학술논문
Cognitive Decline Preceding the Onset of Psychosis in Patients With 22q11.2 Deletion Syndrome
Document Type
article
Author
Vorstman, Jacob AS; Breetvelt, Elemi J; Duijff, Sasja N; Eliez, Stephan; Schneider, Maude; Jalbrzikowski, Maria; Armando, Marco; Vicari, Stefano; Shashi, Vandana; Hooper, Stephen R; Chow, Eva WC; Fung, Wai Lun Alan; Butcher, Nancy J; Young, Donald A; McDonald-McGinn, Donna M; Vogels, Annick; van Amelsvoort, Therese; Gothelf, Doron; Weinberger, Ronnie; Weizman, Abraham; Klaassen, Petra WJ; Koops, Sanne; Kates, Wendy R; Antshel, Kevin M; Simon, Tony J; Ousley, Opal Y; Swillen, Ann; Gur, Raquel E; Bearden, Carrie E; Kahn, René S; Bassett, Anne S
Source
JAMA Psychiatry. 72(4)
Subject
Language
Abstract
ImportancePatients with 22q11.2 deletion syndrome (22q11DS) have an elevated (25%) risk of developing schizophrenia. Recent reports have suggested that a subgroup of children with 22q11DS display a substantial decline in cognitive abilities starting at a young age.ObjectiveTo determine whether early cognitive decline is associated with risk of psychotic disorder in 22q11DS.Design, setting, and participantsProspective longitudinal cohort study. As part of an international research consortium initiative, we used the largest data set of intelligence (IQ) measurements in patients with 22q11DS reported to date to investigate longitudinal IQ trajectories and the risk of subsequent psychotic illness. A total of 829 patients with a confirmed hemizygous 22q11.2 deletion, recruited through 12 international clinical research sites, were included. Both psychiatric assessments and longitudinal IQ measurements were available for a subset of 411 patients (388 with ≥1 assessment at age 8-24 years).Main outcomes and measuresDiagnosis of a psychotic disorder, initial IQ, longitudinal IQ trajectory, and timing of the last psychiatric assessment with respect to the last IQ test.ResultsAmong 411 patients with 22q11DS, 55 (13.4%) were diagnosed as having a psychotic disorder. The mean (SD) age at the most recent psychiatric assessment was 16.1 (6.2) years. The mean (SD) full-scale IQ at first cognitive assessment was lower in patients who developed a psychotic disorder (65.5 [12.0]) compared with those without a psychotic disorder (74.0 [14.0]). On average, children with 22q11DS showed a mild decline in IQ (full-scale IQ, 7.04 points) with increasing age, particularly in the domain of verbal IQ (9.02 points). In those who developed psychotic illness, this decline was significantly steeper (P