Importance Schizophrenia is associated with major cognitive deficits and has been conceptualized as both a neurodevelopmental and a neurodegenerative disorder. However, when deficits develop and how they change over the course of illness is uncertain. Objective To trace cognition from elementary school to old age to test neurodevelopmental and neurodegenerative theories of psychotic disorders. Design, Setting, and Participants Data were taken from the Suffolk County Mental Health Project, a first-admission longitudinal cohort study of individuals with psychotic disorders. Participants were recruited from all 12 inpatient psychiatric facilities in Suffolk County, New York. This analysis concerns the 428 participants with at least 2 estimates of general cognitive ability. Data were collected between September 1989 and October 2019, and data were analyzed from January 2020 to October 2021. Exposures Psychiatric hospitalization for psychosis. Main Outcomes and Measures Preadmission cognitive scores were extracted from school and medical records. Postonset cognitive scores were based on neuropsychological testing at 6-month, 24-month, 20-year, and 25-year follow-ups. Results Of the 428 included individuals (212 with schizophrenia and 216 with other psychotic disorders), 254 (59.6%) were male, and the mean (SD) age at psychosis onset was 27 (9) years. Three phases of cognitive change were observed: normative, declining, and deteriorating. In the first phase, cognition was stable. Fourteen years before psychosis onset, those with schizophrenia began to experience cognitive decline at a rate of 0.35 intelligence quotient (IQ) points per year (95% CI, 0.29-0.42; P < .001), a significantly faster decline than those with other psychotic disorders (0.15 IQ points per year; 95% CI, 0.08-0.22, P < .001). At 22 years after onset, both groups declined at a rate of 0.59 IQ points per year (95% CI, 0.25-0.94; P < .001). Conclusions and Relevance In this cohort study, cognitive trajectories in schizophrenia were consistent with both a neurodevelopmental and neurodegenerative pattern, resulting in a loss of 16 IQ points over the period of observation. Cognitive decline began long prior to psychosis onset, suggesting the window for primary prevention is earlier than previously thought. A window for secondary prevention emerges in the third decade of illness, when cognitive declines accelerate in individuals with schizophrenia and other psychotic disorders.

中文翻译：

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精神障碍患者的一般认知能力过程。


重要性 精神分裂症与严重的认知缺陷有关，并且被概念化为神经发育障碍和神经退行性疾病。然而，缺陷何时出现以及它们在疾病过程中如何变化尚不确定。目的追踪从小学到老年的认知，以检验精神障碍的神经发育和神经退行性理论。设计、设置和参与者数据取自萨福克县心理健康项目，这是一项针对精神障碍患者的首次入院纵向队列研究。参与者是从纽约州萨福克县所有 12 家住院精神病院招募的。该分析涉及 428 名参与者，他们对一般认知能力至少有 2 项估计。数据收集于 1989 年 9 月至 2019 年 10 月期间，分析数据于 2020 年 1 月至 2021 年 10 月期间。 暴露因精神病住院的情况。主要结果和措施 入院前认知评分是从学校和医疗记录中提取的。发病后认知评分基于 6 个月、24 个月、20 年和 25 年随访时的神经心理学测试。结果 在 428 名受试者中（212 名患有精神分裂症，216 名患有其他精神障碍），其中 254 名（59.6%）为男性，精神病发病的平均 (SD) 年龄为 27 (9) 岁。观察到认知变化的三个阶段：正常、下降和恶化。第一阶段，认知稳定。在精神病发作前 14 年，精神分裂症患者的认知能力开始以每年 0.35 分的速度下降（95% CI，0.29-0.42；P < .001），下降速度明显快于其他患者精神障碍 (0.每年15个智商点； 95% CI，0.08-0.22，P < .001)。发病 22 年后，两组智商均以每年 0.59 分的速度下降（95% CI，0.25-0.94；P < .001）。结论和相关性 在这项队列研究中，精神分裂症患者的认知轨迹与神经发育和神经退行性模式一致，导致观察期间智商下降 16 分。认知能力下降早在精神病发作之前就开始了，这表明一级预防的窗口期比之前认为的要早。二级预防的窗口出现在疾病的第三个十年，此时精神分裂症和其他精神障碍患者的认知能力下降加速。