor of two year neuropsychological performance in early onset first-episode schizophrenia. Schizophrenia Research 143, 125–131.CrossRefGoogle ScholarPubMed
de Oliveira, M. O., Nitrini, R., Yassuda, M. S., & Brucki, S. M. (2014). Vocabulary is an appropriate measure of premorbid intelligence in a sample with heterogeneous educational level in Brazil. Behavioural Neurology 2014, 875960.CrossRefGoogle Scholar
Dickinson, D., Zaidman, S. R., Giangrande, E. J., Eisenberg, D. P., Gregory, M. D., & Berman, K. F. (2020). Distinct polygenic score profiles in schizophrenia subgroups with different trajectories of cognitive development. American Journal of Psychiatry 177, 298–307.CrossRefGoogle ScholarPubMed
Dollfus, S., Everitt, B., Ribeyre, J. M., Assouly-Besse, F., Sharp, C., & Petit, M. (1996). Identifying subtypes of schizophrenia by cluster analyses. Schizophrenia Bulletin 22, 545–555.CrossRefGoogle ScholarPubMed
Farfel, J. M., Nitrini, R., Suemoto, C. K., Grinberg, L. T., Ferretti, R. E., & Leite, R. E., … Brazilian Aging Brain Study, G. (2013). Very low levels of education and cognitive reserve: A clinicopathologic study. Neurology 81, 650–657.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, D.C.: American Psychiatric Press, Inc.Google Scholar
Flemenbaum, A., & Zimmermann, R. L. (1973). Inter- and intra-rater reliability of the brief psychiatric rating scale. Psychological Reports 32, 783–792.CrossRefGoogle ScholarPubMed
Gonzalez-Ortega, I., Gonzalez-Pinto, A., Alberich, S., Echeburua, E., Bernardo, M., Cabrera, B., … Selva, G. (2019). Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis. Psychological Medicine, 50(16), 2702–2710.CrossRefGoogle ScholarPubMed
Gunnell, D., Harrison, G., Rasmussen, F., Fouskakis, D., & Tynelius, P. (2002). Associations between premorbid intellectual performance, early-life exposures and early-onset schizophrenia. Cohort study. British Journal of Psychiatry 181, 298–305.CrossRefGoogle ScholarPubMed
Herrero, P., Contador, I., Stern, Y., Fernandez-Calvo, B., Sanchez, A., & Ramos, F. (2020). Influence of cognitive reserve in schizophrenia: A systematic review. Neuroscience & Biobehavioral Reviews 108, 149–159.CrossRefGoogle ScholarPubMed
Joyce, E. M., Hutton, S. B., Mutsatsa, S. H., & Barnes, T. R. (2005). Cognitive heterogeneity in first-episode schizophrenia. British Journal of Psychiatry 187, 516–522.CrossRefGoogle ScholarPubMed
Kanchanatawan, B., Sriswasdi, S., Thika, S., Stoyanov, D., Sirivichayakul, S., Carvalho, A. F., … Maes, M. (2018). Towards a new classification of stable phase schizophrenia into major and simple neuro-cognitive psychosis: Results of unsupervised machine learning analysis. Journal of Evaluation in Clinical Practice 24, 879–891.CrossRefGoogle ScholarPubMed
Kartschmit, N., Mikolajczyk, R., Schubert, T., & Lacruz, M. E. (2019). Measuring cognitive reserve (CR) − A systematic review of measurement properties of CR questionnaires for the adult population. PLoS One 14, e0219851.CrossRefGoogle ScholarPubMed
Khandaker, G. M., Barnett, J. H., White, I. R., & Jones, P. B. (2011). A quantitative meta-analysis of population-based studies of premorbid intelligence and schizophrenia. Schizophrenia Research 132, 220–227.CrossRefGoogle ScholarPubMed
Koenen, K. C., Moffitt, T. E., Roberts, A. L., Martin, L. T., Kubzansky, L., Harrington, H., … Caspi, A. (2009). Childhood IQ and adult mental disorders: A test of the cognitive reserve hypothesis. American Journal of Psychiatry 166, 50–57.CrossRefGoogle ScholarPubMed
Lee, S. Y., Kang, J. M., Kim, D. J., Woo, S. K., Lee, J. Y., & Cho, S. J. (2020). Cognitive reserve, leisure activity, and neuropsychological profile in the early stage of cognitive decline. Frontiers in Aging Neuroscience 12, 590607.CrossRefGoogle ScholarPubMed
Leeson, V. C., Harrison, I., Ron, M. A., Barnes, T. R., & Joyce, E. M. (2012). The effect of cannabis use and cognitive reserve on age at onset and psychosis outcomes in first-episode schizophrenia. Schizophrenia Bulletin 38, 873–880.CrossRefGoogle ScholarPubMed
Leeson, V. C., Sharma, P., Harrison, M., Ron, M. A., Barnes, T. R., & Joyce, E. M. (2011). IQ Trajectory, cognitive reserve, and clinical outcome following a first episode of psychosis: A 3-year longitudinal study. Schizophrenia Bulletin 37, 768–777.CrossRefGoogle ScholarPubMed
Lezak, M. (1995). Neuropsychological assessment. New York: Oxford University Press.Google Scholar
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet 396, 413–446.CrossRefGoogle ScholarPubMed
Mañá, S., Ivorra, J., & Girón, M. (1998). Adaptación y fiabilidad de la entrevista para la evaluación de la discapacidad social en pacientes psiquiátricos (OMS). Revista de Psiquiatria de la Facultad de Medicina de Barcelona 25, 43–48.Google Scholar
Mayoral-van Son, J., de la Foz, V. O., Martinez-Garcia, O., Moreno, T., Parrilla-Escobar, M., Valdizan, E. M., & Crespo-Facorro, B. (2016). Clinical outcome after antipsychotic treatment discontinuation in functionally recovered first-episode nonaffective psychosis individuals: A 3-year naturalistic follow-up study. The Journal of Clinical Psychiatry 77, 492–500.CrossRefGoogle ScholarPubMed
Meier, M. H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R. S., … Moffitt, T. E. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences of the United States of America 109, E2657–E2664.Google ScholarPubMed
Nuechterlein, K. H., Barch, D. M., Gold, J. M., Goldberg, T. E., Green, M. F., & Heaton, R. K. (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research 72, 29–39.CrossRefGoogle ScholarPubMed
Osterrieth, P. A. (1944). Contribution a l'étude de la perception et de la memoire (The test of copying a complex figure: A contribution to the study of perception and memory). Archive de Psychologie 30, 286–350.Google Scholar
Pan, Y., Pu, W., Chen, X., Huang, X., Cai, Y., Tao, H., … Palaniyappan, L. (2020). Morphological profiling of schizophrenia: Cluster analysis of MRI-based cortical thickness data. Schizophrenia Bulletin 46, 623–632.CrossRefGoogle ScholarPubMed
Park, D. C., & Bischof, G. N. (2013). The aging mind: Neuroplasticity in response to cognitive training. Dialogues in Clinical Neuroscience 15, 109–119.CrossRefGoogle ScholarPubMed
Pelayo-Teran, J. M., Perez-Iglesias, R., Ramirez-Bonilla, M. L., Gonzalez-Blanch, C., Martinez-Garcia, O., Pardo-Garcia, G., … Crespo-Facorro, B. (2008). Epidemiological factors associated with treated incidence of first-episode non-affective psychosis in Cantabria: Insights from the clinical programme on early phases of psychosis. Early Intervention in Psychiatry 2, 178–187.CrossRefGoogle ScholarPubMed
Reichenberg, A., Harvey, P. D., Bowie, C. R., Mojtabai, R., Rabinowitz, J., Heaton, R. K., & Bromet, E. (2009). Neuropsychological function and dysfunction in schizophrenia and psychotic affective disorders. Schizophrenia Bulletin 35, 1022–1029.CrossRefGoogle ScholarPubMed
Reitan, R. M., & Wolfson, D. (1985). The Halstead–Reitan neuropsychological test battery: Therapy and clinical interpretation. Tucson, AZ: Neuropsychological Press.Google Scholar
Rey, A. (1964). L'examen clinique en psychologie. Paris: Presses universitaires de France.Google Scholar
Ringe, W. K., Saine, K. C., Lacritz, L. H., Hynan, L. S., & Cullum, C. M. (2002). Dyadic short forms of the Wechsler Adult Intelligence Scale-III. Assessment 9, 254–260.CrossRefGoogle ScholarPubMed
Ringen, P. A., Nesvag, R., Helle, S., Lagerberg, T. V., Lange, E. H., Loberg, E. M., … Melle, I. (2016). Premorbid cannabis use is associated with more symptoms and poorer functioning in schizophrenia spectrum disorder. Psychological Medicine 46, 3127–3136.CrossRefGoogle ScholarPubMed
Scarmeas, N., & Stern, Y. (2003). Cognitive reserve and lifestyle. Journal of Clinical and Experimental Neuropsychology 25, 625–633.CrossRefGoogle ScholarPubMed
Setien-Suero, E., Neergaard, K., Ortiz-Garcia de la Foz, V., Suarez-Pinilla, P., Martinez-Garcia, O., Crespo-Facorro, B., & Ayesa-Arriola, R. (2019). Stopping cannabis use benefits outcome in psychosis: Findings from 10-year follow-up study in the PAFIP-cohort. Acta Psychiatrica Scandinavica 140, 349–359.CrossRefGoogle ScholarPubMed
Son, J. M., Gomez-Revuelta, M., Ayesa-Arriola, R., Vazquez-Bourgon, J., Foz, V. O., Ruiz-Veguilla, M., … Crespo-Facorro, B. (2021). Comparison of aripiprazole and risperidone effectiveness in first episode non-affective psychosis: Rationale and design of a prospective, randomized, 3-phase, investigat-orinitiated study (PAFIP-3). Revista de Psiquiatría y Salud Mental, 14(3), 157–163.CrossRefGoogle Scholar
Stern, Y. (2012). Cognitive reserve in ageing and Alzheimer's disease. The Lancet Neurology 11, 1006–1012.CrossRefGoogle ScholarPubMed
Van Rheenen, T. E., Cropley, V., Fagerlund, B., Wannan, C., Bruggemann, J., Lenroot, R. K., … Pantelis, C. (2020). Cognitive reserve attenuates age-related cognitive decline in the context of putatively accelerated brain ageing in schizophrenia-spectrum disorders. Psychological Medicine 50, 1475–1489.CrossRefGoogle ScholarPubMed
Wechsler, D. (1997). Wechsler adult intelligence scale-III. San Antonio, TX: The Psychological Corporation.Google Scholar
Wilson, R. S., Yu, L., Lamar, M., Schneider, J. A., Boyle, P. A., & Bennett, D. A. (2019). Education and cognitive reserve in old age. Neurology 92, e1041–e1050.CrossRefGoogle ScholarPubMed
Yates, L. A., Ziser, S., Spector, A., & Orrell, M. (2016). Cognitive leisure activities and future risk of cognitive impairment and dementia: Systematic review and meta-analysis. International Psychogeriatrics 28, 1791–1806.CrossRefGoogle ScholarPubMed
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed
Yucel, M., Bora, E., Lubman, D. I., Solowij, N., Brewer, W. J., Cotton, S. M., … Pantelis, C. (2012). The impact of cannabis use on cognitive functioning in patients with schizophrenia: A meta-analysis of existing findings and new data in a first-episode sample. Schizophrenia Bulletin 38, 316–330.CrossRefGoogle Scholar
Supplementary material: File

Ayesa-Arriola et al. supplementary material

Ayesa-Arriola et al. supplementary material

Download Ayesa-Arriola et al. supplementary material(File)
File 83.5 KB