Antipsychotics and Cognition: Study Reveals Treatment Gaps and Need for Innovation

Antipsychotics and Cognition: Study Reveals Treatment Gaps and Need for Innovation

A recent systematic review and network meta-analysis explored the effects of antipsychotic drugs on cognitive function in patients with schizophrenia spectrum disorders (SSDs), analysing 68 clinical trials with a total of 9,525 participants. The findings revealed no clear evidence suggesting one antipsychotic is superior to others in improving cognitive performance. First-generation dopamine antagonists such as haloperidol and fluphenazine, as well as clozapine, which possesses anticholinergic properties, ranked poorly in cognitive outcomes. Additionally, no individual antipsychotic demonstrated a significant advantage over placebo, though antipsychotics as a group showed small effects. These effects are thought to stem from reduced disorganised thinking due to fewer positive symptoms, rather than direct enhancement of cognitive abilities. As noted in the study, “Antipsychotic drugs are not cognitive enhancers, but due to their different receptor-binding profiles, they could differ in their effects on cognition”. See more

The study identified a major challenge in the inconsistent ways cognitive performance is measured in clinical trials. This inconsistency makes it hard to draw clear and consistent conclusions, showing the urgent need for standardised ways to assess cognitive performance in research. The findings underscore that antipsychotics are not cognitive enhancers, pointing to the necessity of developing drugs with novel mechanisms of action to effectively address cognitive deficits, a key and burdensome feature of SSDs. The study suggests, “Although data are relatively sparse, those reviewed in this study suggest that first-generation dopamine antagonists and clozapine should be avoided when cognitive deficits are a concern”. See more

Researchers emphasise the critical importance of harmonising assessment methods in clinical studies to generate reliable data and inform better treatment strategies. The study’s conclusions reflect a call for innovation in therapeutic approaches, advocating for medications and targeted interventions that prioritise improving cognitive function for individuals with SSDs. This represents a significant step towards addressing an unmet need in the treatment of these complex disorders.

Source: Jama Network

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