Community living linked to improved cognition in schizophrenia
medwireNews: Chronically institutionalised patients with schizophrenia show cognitive improvement when they move to community-based living, Japanese research shows.
“These results suggest that care settings affect the course of cognition, and addressing these conditions may lead to a certain degree of cognitive improvement even among schizophrenia patients who have been chronically institutionalized”, write Takahiro Nemoto (Toho University School of Medicine, Tokyo) and colleagues in Schizophrenia Research.
The researchers studied 78 patients (mean age 54.6 years, 65% men) with schizophrenia who were transferred to community living following the closure of a psychiatric hospital.
The patients, who had spent an average of 25.6 years in hospital, were followed up for 5 years and underwent annual examinations that included measures of cognitive function, psychiatric symptoms and social functioning. Fifty-six (71.8%) of them completed all assessments and cognitive tests.
Nemoto and team found that attention, assessed by the Letter Cancellation Test, and memory, assessed by the delayed recall domain of the Rey–Osterrieth Complex Figure Test, improved significantly after just 1 year in the community. Furthermore, the improvements were maintained for the duration of the study.
By contrast, global cognition, assessed by the Mini-Mental State Examination, improved gradually during the first 4 years but then began to decline, while processing speed, assessed by the Trail Making Test Part A, improved for 2 years before declining. Executive function, assessed by Word Fluency Test letter fluency, also showed initial improvements that peaked at year 3, and then declined.
However, the researchers comment that these changes might represent a genuine decline influenced by ageing, given that the mean age of the participants was almost 60 years by the end of the study period.
In addition to the cognitive improvements, the team observed significant and consistent improvements in symptoms (Positive and Negative Syndrome Scale) and global functioning (Global Assessment of Functioning).
Nemoto et al note that the changes in the variables they assessed were relatively small. Even so, “patients with schizophrenia who have been chronically hospitalized could show a certain degree of improvement in some cognitive deficits after dwelling within the community following their discharge from hospital”, they say.
They add that the study participants received continuous well-planned comprehensive interventions, indicating that “appropriate community services, in addition to living in a community, might have also contributed to the improvements in cognition seen in the subjects.”
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By Laura Cowen, medwireNews Reporter