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. 2021 Sep 29;27:100217. doi: 10.1016/j.scog.2021.100217

Table 2.

Publications on the association of cognition with change in functioning.

Publication name [Quality] Type of publication Sample size/No. of studies (total sample size) FUP Population Cognitive domains assessed Functioning domains assessed Key results
Santesteban-Echarri 2017 [Q = High] SLR with meta-analysis Total studies: 50 (n = 6669) >12 mo FEP Only NC Domains: social, occupational, independent living
(Only RWF)		 Most baseline cognitive variables (general cognitive ability, attention, processing speed, verbal fluency, verbal memory and working memory) were significantly associated with functioning over time.
Correlation between baseline cognition and follow-up functioning/recovery:
  • •

    General cognitive ability: r = 0.183; 95% CI, 0.074 to 0.287; p < 0.001

  • •

    Attention: r = 0.216; 95% CI, 0.112 to 0.315; p < 0.0001

  • •

    Working memory: r = 0.171; 95% CI, 0.084 to 0.255; p < 0.0001

  • •

    Verbal fluency: r = 0.167; 95% CI, 0.081 to 0.251; p < 0.0001

  • •

    Verbal memory: r = 0.145; 95% CI, 0.034 to 0.252; p = 0.011

  • •

    Executive functioning: r = 0.064; 95% CI, −0.031 to 0.157; p = 0.188

  • •

    Processing speed: r = 0.197; 95% CI, 0.098 to 0.292; p < 0.0001

  • •

    Nonverbal memory and learning: r = 0.119; 95% CI, −0.093 to 0.322; p = 0.271

  • •

    Visuo-motor skills: r = 0.143; 95% CI, −0.045 to 0.321; p = 0.136
Allott 2011 [Q = High] SLR Total studies: 22 (n = 1817) 1-7 y FEP Only NC Domains: social, occupational, independent living

(Only RWF)		 Most cognitive domains (verbal skills, global/general cognition, reasoning and problem solving, and verbal learning and memory) predicted functioning.
In 16 of the 22 studies (73%), at least one cognitive domain predicted RWF. RWF was predicted by verbal or language skills in 36% of the studies, global cognition in 31%, and reasoning and problem solving in 26%.
Christensen, 2007 [Q = Medium] SLR Total studies: 21 (n = 1411) 25 w (median) SCZ Only NC Domains: social, occupational, independent living
(FC and RWF)		 Baseline NC influenced subsequent employment, work rehabilitation, work skills and work behavior.
Lysaker 2015 [Q = NA] Narrative review Total studies: 5 (NA), of which 2 studies reported data on longitudinal association 6 mo SCZ Metacognition Domains: social, occupational, independent living
(FC and RWF)		 An association between metacognition and functioning was reported during follow-up.
Green 2004 [Q = NA] Narrative review Total studies: 18 (NA) 6 mo-20 y SCZ Only NC Domains: social, occupational, independent living
(Only RWF)		 Association of cognition with RWF was in the medium to largea ES range across studies (ES for correlations: 0.3 to 0.5).
Lam 2018 [Q = 8/9] PCS 173 Up to 2 y UHR for psychosis Only NC Domains: social, occupational
(Only RWF)		 Baseline cognition was associated with UHR non-remission (OR, 1.67; 95% CI, 1.09-2.95; p = 0.04).
Longitudinal changes in cognition were associated with change in functioning, particularly in the remitters; the differential rate of change in cognition fully accounted for the differential rate of change in functioning between remitters and non-remitters.
Amoretti 2016 [Q = 8/9] PCS 52 2 y FEP Only NC Domains: social, occupational, independent living
(Only RWF)		 Baseline cognitive reserve significantly predicted RWF at baseline (Univariate regression analysis - for FAST: R2, 0.151; p = 0.021, and for GAF: R2, 0.103; p = 0.060).
Baseline cognitive reserve significantly predicted RWF at 2 years (Univariate regression analysis - for FAST: R2, 0.134; p = 0.033, and for GAF: R2, 0.130; p = 0.042).
Bergh 2016 [Q = 6/9] PCS 322 5 y, 10 y SCZ spectrum disorders Only NC Domains: social, occupational, independent living
(Only RWF)		 Baseline GAF (RWF) predicted 10-year NC in univariate analyses (β, 0.02; 95% CI, 0.01 to 0.03; p < 0.001).
Poor academic functioning (RWF) at baseline predicted 10-year global cognition (β, −0.12; 95% CI, −0.18 to −0.06; p < 0.001), speed of processing (β, −0.12; 95% CI, −0.18 to −0.06; p = 0.001), and VLM (β, −0.11; 95% CI, −0.17 to −0.05; p < 0.001) in multivariate analysis.
Browne 2016 [Q = 7/9] PCS 179 2-4 w SCZ, SAD NC and SC Domains: social, occupational, independent living
(FC and RWF)		 SC was significantly associated with FC and RWF (bivariate correlations between SC and social functioning – for UPSA-B: 0.556, p < 0.001; for SSPA: 0.397, p < 0.001; and for SLOF: 0.334, p < 0.001).
Chang 2016 [Q = 7/9] PCS 114 1 y SCZ, SAD Only NC Domains: social, occupational, independent living
(Only RWF)		 NC independently predicted RWF, and explained 5.9% of the variance in RWF.
Simons 2016 [Q = 7/9] PCS 745 3 y Psychosis NC and SC Domains: social, occupational, independent living
(Only RWF)		 All NC domains at baseline were significantly associated with social functioning at three years, with the exception of verbal memory retention and response shifting task – higher cognition at baseline predicted better long-term RWF.
Baseline SC was not associated with longitudinal social functioning.
Lipskaya-Velikovsky 2015 [Q = 7/9] PCS Stage 1: 104
Stage 2: 70		 6 m SCZ Only NC Domain: independent living
(FC and RWF)		 NC, along with other variables, was a significant predictor of ADL and IADL.
Prediction of ADL by the severity of negative symptoms, NC, and the number of hospitalizations: 51.2%
Prediction of IADL by functional capacity, NC, and the number of hospitalizations: 60.1%
Norman 2015 [Q = 8/9] PCS 113 5 y FEP Only NC Domains: social, occupational
(Only RWF)		 NC assessed at one-year post-baseline predicted some, but not all, occupational/vocational outcomes such as being in full-time work or studies, time spent in full-time occupation, and being on disability pension.
Heinrichs 2010 [Q = 7/9] PCS 127 10 m SCZ, SAD Only NC Domains: occupational, independent living
(FC and RWF)		 NC, along with demographic and clinical factors accounted for 35%–38% of variance in community independence.
Robinson 2004 [Q = 7/9] PCS 118 8 y SCZ, SAD Only NC Domains: social, occupational
(Only RWF)		 Following stabilization of acute psychosis, better cognitive functioning independently predicted adequate social/vocational functioning and recovery.

ADL, activities of daily living; B, unstandardized regression coefficient; β (beta), standardized regression coefficient; CI, confidence interval; ES, effect size; FAST, Functioning Assessment Short Test; FC, functional capacity; FEP, first episode psychosis; GAF, Global Assessment of Functioning scale; IADL, instrumental activities of daily living; mo, months; NA, not applicable; NC, neurocognition; OR, odds ratio; PCS, prospective cohort study; Q, quality; R2, coefficient of determination; RWF, real-world functioning; SAD, schizoaffective disorder; SC, social cognition; SCZ, schizophrenia; SLOF, Specific Levels of Functioning scale; SLR, systematic literature review; SSPA, Social Skills Performance Assessment; UHR, ultra-high risk for psychosis; UPSA, University of California San Diego Performance-based Skills Assessment; VLM, visual learning and memory; w, weeks; y, years.

a

ES interpretation as reported by the respective study authors.