Anja P Husa1, Irina Rannikko2, Jani Moilanen3, Marianne Haapea4, Graham K Murray5, Jennifer Barnett6, Peter B Jones7, Matti Isohanni8, Hannu Koponen9, Jouko Miettunen10, Erika Jääskeläinen10. 1. University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O. Box 5000, 90014 University of Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Finland. Electronic address: anja.husa@student.oulu.fi. 2. University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O. Box 5000, 90014 University of Oulu, Finland. 3. University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O. Box 5000, 90014 University of Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Finland; Oulu University Hospital, Department of Psychiatry, P.O. Box 26, 90029 OYS, Finland. 4. University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O. Box 5000, 90014 University of Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Finland; Oulu University Hospital, Department of Psychiatry, P.O. Box 26, 90029 OYS, Finland; Oulu University Hospital, Department of Diagnostic Radiology, P.O. Box 50, 90029 OYS, Finland. 5. University of Cambridge, Department of Psychiatry, Box 189 Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; University of Cambridge, Behavioural and Clinical Neuroscience Institute, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge CB2 0SZ, United Kingdom. 6. University of Cambridge, Department of Psychiatry, Box 189 Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Cambridge Cognition Ltd, Tunbridge Court, Bottisham, Cambridge, United Kingdom. 7. University of Cambridge, Department of Psychiatry, Box 189 Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom. 8. University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O. Box 5000, 90014 University of Oulu, Finland; Oulu University Hospital, Department of Psychiatry, P.O. Box 26, 90029 OYS, Finland. 9. Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, P.O. Box 22, 00014 Helsinki, Finland; Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FIN-00029 HUS, Finland. 10. University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O. Box 5000, 90014 University of Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Finland; Oulu University Hospital, Department of Psychiatry, P.O. Box 26, 90029 OYS, Finland; University of Oulu, Institute of Health Sciences, P.O. Box 5000, 90014 Oulu, Finland.
Abstract
BACKGROUND: The association between the course of cognition and long-term antipsychotic medication in schizophrenia remains unclear. We analysed the association between cumulative lifetime antipsychotic medication dose and change of verbal learning and memory during a 9-year follow-up. METHOD: Forty schizophrenia subjects and 73 controls from the Northern Finland Birth Cohort 1966 were assessed by California Verbal Learning Test (CVLT) at the ages of 34 and 43 years. Data on the lifetime antipsychotic doses in chlorpromazine equivalents were collected. The association between antipsychotic dose-years and baseline performance and change in CVLT was analysed, controlling for baseline performance, gender, age of onset and severity of illness. RESULTS: Higher antipsychotic dose-years by baseline were significantly associated with poorer baseline performance in several dimensions of verbal learning and memory, and with a larger decrease in short-delay free recall during the follow-up (p=0.031). Higher antipsychotic dose-years during the follow-up were associated with a larger decrease of immediate free recall of trials 1-5 during the follow-up (p=0.039). Compared to controls, decline was greater in some CVLT variables among those using high-doses, but not among those using low-doses. CONCLUSION: This is the first report of an association between cumulative lifetime antipsychotic use and change in cognition in a long-term naturalistic follow-up. The use of high doses of antipsychotics may be associated with a decrease in verbal learning and memory in schizophrenia years after illness onset. The results do not support the view that antipsychotics in general prevent cognitive decline or promote cognitive recovery in schizophrenia.
BACKGROUND: The association between the course of cognition and long-term antipsychotic medication in schizophrenia remains unclear. We analysed the association between cumulative lifetime antipsychotic medication dose and change of verbal learning and memory during a 9-year follow-up. METHOD: Forty schizophrenia subjects and 73 controls from the Northern Finland Birth Cohort 1966 were assessed by California Verbal Learning Test (CVLT) at the ages of 34 and 43 years. Data on the lifetime antipsychotic doses in chlorpromazine equivalents were collected. The association between antipsychotic dose-years and baseline performance and change in CVLT was analysed, controlling for baseline performance, gender, age of onset and severity of illness. RESULTS: Higher antipsychotic dose-years by baseline were significantly associated with poorer baseline performance in several dimensions of verbal learning and memory, and with a larger decrease in short-delay free recall during the follow-up (p=0.031). Higher antipsychotic dose-years during the follow-up were associated with a larger decrease of immediate free recall of trials 1-5 during the follow-up (p=0.039). Compared to controls, decline was greater in some CVLT variables among those using high-doses, but not among those using low-doses. CONCLUSION: This is the first report of an association between cumulative lifetime antipsychotic use and change in cognition in a long-term naturalistic follow-up. The use of high doses of antipsychotics may be associated with a decrease in verbal learning and memory in schizophrenia years after illness onset. The results do not support the view that antipsychotics in general prevent cognitive decline or promote cognitive recovery in schizophrenia.
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