Predictors and Outcomes Associated with 25-Year Cognitive Decline in Psychotic Disorders

Abstract Background and Hypothesis Cognitive impairment, a key feature of psychosis, is linked to poor functional outcomes. This study aimed to identify predictors and outcomes associated with cognitive decline in psychotic disorders. Study Design 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. Cognitive function was assessed at 6-month, 24-month, 20-year, and 25-year follow-ups. This analysis includes 400 participants with at least 2 estimates of general cognitive ability. A mixed effects model with random slopes and random intercepts was employed to estimate individual cognitive trajectories. The estimated random slopes for each participant were then used to predict 25-year clinical outcomes. Study Results No baseline predictors of subsequent cognitive decline were identified. Faster cognitive decline was associated with lower odds of remission, recovery, employment, financial independence, and worse social function 25 years after first admission. Conclusion Cognitive decline may be an indicator of illness severity more broadly and may therefore be a useful indicator of who might benefit from known interventions targeting clinical outcomes. Intervening in cognitive decline itself may have widespread beneficial effects on outcomes in psychotic disorders.