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Stability and Course of Neuropsychological Deficits in Schizophrenia
Robert K. Heaton, PhD;
Julie Akiko Gladsjo, PhD;
Barton W. Palmer, PhD;
Julia Kuck, PhD;
Thomas D. Marcotte, PhD;
Dilip V. Jeste, MD
Arch Gen Psychiatry. 2001;58:24-32.
Background Neuropsychological deficits in schizophrenia appear to predate clinical
symptoms of the disease and become more pronounced at illness onset, but controversy
exists about whether and when further neuropsychological progression may occur.
Objective To identify and characterize any subset of patients who evidenced progressive
neuropsychological impairment, we compared the longitudinal stability of neuropsychological
functioning in schizophrenic outpatients and normal comparison subjects.
Methods One hundred forty-two schizophrenic outpatients and 206 normal comparison
subjects were given annually scheduled comprehensive neuropsychological evaluations
during an average of 3 years (range, 6 months to 10 years). Clinically and
demographically defined subgroups were compared, and test-retest norms were
used to identify individual patients who showed unusual worsening over time.
Results The schizophrenic group was neuropsychologically more impaired than
the normal comparison subjects but showed comparable test-retest reliability
and comparable neuropsychological stability over both short (mean, 1.6 years)
and long (mean, 5 years) follow-up periods. No significant differences in
neuropsychological change were found between schizophrenic subgroups defined
by current age, age at onset of illness, baseline level of neuropsychological
impairment, improvement or worsening of clinical symptoms, and occurrence
of incident tardive dyskinesia. Norms for change also failed to show neuropsychological
progression in individuals with schizophrenia.
Conclusions Neuropsychological impairment in ambulatory persons with schizophrenia
appears to remain stable, regardless of baseline characteristics and changes
in clinical state. Our results may not be generalizable to the minority of
institutionalized poor-outcome patients.
From the Department of Psychiatry, University of California, San Diego
(Drs Heaton, Gladsjo, Palmer, Kuck, Marcotte, and Jeste, and the Veterans
Affairs San Diego Healthcare System, San Diego, Calif (Dr Jeste).
Reprints: Robert K. Heaton, PhD, Department of Psychiatry, University
of California, San Diego, 140 Arbor Dr, San Diego, CA 92103 (e-mail: rheaton{at}ucsd.edu).
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