The longitudinal relationship of clinical symptoms, cognitive functioning,and adaptive life in geriatric schizophrenia

Cognitive dysfunction is increasingly being recognized as a major contribut or to the adaptive impairment seen in most patients with schizophrenia. Rep orted here is a prospective longitudinal evaluation of the relationship bet ween cognitive and adaptive functioning in elderly patients with schizophre nia. It was hypothesized that baseline cognitive and negative, but not posi tive symptoms, would be predictive of cross-sectional impairment and longit udinal outcome. Subjects were 168 elderly patients with schizophrenia, free of major neurological disorders, who were residents of a long-term psychia tric facility. Subjects were assessed at baseline and again an average of 1 5 months later. The PANSS was used to assess the severity of symptoms of sc hizophrenia. Cognitive symptoms were assessed using the components of the C ERAD cognitive battery. Social and adaptive functioning was assessed using the SAFE scale. Spearman correlations were determined among clinical variab les, and the rank ordering of prediction of SAFE scale scores at follow-up was determined using a stepwise regression procedure. At follow-up, adaptiv e life skills correlated with cognitive performance and negative symptoms ( Spearman rho values 0.41-0.57. all p values <0.0001), but not positive symp toms (r = 0.09, n.s.). Among cognitive tasks, verbal learning and memory we re most highly correlated with adaptive skills at follow-up. These results confirm and extend previous studies that indicate that cognitive impairment s are predictive, both cross-sectionally and longitudinally, of adaptive li fe skills in persons with schizophrenia. Negative symptoms, but not positiv e symptoms, were correlated with impaired adaptive skills. Taken together t hese results underscore the need to develop more effective treatments for c ognitive and negative symptoms in schizophrenia. (C) 2000 Elsevier Science B.V. All rights reserved.