Do 7-year-old children at familial high risk of schizophrenia spectrum disorders or bipolar disorder have neurocognitive impairments, and how do their neurocognitive profiles differ?
This multisite population-based Danish cohort study of 514 children demonstrated significant neurocognitive impairments in those at familial high risk of schizophrenia, with the most pronounced deficits in processing speed and working memory. Children at familial high risk of bipolar disorder performed significantly better than children at familial high risk of schizophrenia, but did not differ significantly from controls.
Early identification of children at familial high risk of schizophrenia with neurocognitive impairments is warranted to monitor their developmental pathophysiology, prevent transition to psychosis, and inform early intervention programs.
Children at familial high risk of schizophrenia spectrum disorders (FHR-SZ) or bipolar disorder (FHR-BP) exhibit neurocognitive impairments. Large studies of neurocognition in young children at familial high risk at the same age are important to differentiate the pathophysiology and developmental trajectory of these 2 groups.
To characterize neurocognitive functions in 7-year-old children with FHR-SZ or FHR-BP and a control population.
Design, Setting, and Participants
This multisite population-based cohort study collected data from January 1, 2013, to January 31, 2016, in the first wave of the Danish High Risk and Resilience Study VIA 7 at 2 university hospital research sites in Copenhagen and Aarhus using Danish registries. Participants (n = 514) included 197 children with FHR-SZ, 118 with FHR-BP, and 199 controls matched with the FHR-SZ group for age, sex, and municipality. Assessors were blinded to risk status.
Parents with schizophrenia, bipolar disorder, or neither diagnosis.
Main Outcomes and Measures
Neurocognitive functions were measured across 23 tests. Four neurocognitive domains were derived by principal component analysis, including processing speed and working memory, verbal functions, executive and visuospatial functions, and declarative memory and attention.
A total of 514 children aged 7 years were included in the analysis (46.3% girls), consisting of 197 children with FHR-SZ (46.2% girls), 118 with FHR-BP (46.6% girls), and 199 controls (46.2% girls). Children with FHR-SZ were significantly impaired compared with controls on processing speed and working memory (Cohen d = 0.50; P < .001), executive and visuospatial functions (Cohen d = 0.28; P = .03), and declarative memory and attention (Cohen d = 0.29; P = .02). Compared with children with FHR-BP, children with FHR-SZ performed significantly poorer in processing speed and working memory (Cohen d = 0.40; P = .002), executive and visuospatial functions (Cohen d = 0.35; P = .008), and declarative memory and attention (Cohen d = 0.31; P = .03). Children with FHR-BP and controls did not differ.
Conclusions and Relevance
Children with FHR-SZ had widespread neurocognitive impairments, supporting the hypothesis of neurocognitive functions as endophenotypes of schizophrenia. The absence of neurocognitive deficits in children with FHR-BP suggests distinct neurodevelopmental manifestations in these familial high-risk groups at this age. Early detection of children with FHR-SZ and cognitive impairments is warranted to investigate associations of neurocognition with transition to psychosis, add to the knowledge of their developmental pathophysiology, and inform early intervention programs.
Hemager N, Plessen KJ, Thorup A, et al. Assessment of Neurocognitive Functions in 7-Year-Old Children at Familial High Risk for Schizophrenia or Bipolar Disorder: The Danish High Risk and Resilience Study VIA 7. JAMA Psychiatry. 2018;75(8):844–852. doi:10.1001/jamapsychiatry.2018.1415
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