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Schizophrenia Research
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a r t i c l e
i n f o
Article history:
Received 14 October 2011
Received in revised form 3 October 2012
Accepted 25 October 2012
Available online xxxx
Keywords:
Cognitive reserve
Schizophrenia
First episode
Psychosis
Cognition
a b s t r a c t
Introduction: The concept of cognitive reserve (CR) has been dened as individual differences in the efcient
utilization of brain networks which allow some people to cope better than others with brain pathology. CR
has been developed mainly in the eld of aging and dementia after it was observed that there appears to
be no direct relationship between the degree of brain pathology and the severity of clinical manifestations
of this damage. The present study applies the concept of CR to a sample of children and adolescents with a
rst episode of schizophrenia, aiming to assess the possible inuence of CR on neuropsychological performance after two year follow-up, controlling for the inuence of clinical psychopathology.
Methods: 35 patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder (SSD) and 98
healthy controls (HC) matched for age and gender were included. CR was assessed at baseline, taking into
account premorbid IQ, educationaloccupational level and leisure activities. Clinical and neuropsychological
assessments were completed by all patients at two year follow-up.
Results: The CR proxy was able to predict working memory and attention at two year follow-up. Verbal
memory and cognitive exibility were not predicted by any of the variables included in the regression model.
The SSD group obtained lower scores than HC on CR. CR measures correctly classied 79.8% of the sample as
being SSD or HC.
Conclusions: Lower scores on CR were observed in SSD than in HC and the CR measure correctly classied a high
percentage of the sample into the two groups. CR may predict SSD performance on working memory and attention tasks.
2012 Elsevier B.V. All rights reserved.
1. Introduction
The concept of cognitive reserve (CR) has developed in the eld of
aging and dementia after it was observed that people with the same
amount of brain damage could show different clinical expressions
depending on their compensatory capacity. CR has been dened as
individual differences in how people process tasks which allow some
Corresponding author at: Department of Child and Adolescent Psychiatry and
Psychology, Hospital Clnic Universitari de Barcelona, C/ Villarroel, 170, Barcelona 08036,
Spain. Tel./fax: +34 93 2279974.
E-mail address: eserna@clinic.ub.es (E. de la Serna).
to cope better than others with brain pathology (Stern, 2009). This
concept is focused on the ability to optimize performance based on
more efcient brain network utilization, and may vary depending on
environment and lifetime exposure to certain environmental factors.
Although it has been used primarily in the elds of dementia and
brain injury, this concept could potentially be applicable to a whole
range of neurological and psychiatric conditions. For example, CR
could play an important role in the expression of symptoms and functional outcome of schizophrenia patients (Barnett et al., 2006). Studies
have shown that patients with schizophrenia with better performance
on cognitive tests have better social and functional outcomes (Green
et al., 2000; Munro et al., 2002). Holthausen et al. (2002) studied a
0920-9964/$ see front matter 2012 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.schres.2012.10.026
Please cite this article as: de la Serna, E., et al., Cognitive reserve as a predictor of two year neuropsychological performance in early onset rstepisode schizophrenia, Schizophr. Res. (2012), http://dx.doi.org/10.1016/j.schres.2012.10.026
Please cite this article as: de la Serna, E., et al., Cognitive reserve as a predictor of two year neuropsychological performance in early onset rstepisode schizophrenia, Schizophr. Res. (2012), http://dx.doi.org/10.1016/j.schres.2012.10.026
Table 1
Socio-demographic characteristics of SSD and HC.
Gender: Male
Age
Socio-economic statusa
a
SSD
N= 35(%)
HC
N= 98(%)
p-value
23 (65.71%)
64 (65.3%)
0.002
0.965
Mean SD
Mean SD
p-value
15.00 1.9
35.22 17.1
15.17 1.93
38.35 15.75
0.454
0.721
0.651
0.327
Please cite this article as: de la Serna, E., et al., Cognitive reserve as a predictor of two year neuropsychological performance in early onset rstepisode schizophrenia, Schizophr. Res. (2012), http://dx.doi.org/10.1016/j.schres.2012.10.026
Table 2
CFA model t summary for CR and cognitive domains.
2
df
Ratio IND
2/df AIC
Model
AIC
202.009
43.942 .909
0.045 (0.0270.061)
239.78
44.24
0.039 (0.020.051)
.921
AIC: Akaike Information Criterion; BBFNI: BentlerBonet Normed Fit Index; RMSEA:
Root Mean-Square Error of Approximation.
Table 3
Standardized parameters. Factor loading of CR variables on CR model.
Variable
Premorbid Education/
Lifetime leisure
IQ (F1)
occupation (F2) activities (F3)
Vocabulary subtest of
0.573
WAIS-III/WISC-R
Years of formal education
School performance before the
beginning of the disorder
Parents' educational level
Questions about the development of
language, motor functions and
writing and reading
Intellectual hobbies
Family hobbies
Peer relationships
Sociability
0.487
0.348
0.337
0.953
0.229
0.836
0.900
0.901
p b 0.001.
p b 0.01.
Working
memory
(F1)
Digits forward
Digits backward
Letter-Number Sequencing
Trail Making Test part B
Trail Making Test part A
Reaction time of CPT
Correct responses on CPT
TAVEC immediate memory score
TAVEC delayed memory score
TAVEC
WCST errors
WCST perseverative errors
WCST perseverative responses
Stroop Interference score
0.943
0.681
0.650
0.799
p b 0.001.
p b 0.05.
Attention
(F2)
0.646
0.211
0.185
Verbal
memory
(F3)
0.910
0.780
0.751
Cognitive
exibility
(F4)
0.882
0.833
0.992
0.872
Please cite this article as: de la Serna, E., et al., Cognitive reserve as a predictor of two year neuropsychological performance in early onset rstepisode schizophrenia, Schizophr. Res. (2012), http://dx.doi.org/10.1016/j.schres.2012.10.026
Table 5
Results of linear regression analysis assessing the predictive capacity of CR and premorbid IQ on neuropsychological variables after two years.
S.E.
Cognitive domain
Predictor
Working memory
R = 0.635
R2 = 0.403
Corrected R2 = 0.360
F = 9.438
p = 0.001
Cognitive reserve
PANSS total score
0.255
0.020
0.061
0.025
0.609
0.118
t
4.143
0.804
P
b0.001
0.428
Attention
R = 0.510
R2 = 0.260
Corrected R2 = 0.193
F = 3.874
p = 0.036
Cognitive Reserve
PANSS total score
0.047
0.009
0.019
0.008
0.443
0.205
2.402
1.111
0.025
0.279
Verbal memory
R = 0.326
R2 = 0.107
Corrected R2 = 0.043
F = 1.669
p = 0.207
Cognitive reserve
PANSS total score
0.186
0.001
0.103
0.041
0.326
0.002
1.812
0.013
0.081
0.990
Cognitive exibility
R = 0.327
R2 = 0.107
Corrected R2 = 0.043
F = 1.672
p = 0.206
Cognitive reserve
PANSS total score
0.049
0.036
0.054
0.021
0.166
0.302
0.921
1.679
0.365
0.104
Working memory
R = 0.517
R2 = 0.267
Corrected R2 = 0.221
F = 5.831
p = 0.007
Premorbid IQ
PANSS total score
0.610
0.030
0.192
0.025
0.480
0.179
3.173
1.183
0.003
0.245
Attention
R = 0.385
R2 = 0.148
Corrected R2 = 0.074
F = 1.996
p = 0.159
Premorbid IQ
PANSS total score
0.091
0.011
0.061
0.008
0.285
0.251
1.481
1.303
0.152
0.205
Verbal memory
R = 0.412
R2 = 0.170
Corrected R2 = 0.118
F = 3.269
p = 0.051
Premorbid IQ
PANSS total score
0.711
0.007
0.280
0.037
0.410
0.031
2.544
0.193
0.016
0.848
Cognitive exibility
R = 0.428
R2 = 0.183
Corrected R2 = 0.132
F = 3.580
p = 0.040
Premorbid IQ
PANSS total score
0.291
0.035
0.145
0.019
0.321
0.290
2.010
1.815
0.053
0.079
Please cite this article as: de la Serna, E., et al., Cognitive reserve as a predictor of two year neuropsychological performance in early onset rstepisode schizophrenia, Schizophr. Res. (2012), http://dx.doi.org/10.1016/j.schres.2012.10.026
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Please cite this article as: de la Serna, E., et al., Cognitive reserve as a predictor of two year neuropsychological performance in early onset rstepisode schizophrenia, Schizophr. Res. (2012), http://dx.doi.org/10.1016/j.schres.2012.10.026