Association of early life stress and cognitive performance in patients with schizophrenia and healthy controls

Fanny Senner; Thomas Schneider-Axmann; Lalit Kaurani; Jörg Zimmermann; Jens Wiltfang; Martin von Hagen; Thomas Vogl; Carsten Spitzer; Simon Senner; Eva C Schulte; Max Schmauß; Sabrina K Schaupp; Jens Reimer; Daniela Reich-Erkelenz; Sergi Papiol; Mojtaba Oraki Kohshour; Fabian U Lang; Carsten Konrad; Sophie-Kathrin Kirchner; Janos L Kalman; Georg Juckel; Maria Heilbronner; Urs Heilbronner; Christian Figge; Ruth E Eyl; Detlef Dietrich; Monika Budde; Ion-George Angelescu; Kristina Adorjan; Andrea Schmitt; Andre Fischer; Peter Falkai; Thomas G Schulze

doi:10.1016/j.scog.2023.100280

Association of early life stress and cognitive performance in patients with schizophrenia and healthy controls

Schizophr Res Cogn. 2023 Feb 11:32:100280. doi: 10.1016/j.scog.2023.100280. eCollection 2023 Jun.

Authors

Fanny Senner^{1

2}, Thomas Schneider-Axmann¹, Lalit Kaurani³, Jörg Zimmermann⁴, Jens Wiltfang^{3

5

6}, Martin von Hagen⁷, Thomas Vogl², Carsten Spitzer⁸, Simon Senner⁹, Eva C Schulte^{1

2}, Max Schmauß¹⁰, Sabrina K Schaupp², Jens Reimer¹¹, Daniela Reich-Erkelenz², Sergi Papiol^{1

2}, Mojtaba Oraki Kohshour^{2

12}, Fabian U Lang¹³, Carsten Konrad¹⁴, Sophie-Kathrin Kirchner^{1

10}, Janos L Kalman^{1

2}, Georg Juckel¹⁵, Maria Heilbronner², Urs Heilbronner², Christian Figge¹⁶, Ruth E Eyl¹⁷, Detlef Dietrich¹⁸, Monika Budde², Ion-George Angelescu¹⁹, Kristina Adorjan^{1

2}, Andrea Schmitt^{1

20}, Andre Fischer^{3

5

21}, Peter Falkai¹, Thomas G Schulze^{2

22

23}

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich 80336, Germany.
² Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich 80336, Germany.
³ German Center of Neurodegenerative Diseases (DZNE), Göttingen 37075, Germany.
⁴ Psychiatrieverbund Oldenburger Land gGmbH, Karl-Jaspers-Klinik, Bad Zwischenahn 26160, Germany.
⁵ Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen 37075, Germany.
⁶ Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
⁷ Clinic for Psychiatry and Psychotherapy, Clinical Center Werra-Meißner, Eschwege 37269, Germany.
⁸ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock 18147, Germany.
⁹ Center for Psychiatry Reichenau, Academic Hospital University of Konstanz, Konstanz 78479, Germany.
¹⁰ Department of Psychiatry and Psychotherapy, Bezirkskrankenhaus Augsburg, Augsburg 86156, Germany.
¹¹ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.
¹² Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
¹³ Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, 89312, Germany.
¹⁴ Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg 27356, Germany.
¹⁵ Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum 44791, Germany.
¹⁶ Karl-Jaspers Clinic, European Medical School Oldenburg-Groningen, Oldenburg 26160, Germany.
¹⁷ Stuttgart Cancer Center -Tumorzentrum Eva Mayr-Stihl, Klinikum Stuttgart, Stuttgart 70174, Germany.
¹⁸ AMEOS Clinical Center Hildesheim, Hildesheim 31135, Germany.
¹⁹ Department of Psychiatry and Psychotherapy, Mental Health Institute Berlin, Berlin 14050, Germany.
²⁰ Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil.
²¹ Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany.
²² Department of Psychiatry and Behavorial Sciences, SUNY Upstate Medical University, Syracuse, 54, NY, USA.
²³ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

As core symptoms of schizophrenia, cognitive deficits contribute substantially to poor outcomes. Early life stress (ELS) can negatively affect cognition in patients with schizophrenia and healthy controls, but the exact nature of the mediating factors is unclear. Therefore, we investigated how ELS, education, and symptom burden are related to cognitive performance. The sample comprised 215 patients with schizophrenia (age, 42.9 ± 12.0 years; 66.0 % male) and 197 healthy controls (age, 38.5 ± 16.4 years; 39.3 % male) from the PsyCourse Study. ELS was assessed with the Childhood Trauma Screener (CTS). We used analyses of covariance and correlation analyses to investigate the association of total ELS load and ELS subtypes with cognitive performance. ELS was reported by 52.1 % of patients and 24.9 % of controls. Independent of ELS, cognitive performance on neuropsychological tests was lower in patients than controls (p < 0.001). ELS load was more closely associated with neurocognitive deficits (cognitive composite score) in controls (r = -0.305, p < 0.001) than in patients (r = -0.163, p = 0.033). Moreover, the higher the ELS load, the more cognitive deficits were found in controls (r = -0.200, p = 0.006), while in patients, this correlation was not significant after adjusting for PANSS. ELS load was more strongly associated with cognitive deficits in healthy controls than in patients. In patients, disease-related positive and negative symptoms may mask the effects of ELS-related cognitive deficits. ELS subtypes were associated with impairments in various cognitive domains. Cognitive deficits appear to be mediated through higher symptom burden and lower educational level.

Keywords: Cognitive dysfunction; Early life stress; Healthy controls; Schizophrenia.