Associations between cognitive symptoms and poor clinical outcomes in schizophrenia: real-world evidence from an electronic health record study

Abstract: Background Cognitive dysfunction is a core feature of schizophrenia and is associated with worse long-term functioning. No therapies exist to improve cognitive function to a clinically meaningful degree. The current study analysed real-world data from electronic health records to characterise cognitive dysfunction in large and representative sample of patients with schizophrenia and its association with clinical outcomes. Methods De-identified data were extracted from electronic health records across 25 US mental healthcare providers. Adults with a diagnosis of schizophrenia were included in the study. Symptoms of cognitive dysfunction recorded within 14 days of the date of schizophrenia diagnosis were derived from free-text using natural language processing applications.4.5 Cox and generalised linear model regression analyses were performed to evaluate the association of cognitive symptoms with 1) time to psychiatric hospitalisation and 2) number of unique antipsychotic trials in the 12 months following diagnosis. Models were adjusted for age, gender, race, antipsychotic prescription, comorbid substance use disorder and illness severity. Results A total of 10,070 participants were included in the study. 2,834 (28.1%) had clinician-reported cognitive symptoms. Presence of cognitive symptoms was associated with increased risk of hospitalisation (HR=1.23, 95% CI=1.16, 1.31, p < 0.001) and a higher number of unique antipsychotic trials in the year following diagnosis (n =4,318, IRR=1.11, 95% CI=1.01, 1.21, p=0.02). Conclusions This finding adds further evidence that cognitive dysfunction may be a marker of a worse illness course in schizophrenia, and that development of novel treatments for this patient group should be a clinical priority.Short Description: We applied natural language processing to de-identified electronic health record data to identify cognitive symptoms that were documented during the mental state examination of patients with schizophrenia. Associations between cognitive symptoms and clinical outcomes were then investigated. Patients with schizophrenia with cognitive impairment were at higher risk of poor clinical outcomes compared to those without cognitive impairment. These included an increased risk of hospitalisation and higher number of unique antipsychotic prescriptions across the illness course.Name of Sponsoring Organization(s): N/A