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To lump or to split: cognitive impairment across mood and psychotic disorders

Neuropsychopharmacology volume 49, pages 493–494 (2024)Cite this article

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The study by Wenzel and the PRONIA Consortium [1] included in this issue identified cognitive subtypes in people with recent onset psychosis (ROP), recent onset depression (ROD), or at clinical high risk for psychosis (CHR), and examined the extent to which cognitive subtypes exist along a fully transdiagnostic continuum and are correlated with symptoms, functioning, and brain measures across and within diagnostic groups. Like reports in established schizophrenia spectrum disorders (SSD) and mood disorders (MD), they identified cognitively impaired and cognitively spared subgroups transdiagnostically (e.g. [2]). Also consistent with previous findings in established SSD and MD, diagnostic groups were distributed between the impaired and spared clusters, but not evenly, with a greater proportion of ROP participants classified in the impaired cluster and a greater proportion of ROD participants classified in the spared cluster. The impaired and spared subgroups with ROP performed worse than their respective subgroups with ROD. CHR participants were also more likely to be classified in the spared cluster.

In addition to diagnostic differences in proportion of cognitive subgroup membership, different patterns of association between cognition, functioning, and symptoms were identified by diagnosis. In the ROP group, impaired cluster membership was associated with worse functioning and negative symptom severity, whereas in the ROD group the association between functioning and cognitive cluster membership was weaker, and depression severity was actually higher in the spared cluster. In terms of neuroimaging outcomes, gray matter volume differentiated the spared group from healthy controls but could not differentiate the impaired group from either the spared or control groups, suggesting little association between cognition and gray matter volume. While resting state connectivity (rsFC) was able to differentiate patient groups from healthy controls, rsFC outcomes were unable to differentiate impaired and spared cognitive clusters transdiagnostically or within diagnostic subgroups. These findings suggest that the imaging outcomes measured here may be more reflective of patient status than cognition. This is consistent with previous findings of associations between rsFC and patient status (spared patients vs. healthy controls) and cognitive impairment (spared vs. impaired patients), suggesting that there may be separability between brain markers of cognitive impairment and those related to psychopathology more generally [3].

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References

  1. Wenzel J, Badde L, Haas SS, Bonivento C, Van Rheenen TE, Antonucci LA, et al. Transdiagnostic subgroups of cognitive impairment in early affective and psychotic illness. Neuropsychopharmacology. 2023. Online ahead of print.

  2. Van Rheenen TE, Lewandowski KE, Tan EJ, Ospina LH, Ongur D, Neill E, et al. Characterizing cognitive heterogeneity on the schizophrenia-bipolar disorder spectrum. Psychol Med. 2017;47:1848–64.

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Authors and Affiliations

  1. McLean Hospital Schizophrenia and Bipolar Disorder Program, Belmont, MA, USA

    Kathryn E. Lewandowski

  2. Harvard Medical School Department of Psychiatry, Boston, MA, USA

    Kathryn E. Lewandowski

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  1. Kathryn E. Lewandowski
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Correspondence to Kathryn E. Lewandowski.

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Lewandowski, K.E. To lump or to split: cognitive impairment across mood and psychotic disorders. Neuropsychopharmacol. 49, 493–494 (2024). https://doi.org/10.1038/s41386-023-01770-6

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  • DOI: https://doi.org/10.1038/s41386-023-01770-6

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