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Original Investigation |

Neurocognitive Growth Charting in Psychosis Spectrum Youths

Ruben C. Gur, PhD1; Monica E. Calkins, PhD1; Theodore D. Satterthwaite, MD, MA1; Kosha Ruparel, MSE1; Warren B. Bilker, PhD2; Tyler M. Moore, PhD1; Adam P. Savitt, BA1; Hakon Hakonarson, MD, PhD3; Raquel E. Gur, MD, PhD1
[+] Author Affiliations
1Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
2Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
3Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
JAMA Psychiatry. 2014;71(4):366-374. doi:10.1001/jamapsychiatry.2013.4190.
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Importance  Psychosis-risk studies have examined help-seeking adolescents and young adults. Population-based studies evaluating psychotic symptoms and neurocognitive performance across childhood are needed for “growth charting” cognitive development. We hypothesized that psychosis spectrum youths have delayed neurocognitive age relative to chronological age. We expected larger lags with increased symptom severity and in late adolescence and early adulthood.

Objectives  To examine neurocognitive age and compare typically developing participants with psychosis spectrum participants.

Design, Setting, and Participants  The Philadelphia Neurodevelopmental Cohort is a genotyped sample, with electronic medical records, enrolled in the study of brain behavior. In an academic and children’s hospital health care network, a structured psychiatric evaluation was performed and a computerized neurocognitive battery administered to evaluate performance in several domains. From 18 344 youths in the recruitment pool who were aged 8 to 21 years, physically and cognitively capable of participating, and proficient in English, participants were randomly selected with stratification for age, sex, and ethnicity. A total of 9138 participants were enrolled in the study between November 1, 2009, and November 30, 2011, and 2321 endorsed psychotic symptoms: 1423 significant (psychosis spectrum) and 898 limited (psychosis limited). They had no comorbid medical conditions. They were compared with 981 participants endorsing significant other psychiatric symptoms and with 1963 typically developing children with no psychiatric or medical disorders.

Main Outcomes and Measures  The computerized neurocognitive battery provides accuracy and speed measures on 12 tests and speed measures alone on 2, yielding 26 measures used in a regression analysis to predict chronological age. Prediction was performed on the entire set and separately for each domain (executive, episodic memory, complex cognition, social cognition, and sensorimotor speed).

Results  Throughout childhood and adolescence, the psychosis spectrum group had lower predicted age compared with the typically developing group and the group with other psychiatric symptoms. The psychosis spectrum group had a greater developmental lag than the psychosis limited group. The lags were most pronounced for complex cognition and social cognition and were smallest for sensorimotor speed.

Conclusions and Relevance  Individuals who endorse psychotic symptoms are neurocognitively delayed across the age range; this delay relates to symptom severity and is not prominent in other psychiatric disorders. Combined clinical and neurocognitive assessment can facilitate early detection and targeted intervention to delay or ameliorate disease progression.

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Figure 1.
Chronological Age Compared With Predicted Neurocognitive Age for Female and Male Psychosis Spectrum Participants and Typically Developing Participants

Chronological age compared with predicted neurocognitive age in years for typically developing (TD) participants, female psychosis spectrum (PS) participants, and male PS participants. Growth charts are provided for predicted age based on all scores (all domains) (A) and based on tests grouped by each of the 5 domains, including executive (B), memory (C), complex cognition (D), social cognition (E), and sensorimotor (F).

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Figure 2.
Chronological Age Compared With Predicted Neurocognitive Age for Psychosis Limited, Psychosis Spectrum, and Typically Developing Participants

Chronological age compared with predicted neurocognitive age in years for typically developing (TD), psychosis spectrum (PS), and psychosis limited (PL) groups. Growth charts are provided for predicted age based on all scores (all domains) (A) and based on tests grouped by each of the 5 domains, including executive (B), memory (C), complex cognition (D), social cognition (E), and sensorimotor (F).

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