Romanowska Sylvia, Best Michael W, Bowie Christopher R, Depp Colin A, Patterson Thomas L, Penn David L, Pinkham Amy E, Harvey Philip D
Department of Psychological Science, University of Toronto Scarborough, Toronto, ON, Canada.
Department of Psychology, Queen's University, Kingston, ON, Canada.
Schizophr Res Cogn. 2022 Apr 26;29:100254. doi: 10.1016/j.scog.2022.100254. eCollection 2022 Sep.
There is considerable variability in neurocognitive functioning within schizophrenia-spectrum disorders, and neurocognitive performance ranges from severe global impairment to normative performance. Few investigations of neurocognitive clusters have considered the degree to which deterioration relative to premorbid neurocognitive abilities is related to key illness characteristics. Moreover, while neurocognition and community functioning are strongly related, understanding of the sources of variability in the association between these two domains is also limited; it is unknown what proportion of participants would over-perform or under-perform the level of functioning expected based on current neurocognitive performance vs. lifelong attainment. This study examined data from 954 outpatients with schizophrenia-spectrum disorders across three previous studies. Neurocognition, community functioning, and symptoms were assessed. Neurocognitive subgroups were created based on current neurocognition, estimated premorbid IQ, and degree of deterioration from premorbid using z-score cut-offs; functional subgroups were created with cluster analysis based on the Specific Level of Functioning Scale and current neurocognition. The sample was neurocognitively heterogeneous; 65% displayed current neurocognitive impairment and 84% experienced some level of deterioration. Thirty percent of our sample was relatively higher functioning despite significant neurocognitive impairment. Individuals with better community functioning, regardless of neurocognitive performance, had lower symptom severity compared to those with worse functioning. These results highlight the variability in neurocognition and its role in functioning. Understanding individual differences in neurocognitive and functional profiles and the interaction between prior and current cognitive functioning can guide individualized treatment and selection of participants for clinical treatment studies.
在精神分裂症谱系障碍中，神经认知功能存在相当大的变异性，神经认知表现范围从严重的整体损害到正常表现。很少有关于神经认知集群的研究考虑相对于病前神经认知能力的衰退程度与关键疾病特征之间的关系。此外，虽然神经认知与社区功能密切相关，但对这两个领域之间关联变异性来源的理解也很有限；目前尚不清楚基于当前神经认知表现与终身成就，有多大比例的参与者的功能水平会高于或低于预期。本研究检查了来自之前三项研究的954名精神分裂症谱系障碍门诊患者的数据。评估了神经认知、社区功能和症状。根据当前神经认知、估计的病前智商以及使用z分数临界值计算的病前衰退程度创建神经认知亚组；使用基于功能特定水平量表和当前神经认知的聚类分析创建功能亚组。该样本在神经认知方面具有异质性；65%的人目前存在神经认知损害，84%的人经历了一定程度的衰退。尽管存在明显的神经认知损害，但我们样本中有30%的人的功能相对较高。与功能较差的人相比，无论神经认知表现如何，社区功能较好的人的症状严重程度较低。这些结果突出了神经认知的变异性及其在功能中的作用。了解神经认知和功能概况的个体差异以及既往和当前认知功能之间的相互作用，可以指导个体化治疗以及为临床治疗研究选择参与者。
