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Maccabe JH, Wicks S, Löfving S, David AS, Berndtsson Å, Gustafsson JE, Allebeck P, Dalman C. Decline in cognitive performance between ages 13 and 18 years and the risk for psychosis in adulthood: a Swedish longitudinal cohort study in males. JAMA Psychiatry . 2013 Mar ; 70(3):261-70. PubMed Abstract

Comments on Paper and Primary News
Comment by:  Terry Goldberg
Submitted 12 February 2013 Posted 12 February 2013

Intellectual decline in schizophrenia has been an area of active investigation for well over two decades. In a twin paradigm, we reported evidence for intellectual decline in the schizophrenia proband, using both reading level and current IQ (Goldberg et al., 1990). In a later study we determined that intellectual decline is present in about 50 percent of patients and appears to be the modal presentation (Weickert et al., 2000).

In the current paper, MacCabe and colleagues attempt to pinpoint the timing of cognitive decline in a Swedish population-based study. They found strong evidence for decline in verbal ability in the 13-18 years of age period. Nevertheless, there are several unexpected features to the report.

First, though it is “population based,” the schizophrenia/schizoaffective N = 50 and bipolar N = 18 are rather small compared to many other studies in the area.

Second, the schizophrenia group has a relatively late onset (28 years at first hospitalization). This...  Read more

View all comments by Terry Goldberg

Comment by:  Timothea Toulopoulou
Submitted 22 February 2013 Posted 22 February 2013

Adolescence is a period of dramatic brain maturation and reorganization, and may also be a time of particular risk for pathophysiological processes underpinning neurodevelopmental models for psychiatric disorders such as schizophrenia. It, therefore, represents a particularly good period to examine for cognitive changes, as indices of that neurobiological risk, as they occur during that time of development. MacCabe’s excellent work complements numerous other streams of research that point in a similar direction, i.e., that a failure of normal verbal maturation during adolescence indicates later psychosis risk. However, without wanting to take anything away from the value of the study, we are left wondering whether we have been distracted by large samples, and association studies, for too long, perhaps confusing bigger with better? Epidemiological studies cannot tell us about the underlying neurobiology of the changes that occur during this period of development, and isn’t that where we should focus?

View all comments by Timothea Toulopoulou

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