The Role of Education in Executive Functions, Behavioral Problems and Functional Performance in People With Schizophrenia

Objective: This cross-sectional study examined the influence of education on executive functions, behavioral problems and functional performance in people with chronic schizophrenia. Method: Our sample was composed of 116 subjects with a schizophrenia diagnosis (evolution time = 17.5 ± 9.5 years) from consecutive referrals to the Rehabilitation Unit of Benito Menni Hospital (Valladolid, Spain). All participants completed an extensive standardized protocol including a neuropsychological testing of executive functions (processing speed, working memory, inhibition, interference control, mental flexibility), the assessment of behavioral symptoms, and functional performance. Hierarchical regression models (HRMs) were carried out to determine whether education (in years) relates to executive functions after controlling for the effect of demographics, IQ, and clinical factors. Results: Both IQ and years of education were associated with a later onset of the illness. Specifically, high education (in years) significantly correlated with fewer behavioral problems and better functional performance in daily life. Further, HRMs showed that education was associated with digit span and sematic verbal fluency tasks after controlling for the effect of age, sex, and IQ as covariates. Conclusions: Higher education may ameliorate executive deficits in patients with chronic schizophrenia and, in turn, diminish the behavioral and functional problems of the illness. Key Points Question: This research addresses the role of education, as cognitive reserve proxy, on cognitive, functional, and behavioral outcomes in people with chronic schizophrenia. Findings: Higher education is associated with less executive dysfunction, behavioral problems, and better daily life functioning in individuals with chronic schizophrenia. Importance: The engagement in cognitive stimulating activities may help people with chronic schizophrenia to cope better with manifestations of the illness. Next Steps: Longitudinal studies combining behavioral and neuroimaging data are required to determine specific weights of different cognitive reserve proxies on the clinical course of schizophrenia.