Relationship between changes in metabolic syndrome constituent components over 12 months of treatment and cognitive performance in first-episode schizophrenia

  • H. K. LuckhoffEmail author
  • S. Kilian
  • M. R. Olivier
  • L. Phahladira
  • F. Scheffler
  • S. du Plessis
  • B. Chiliza
  • L. Asmal
  • R. Emsley
Original Article


Few studies have investigated the longitudinal effects of treatment-emergent metabolic syndrome changes on cognitive performance in first-episode psychosis. The aim of the present study was to determine the associations between changes in metabolic syndrome constituent component over 12 months of treatment and end-point cognitive performance in schizophrenia spectrum disorders. This single site-cohort study included 72 minimally treated or antipsychotic-naïve first-episode patients. Cognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB). Our primary objective of interest was the relationship between metabolic syndrome constituent component changes over 12 months of treatment and end-point cognitive performance. Secondary objectives included investigating whether this relationship was affected by age, sex, antipsychotic dose, treatment duration and substance use. Weight gain predicted better overall cognition (p = 0.02) at end-point, adjusting for age, sex, substance use, baseline cognitive score and BMI, modal antipsychotic dose and treatment duration. Weight loss (p = 0.04) and substance use (p = 0.01) were both associated with poorer working memory performance at end-point. Low baseline BMI showed differential effects on end-point working memory performance in substance users (unfavorable) compared to non-users (favorable) (p < 0.05). In conclusion, weight gain over the course of antipsychotic treatment is associated with better overall cognitive performance and the working memory domain in first-episode schizophrenia spectrum disorder patients. In contrast, low baseline BMI may represent an unfavorable marker in substance users, who demonstrated weight loss compared to non-users.


First-episode schizophrenia spectrum disorders Cognitive performance Working memory MCCB Weight gain 



This study was funded by New Partnership for Africa’s Development (NEPAD) grant, through the Department of Science and Technology of South Africa, the Medical Research Council of South Africa ‘SHARED ROOTS’ Flagship Project Grant no.MRC-RFA-IFSP-01-2013 (Grantholder S Seedat) and an unrestricted grant from Lundbeck International.

Compliance with ethical standards

Conflicts of interest

Bonginkosi Chiliza has received honoraria from Lundbeck, Mylan and Sandoz for speaking at educational meetings. Robin Emsley has participated in speakers/advisory boards and received honoraria from Janssen, Lundbeck, Servier and Otsuka. Hilmar Luckhoff, Lebogang Phahladira, Freda Scheffler, Stefan du Plessis, Laila Asmal, Riaan Oosthuizen, and Sanja Kilian declare that they have no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • H. K. Luckhoff
    • 1
    Email author
  • S. Kilian
    • 1
  • M. R. Olivier
    • 1
  • L. Phahladira
    • 1
  • F. Scheffler
    • 1
  • S. du Plessis
    • 1
  • B. Chiliza
    • 2
  • L. Asmal
    • 1
  • R. Emsley
    • 1
  1. 1.Department of Psychiatry, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
  2. 2.Department of Psychiatry, Nelson R Mandela School of MedicineUniversity of Kwazulu-NatalDurbanSouth Africa

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