The Complex Interaction of Cognitive Issues

Cognitive impairment is a common symptom in many psychiatric and neurologic conditions. Practitioners and researchers need to take cognitive issues very seriously as they go about treating and studying diseases of the brain. Cognitive abilities influence daily function, social interactions, behaviors, care and supervision needs, treatment options, medication compliance, clinical outcomes, and economic costs, and, ultimately, have a profound effect on the quality of life for both patients and caregivers. Careful patient management to maximize cognitive abilities and minimize specific medications and other risks that could impair cognition will ultimately provide improved patient functioning.

In dementia conditions, the cognitive deficits are the primary feature of the disease, while in many psychiatric disorders, impaired cognition might only be an occasional problem that may worsen depending on a variety of factors, including adverse effects from medications. In Alzheimer's disease, cognitive decline is the hallmark of the disorder and its progression continues unabated to death (Scharre, 2003). Medications currently available may slow the process a bit but cannot stop it. In schizophrenia, while psychosis is the cardinal feature, cognitive disturbances are present and appear to stay fairly constant over time (Rund, 1998). Since cognitive deficits are good predictors of functional abilities, it is important to measure and to optimize them (Green et al., 2000). Treatments designed to improve psychosis must also be measured by their effect on cognition. In depression, mood disturbance can exist with or without significant cognitive impairment (Green et al., 2003). The degree of cognitive deficits will influence treatment options, response to treatment and outcomes.

The articles selected for this Psychiatric Times special report provide a sampling of some important and topical issues regarding the influence of various factors on cognition in individuals with neuropsychiatric conditions. These topics are particularly important for practicing clinicians and clinical researchers. They deal with common disease states and situations. Schizophrenia and the importance of age and treatment effects on cognition are discussed in articles by Steffen Moritz, Ph.D., and Dieter Naber, Ph.D., and by Philip D. Harvey, Ph.D., and Christopher R. Bowie, Ph.D. An article by Marnin J. Heisel, Ph.D., reports how suicidal thoughts and possibly suicide prevention in the elderly are influenced by the cognitive abilities of the individual. Data regarding the boundaries between dementia and depression and the need to assess cognitive status and treat mood symptoms are presented by Malaz Boustani, M.D., M.P.H., and Lea Watson, M.D., M.P.H. Improving our understanding of cognitive issues and their complex interactions will help us all with patient management issues.

It is the hope that the articles in this issue will help stimulate further interest and research in the area of cognitive issues in neuropsychiatric conditions. In general, we need to pay more attention and perform more research to assess what effect psychotropics have on cognition. We need to continue to look at novel ways to enhance cognition through medications, cognitive training, psychotherapy, improving mood and behaviors, environmental modification, and brain stimulating techniques. More research is needed in discovering the links between cognition, functioning and behaviors. Let's keep up the great progress we are making. Cognition is a terrible thing to waste.

Psychiatric Times extends a warm thank you to Dr. Scharre for his efforts in planning this special report. Dr. Scharre, a neurobehaviorist, is the medical director of the Memory Disorders Clinic at Ohio State University and conducts clinical research in dementia and cognitive issues.

References:

References

1.

Green RC, Cupples LA, Kurz A et al. (2003), Depression as a risk factor for Alzheimer disease: the MIRAGE Study. Arch Neurol 60(5):753-759.

2.

Green MF, Kern RS, Braff DL, Mintz J (2000), Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"? Schizophr Bull 26(1):119-136.

3.

Rund BR (1998), A review of longitudinal studies of cognitive functions in schizophrenia patients. Schizophr Bull 24(3):425-435.

4.

Scharre DW (2003), Dementia, Alzheimer's disease. In: The 5-Minute Neurology Consult, Lynn DJ, Newton HB, Rae-Grant AD, eds. Philadelphia: Lippincott Williams & Wilkins, pp152-153.