Sæther Linn Sofie, Ueland Thor, Haatveit Beathe, Vaskinn Anja, Bärthel Flaaten Camilla, Mohn Christine, E G Ormerod Monica B, Aukrust Pål, Melle Ingrid, Steen Nils Eiel, Andreassen Ole A, Ueland Torill
Section for Clinical Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Department of Psychology, University of Oslo, Oslo, Norway.
Psychol Med. 2024 Oct 2;54(12):1-11. doi: 10.1017/S003329172400206X.
While inflammation is associated with cognitive impairment in severe mental illnesses (SMI), there is substantial heterogeneity and evidence of transdiagnostic subgroups across schizophrenia (SZ) and bipolar (BD) spectrum disorders. There is however, limited knowledge about the longitudinal course of this relationship.
Systemic inflammation (C-Reactive Protein, CRP) and cognition (nine cognitive domains) was measured from baseline to 1 year follow-up in first treatment SZ and BD ( = 221), and healthy controls (HC, = 220). Linear mixed models were used to evaluate longitudinal changes separately in CRP and cognitive domains specific to diagnostic status (SZ, BD, HC). Hierarchical clustering was applied on the entire sample to investigate the longitudinal course of transdiagnostic inflammatory-cognitive subgroups.
There were no case-control differences or change in CRP from baseline to follow-up. We confirm previous observations of case-control differences in cognition at both time-points and domain specific stability/improvement over time regardless of diagnostic status. We identified transdiagnostic inflammatory-cognitive subgroups at baseline with differing demographics and clinical severity. Despite improvement in cognition, symptoms and functioning, the higher inflammation - lower cognition subgroup (75% SZ; 48% BD; 38% HC) had sustained inflammation and lower cognition, more symptoms, and lower functioning (SMI only) at follow-up. This was in comparison to a lower inflammation - higher cognition subgroup (25% SZ, 52% BD, 62% HC), where SMI participants showed cognitive functioning at HC level with a positive clinical course.
Our findings support heterogenous and transdiagnostic inflammatory-cognitive subgroups that are stable over time, and may benefit from targeted interventions.
虽然炎症与严重精神疾病（SMI）中的认知障碍有关，但在精神分裂症（SZ）和双相情感障碍（BD）谱系障碍中存在显著的异质性和跨诊断亚组的证据。然而，关于这种关系的纵向病程的了解有限。
在首次治疗的SZ和BD患者（n = 221）以及健康对照（HC，n = 220）中，测量从基线到1年随访期间的全身炎症（C反应蛋白，CRP）和认知（九个认知领域）。使用线性混合模型分别评估CRP和特定诊断状态（SZ、BD、HC）的认知领域的纵向变化。对整个样本应用层次聚类来研究跨诊断炎症-认知亚组的纵向病程。
从基线到随访，病例对照之间在CRP上没有差异或变化。我们证实了之前观察到的在两个时间点病例对照在认知上的差异，以及无论诊断状态如何，各领域随时间的特定稳定性/改善情况。我们在基线时确定了具有不同人口统计学和临床严重程度的跨诊断炎症-认知亚组。尽管认知、症状和功能有所改善，但高炎症-低认知亚组（75%为SZ；48%为BD；38%为HC）在随访时仍有持续的炎症和较低的认知、更多症状以及较低的功能（仅针对SMI）。相比之下，低炎症-高认知亚组（25%为SZ，52%为BD，62%为HC）中，SMI参与者的认知功能达到HC水平且临床病程呈阳性。
我们的研究结果支持随时间稳定的异质性和跨诊断炎症-认知亚组，并且可能从针对性干预中受益。
