Spontaneous Parkinsonism Is Associated With Cognitive Impairment in Antipsychotic-Naive Patients With First-Episode Psychosis: A 6-Month Follow-up Study

• Published in: Schizophrenia bulletin Vol. 40; no. 5; pp. 1164 - 1173
• Main Authors: CUESTA, Manuel J, SANCHEZ-TORRES, Ana M, DE JALON, Elena García, CAMPOS, Maria S, IBANEZ, Berta, MORENO-IZCO, Lucía, PERALTA, Victor
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-09-2014
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; Cognition Disorders - diagnosis; Cognition Disorders - epidemiology; Comorbidity; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Organic mental disorders. Neuropsychology; Parkinsonian Disorders - diagnosis; Parkinsonian Disorders - epidemiology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychotic Disorders - diagnosis; Psychotic Disorders - epidemiology; Regular; Schizophrenia; Human; Nervous system diseases; neuropsychological impairment; Cognitive disorder; extrapyramidal signs; Parkinson disease; Schizophrenia; Cognition; Abnormal movement; Cerebral disorder; Parkinsonism; Psychosis; First episode; Follow up study; Central nervous system disease; Degenerative disease; abnormal movements; Extrapyramidal syndrome; schizophrenia; cognition
• ISSN: 0586-7614; 1745-1701
• DOI: 10.1093/schbul/sbt125

There is now growing evidence that parkinsonism and other extrapyramidal signs are highly prevalent in patients with first-episode psychosis who have never been exposed to antipsychotic drugs. However, the neurocognitive correlates of parkinsonism in this population remained to be clarified. A sample comprising 100 consecutive drug-naive patients with first-episode psychosis were enrolled on the study and followed up for 6 months. Seventy-seven completed assessments at 3 time points (baseline, 1 mo, and 6 mo), involving clinical and cognitive examinations and a specific assessment of motor abnormalities. The Simpson-Angus Scale (SAS) was used for the assessment of extrapyramidal signs, and each motor domain was evaluated with a standard assessment scale. Linear mixed models were built to explore the longitudinal relationships between parkinsonism scores and cognitive impairment. Parkinsonism scores showed significant strong longitudinal associations with deficits in memory, executive functioning, and attention. Spontaneous parkinsonism (total SAS score and hypokinesia and rigidity subscores at baseline) showed high 6-month predictive values for cognitive impairment. In addition, they also had high predictive values for neurologic soft-sign abnormalities but not for dyskinesia, akathisia, and pure catatonic abnormalities. No predictive value was found for glabella-salivation or tremor subscores on the SAS scale. These results emphasize the relevance of the assessment of parkinsonism signs prior to starting to administer antipsychotic drugs, as core manifestations of psychotic illness with a high predictive value for cognitive impairment.