The Association Between Psychotropic Medications and Cognitive Functioning in a Real-World Cohort of 869 Individuals with Schizophrenia

Abstract Background Cognitive deficits are a central feature of schizophrenia for which there are not any established pharmacological treatments. Antipsychotics are the mainstay of schizophrenia therapy but the effects of these and other psychotropic medications on the cognitive functioning of people schizophrenia have not been extensively studied in routine real-world settings. Study Design A total of 869 people with schizophrenia receiving community-based care were assessed on a cognitive battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The machine-learning tool of partialing-out least absolute shrinkage and selection operator (LASSO) regression were used to examine the independent association between the RBANS total and index scores and receipt of individual psychotropic medications considering relevant demographic, clinical, and environmental covariates. In this cross-sectional study, we also examined the effects of medication dosage and some medication combinations. Study Results We found that 4 medications, clozapine, quetiapine, benztropine, and oral haloperidol were each independently associated with significantly reduced cognitive scores compared with people not receiving these medications. Three of the 4 medications, clozapine, haloperidol, and benztropine, showed a significant dose-related relationship with total cognitive score. We also documented further reductions in cognitive functioning in people receiving some pair-wise combinations of these medications. Reduced memory was the domain most associated with these medications, especially among people receiving clozapine. Conclusions Prescribers may consider minimizing doses and limiting the administration of combinations of the identified medications. Interventions should be further developed for people with schizophrenia to improve their cognitive functioning and quality of life.