Community transition at younger ages contributes to good cognitive function outcomes in long-term hospitalized patients with schizophrenia spectrum disorder: A 15-year follow-up study with group-based trajectory modeling

Hisashi Kida, Hidehito Niimura, Takahiro Nemoto, Yonosuke Ryu, Kei Sakuma, Masaru Mimura, Masafumi Mizuno

Research output: Contribution to journalArticle

Abstract

Aim: Cognitive dysfunction is a core symptom of schizophrenia spectrum disorder, but the reported long-term cognitive outcomes are heterogeneous. This study aimed to elucidate the long-term trajectories of patients with schizophrenia spectrum disorder who transitioned to community dwelling with integrated care, and to identify predictors of successful community reintegration. Methods: After the closure of a psychiatric hospital, 78 patients with schizophrenia spectrum disorder (mean age: 54.6 years) were transferred to the community. We assessed patients' cognitive function over 15 years with the Mini-Mental State Examination (MMSE) and analyzed the scores every 3 years. Forty-four patients completed all assessments. Results: The mean MMSE score at discharge was 25.8, which changed to 26.8 after 3 years and 25.3 after 6 years. After 12 and 15 years, it had decreased significantly to 23.3 and 23.0, respectively. Group-based trajectory modeling identified two groups of patients: a ‘poor-outcome’ group (63.4%), showing a decline in scores after maintaining post-discharge levels for several years, and a ‘good-outcome’ group (36.6%), maintaining post-discharge scores after showing improved scores. Conclusion: Considering the significant difference in age between the aforementioned groups (P = 0.040), we suggest that community transitions at younger ages contribute to better cognitive function and adaptation to community life. Even middle-aged and elderly patients with chronic schizophrenia spectrum disorder showed improved or maintained cognitive function at least 3 years after discharge, and the good-outcome group maintained cognitive function over 15 years. Improvements were dominated primarily by age at discharge, with cognitive function being maintained longer in patients in the good-outcome group.

Original languageEnglish
JournalPsychiatry and Clinical Neurosciences
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Cognition
Schizophrenia
Independent Living
Psychiatric Hospitals

Keywords

  • cognitive dysfunction
  • community dwelling
  • deinstitutionalization
  • Mini-Mental State Examination
  • schizophrenia spectrum disorder

ASJC Scopus subject areas

  • Neuroscience(all)
  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

@article{32570512598b403bb2b83f9a6521508d,
title = "Community transition at younger ages contributes to good cognitive function outcomes in long-term hospitalized patients with schizophrenia spectrum disorder: A 15-year follow-up study with group-based trajectory modeling",
abstract = "Aim: Cognitive dysfunction is a core symptom of schizophrenia spectrum disorder, but the reported long-term cognitive outcomes are heterogeneous. This study aimed to elucidate the long-term trajectories of patients with schizophrenia spectrum disorder who transitioned to community dwelling with integrated care, and to identify predictors of successful community reintegration. Methods: After the closure of a psychiatric hospital, 78 patients with schizophrenia spectrum disorder (mean age: 54.6 years) were transferred to the community. We assessed patients' cognitive function over 15 years with the Mini-Mental State Examination (MMSE) and analyzed the scores every 3 years. Forty-four patients completed all assessments. Results: The mean MMSE score at discharge was 25.8, which changed to 26.8 after 3 years and 25.3 after 6 years. After 12 and 15 years, it had decreased significantly to 23.3 and 23.0, respectively. Group-based trajectory modeling identified two groups of patients: a ‘poor-outcome’ group (63.4{\%}), showing a decline in scores after maintaining post-discharge levels for several years, and a ‘good-outcome’ group (36.6{\%}), maintaining post-discharge scores after showing improved scores. Conclusion: Considering the significant difference in age between the aforementioned groups (P = 0.040), we suggest that community transitions at younger ages contribute to better cognitive function and adaptation to community life. Even middle-aged and elderly patients with chronic schizophrenia spectrum disorder showed improved or maintained cognitive function at least 3 years after discharge, and the good-outcome group maintained cognitive function over 15 years. Improvements were dominated primarily by age at discharge, with cognitive function being maintained longer in patients in the good-outcome group.",
keywords = "cognitive dysfunction, community dwelling, deinstitutionalization, Mini-Mental State Examination, schizophrenia spectrum disorder",
author = "Hisashi Kida and Hidehito Niimura and Takahiro Nemoto and Yonosuke Ryu and Kei Sakuma and Masaru Mimura and Masafumi Mizuno",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/pcn.12941",
language = "English",
journal = "Psychiatry and Clinical Neurosciences",
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TY - JOUR

T1 - Community transition at younger ages contributes to good cognitive function outcomes in long-term hospitalized patients with schizophrenia spectrum disorder

T2 - A 15-year follow-up study with group-based trajectory modeling

AU - Kida, Hisashi

AU - Niimura, Hidehito

AU - Nemoto, Takahiro

AU - Ryu, Yonosuke

AU - Sakuma, Kei

AU - Mimura, Masaru

AU - Mizuno, Masafumi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aim: Cognitive dysfunction is a core symptom of schizophrenia spectrum disorder, but the reported long-term cognitive outcomes are heterogeneous. This study aimed to elucidate the long-term trajectories of patients with schizophrenia spectrum disorder who transitioned to community dwelling with integrated care, and to identify predictors of successful community reintegration. Methods: After the closure of a psychiatric hospital, 78 patients with schizophrenia spectrum disorder (mean age: 54.6 years) were transferred to the community. We assessed patients' cognitive function over 15 years with the Mini-Mental State Examination (MMSE) and analyzed the scores every 3 years. Forty-four patients completed all assessments. Results: The mean MMSE score at discharge was 25.8, which changed to 26.8 after 3 years and 25.3 after 6 years. After 12 and 15 years, it had decreased significantly to 23.3 and 23.0, respectively. Group-based trajectory modeling identified two groups of patients: a ‘poor-outcome’ group (63.4%), showing a decline in scores after maintaining post-discharge levels for several years, and a ‘good-outcome’ group (36.6%), maintaining post-discharge scores after showing improved scores. Conclusion: Considering the significant difference in age between the aforementioned groups (P = 0.040), we suggest that community transitions at younger ages contribute to better cognitive function and adaptation to community life. Even middle-aged and elderly patients with chronic schizophrenia spectrum disorder showed improved or maintained cognitive function at least 3 years after discharge, and the good-outcome group maintained cognitive function over 15 years. Improvements were dominated primarily by age at discharge, with cognitive function being maintained longer in patients in the good-outcome group.

AB - Aim: Cognitive dysfunction is a core symptom of schizophrenia spectrum disorder, but the reported long-term cognitive outcomes are heterogeneous. This study aimed to elucidate the long-term trajectories of patients with schizophrenia spectrum disorder who transitioned to community dwelling with integrated care, and to identify predictors of successful community reintegration. Methods: After the closure of a psychiatric hospital, 78 patients with schizophrenia spectrum disorder (mean age: 54.6 years) were transferred to the community. We assessed patients' cognitive function over 15 years with the Mini-Mental State Examination (MMSE) and analyzed the scores every 3 years. Forty-four patients completed all assessments. Results: The mean MMSE score at discharge was 25.8, which changed to 26.8 after 3 years and 25.3 after 6 years. After 12 and 15 years, it had decreased significantly to 23.3 and 23.0, respectively. Group-based trajectory modeling identified two groups of patients: a ‘poor-outcome’ group (63.4%), showing a decline in scores after maintaining post-discharge levels for several years, and a ‘good-outcome’ group (36.6%), maintaining post-discharge scores after showing improved scores. Conclusion: Considering the significant difference in age between the aforementioned groups (P = 0.040), we suggest that community transitions at younger ages contribute to better cognitive function and adaptation to community life. Even middle-aged and elderly patients with chronic schizophrenia spectrum disorder showed improved or maintained cognitive function at least 3 years after discharge, and the good-outcome group maintained cognitive function over 15 years. Improvements were dominated primarily by age at discharge, with cognitive function being maintained longer in patients in the good-outcome group.

KW - cognitive dysfunction

KW - community dwelling

KW - deinstitutionalization

KW - Mini-Mental State Examination

KW - schizophrenia spectrum disorder

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