An effect of antipsychotic and anticholinergic treatment on cognitive function in patients with schizophrenia

Tumova MA, Stepanova AA, Zazulina YS, et al. An effect of antipsychotic and anticholinergic treatment on cognitive function in patients with schizophrenia. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(7):80‑85. (In Russ.)
https://doi.org/10.17116/jnevro202312307180

Подписка 2026 Журнал неврологии и психиатрии им. С.С. Корсакова (S.S. Korsakov Journal of Neurology and Psychiatry)

Использование инфографики авторами научных работ

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OBJECTIVE

To reveal the relationships between antipsychotic and anticholinergic drugs and cognitive functions in patients with schizophrenia.

MATERIAL AND METHODS

The observational prospective study was conducted at the Bekhterev National Medical Center of Psychiatry and Neurology. The study involved 41 patients (22 men and 19 women) with paranoid schizophrenia, according to ICD 10 criteria, aged 30.12±8.24 years on stable antipsychotic monotherapy or in combination with anticholinergic drug (trihexiphenidyl). Cognitive functions were assessed using the «Brief Assessment of Cognitive Function in Patients with Schizophrenia» (BACS) scale, severity of mental state and extrapyramidal disturbances were measured using the «Positive and Negative Syndrome Scale (PANSS) and the Simpson-Angus Scale for Assessment of Extrapyramidal Side Effects (SAS). All examination procedures were performed twice at weeks 2 and 8 of therapy. Patients were divided into 2 groups according to the type of antipsychotic therapy. Twelve patients received first generation antipsychotics (FGAs) (group 1), 29 patients received second generation antipsychotics (SGAs) (group 2).

RESULTS

Patients receiving SGAs had a significant decrease in the overall SAS score at week 8 of therapy compared with data at week 2, and there was an improvement in cognitive function, unlike patients receiving FGAs. There were also changes on BACS tests the digit sequencing (V=51.5, p=0.007), token motor task (V=75.5, p=0.007) and Tower of London (V=52, p=0.027) only in patients of group 2.

CONCLUSION

The improved tolerance to the drug, as well as cognitive measures, was shown in patients taking SGAs by week 8. Our study confirms the importance of adhering to the minimum effective dose of antipsychotic drugs for the treatment of schizophrenia to prevent cognitive impairment, and to give preference to SGAs in the choice of treatment.

Keywords:

cognitive function

BACS

extrapyramidal symptoms

SAS

PANSS

first- and second-generation antipsychotics

Authors:

Tumova M.A.

Bekhterev National Medical Research Center for Psychiatry and Neurology

ORCID: 0000-0002-3418-8596

Stepanova A.A.

Bekhterev National Medical Research Center for Psychiatry and Neurology

ORCID: 0000-0002-4029-9401

Zazulina Y.S.

Bekhterev National Medical Research Center for Psychiatry and Neurology

ORCID: 0000-0002-1962-2147

Guseinova Z.T.

Bekhterev National Medical Research Center for Psychiatry and Neurology

ORCID: 0000-0002-6737-5486

Zaitseva M.M.

Bekhterev National Medical Research Center for Psychiatry and Neurology

ORCID: 0000-0002-6055-1037

Dyment I.V.

Bekhterev National Medical Research Center for Psychiatry and Neurology

ORCID: 0000-0002-7373-3825

Kotsyubinsky A.P.

Bekhterev National Medical Research Center for Psychiatry and Neurology

ORCID: 0000-0002-4826-9688

Ivanov M.V.

Bekhterev National Medical Research Center for Psychiatry and Neurology

ORCID: 0000-0001-5851-0626

Received:

10.02.2023

Accepted:

22.03.2023

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References:

Jauhar S, Johnstone M, McKenna PJ. Schizophrenia. Lancet (London, England). 2022;399(10323):473-486. https://doi.org/10.1016/S0140-6736(21)01730-X
Kudryashova VY, Lutova NB. The role of self-regulation of behavior as an aspect of adaptation-compensatory mechanisms in patients with paranoid schizophrenia. V.M. Bekhterev of Psychiatry and Medical Psychology. 2019;(1):26-33. (In Russ.). https://doi.org/10.31363/2313-7053-2019-1-26-33
The Lancet. ICD-11. Lancet (London, England). 2019;393(10188):2275. https://doi.org/10.1016/S0140-6736(19)31205-X
Kahn RS, Keefe RSE. Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry. 2013;70(10):1107-1112. https://doi.org/10.1001/JAMAPSYCHIATRY.2013.155
Dorofeikova MV, Petrova NN. Cognitive dysfunction in schizophrenia and its treatment. Sovremennaja Terapija Psihicheskih Rasstrojstv. 2015;1:2-9. (In Russ.). https://psypharma.ru/sites/default/files/1-2015-2-9.pdf
Picó-Pérez M, Vieira R, Fernández-Rodríguez M, et al. Multimodal meta-analysis of structural gray matter, neurocognitive and social cognitive fMRI findings in schizophrenia patients. Psychol Med. 2022;52(4):614-624. https://doi.org/10.1017/S0033291721005523
Dietsche B, Kircher T, Falkenberg I. Structural brain changes in schizophrenia at different stages of the illness: A selective review of longitudinal magnetic resonance imaging studies. Aust N Z J Psychiatry. 2017;51(5):500-508. https://doi.org/10.1177/0004867417699473
van Erp TGM, Walton E, Hibar DP, et al. Cortical Brain Abnormalities in 4474 Individuals With Schizophrenia and 5098 Control Subjects via the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA) Consortium. Biol Psychiatry. 2018;84(9):644-654. https://doi.org/10.1016/j.biopsych.2018.04.023
Choi KH, Til W, Kurtz MM. Adjunctive pharmacotherapy for cognitive deficits in schizophrenia: Meta-analytical investigation of efficacy. Br J Psychiatry. 2013;203(3):172-178. https://doi.org/10.1192/bjp.bp.111.107359
Ang MS, Abdul Rashid NA, Lam M, Rapisarda A, et al. The Impact of Medication Anticholinergic Burden on Cognitive Performance in People with Schizophrenia. J Clin Psychopharmacol. 2017;37(6):651-656. https://doi.org/10.1097/JCP.0000000000000790
Karpinkaia VYu, Tumova MA, Yanushko MG, et al. The relationship between visual dysfunction and cognitive deficit in schizophrenia. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2021;121(8):61-66. (In Russ.). https://doi.org/10.17116/jnevro202112108161
Zhu R, Wang D, Wei G, et al. Association of negative symptoms with cognitive impairment in Chinese Han patients with chronic schizophrenia. Int J Psychiatry Clin Pract. 2021;25(3):292-298. https://doi.org/10.1080/13651501.2021.1912357
Veselinović T, Scharpenberg M, Heinze M, et al. Disparate effects of first and second generation antipsychotics on cognition in schizophrenia — Findings from the randomized NeSSy trial. Eur Neuropsychopharmacol. 2019;29(6):720-739. https://doi.org/10.1016/J.EURONEURO.2019.03.014
Karson C, Duffy RA, Eramo A, et al. Long-term outcomes of antipsychotic treatment in patients with first-episode schizophrenia: A systematic review. Neuropsychiatr Dis Treat. 2016;12:57-67. https://doi.org/10.2147/NDT.S96392
Monteleone P, Cascino G, Monteleone AM, et al. Prevalence of antipsychotic-induced extrapyramidal symptoms and their association with neurocognition and social cognition in outpatients with schizophrenia in the «real-life». Prog Neuropsychopharmacol Biol Psychiatry. 2021;109:110250. https://doi.org/10.1016/J.PNPBP.2021.110250
Barnes TRE, Drake R, Paton C, et al. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2020;34(1):3-78. https://doi.org/10.1177/0269881119889296
Monteleone P, Cascino G, Rossi A, et al. Evolution of antipsychotic-induced extrapyramidal symptoms in patients with schizophrenia in the real-life: A 4-year follow-up naturalistic study. Schizophr Res. 2022;248:279-286. https://doi.org/10.1016/J.SCHRES.2022.08.015
Yanushko MG, Ivanov MV, Sorokina AV. Cognitive disorders in indogenous psychoses: contemporary perspective in the light of dimensional approach. Socialnaja i Klinicheskaja Psihiatrija. 2014;24(1):90-95. (In Russ.).
Eum S, Hill SK, Rubin LH, Carnahan RM, et al. Cognitive burden of anticholinergic medications in psychotic disorders. Schizophr Res. 2017;190:129-135. https://doi.org/10.1016/J.SCHRES.2017.03.034
Kim SJ, Jung D, Shim JC, et al. The effect of anticholinergic burden on cognitive and daily living functions in patients with schizophrenia. Asian J Psychiatr. 2019;46:111-117. https://doi.org/10.1016/J.AJP.2019.10.013
Keefe RSE, Eesley CE, Poe MP. Defining a cognitive function decrement in schizophrenia. Biol Psychiatry. 2005;57(6):688-691. https://doi.org/10.1016/j.biopsych.2005.01.003
González-Maeso J, Ang RL, Yuen T, et al. Identification of a serotonin/glutamate receptor complex implicated in psychosis. Nature. 2008;452(7183):93-97. https://doi.org/10.1038/nature06612
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261-276. https://doi.org/10.1093/schbul/13.2.261
Lindenmayer JP, Bernstein-Hyman R, Grochowski S. Five-factor model of schizophrenia initial validation. J Nerv Ment Dis. 1994;182(11):631-638. https://doi.org/10.1097/00005053-199411000-00006
Lehman AF, Lieberman JA, Dixon LB, et al. American Psychiatric Association; Steering Committee on Practice Guidelines. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004;161(2 suppl):1-56.
Miyamoto S, Duncan GE, Marx CE, Lieberman JA. Treatments for schizophrenia: A critical review of pharmacology and mechanisms of action of antipsychotic drugs. Mol Psychiatry. 2005;10(1):79-104. https://doi.org/10.1038/sj.mp.4001556
Sonnenschein SF, Grace AA. Insights on current and novel antipsychotic mechanisms from the MAM model of schizophrenia. Neuropharmacology. 2020;163:107632. https://doi.org/10.1016/J.NEUROPHARM.2019.05.009
Wichniak A, Samochowiec J, Szulc A, et al. The position statement of the Working Group of the Polish Psychiatric Association on the use of D2/D3 dopamine receptor partial agonists in the treatment of mental disorders. Psychiatr Pol. 2021;55(5):941-966. https://doi.org/10.12740/PP/138177
Sheffield JM, Barch DM. Cognition and resting-state functional connectivity in schizophrenia. Neurosci Biobehav Rev. 2016;61:108-120. https://doi.org/10.1016/J.NEUBIOREV.2015.12.007
Ivanov MV, Tumova MA, Kosterin DN, et al. Neuromorphometric characteristics (results of PET diagnostics with 18F-FDG) in patients with chronic auditory hallucinosis in schizophrenia. Siberian Herald of Psychiatry and Addiction Psychiatry. 2018;1(98):11-17. (In Russ.). https://doi.org/10.26617/1810-3111-2018-1(98)-11-17