Identification of clinically meaningful relationships among cognition, functionality, and symptoms in subjects with schizophrenia or schizoaffective disorder

ArticleinSchizophrenia Research 143(2) · December 2012with4 Reads
DOI: 10.1016/j.schres.2012.11.031 · Source: PubMed
Introduction: Cognitive impairment in schizophrenia and schizoaffective disorder is a major determinant of disability. This study explored the relationships among cognitive functioning, clinical symptoms, overall functionality, and demographic characteristics. Methods: This was a post hoc analysis of a 52-week, prospective, randomized, double-blind study (N=323) comparing 2 doses of risperidone long-acting injectable (RLAI) in stable subjects with schizophrenia or schizoaffective disorder. Cognitive evaluations were performed and standardized using a healthy age- and sex-matched comparison group. Simple and multiple regression models were used to identify relationships among neurocognitive composite scores (NCS), clinical symptom end points (Positive and Negative Syndrome Scale [PANSS] total and factor scores), overall functionality (Personal and Social Performance [PSP] score), and demographics. Results: A simple regression model identified significant relationships between the NCS at end point and PANSS total score, PANSS disorganized thoughts factor score, functioning (PSP) and age. A 1-point decrease on PANSS total score and PANSS disorganized thoughts factor score corresponded to an increase in NCS of 0.126-point, and 0.81-point increases, respectively. A 1-point increase on the PSP corresponded to a 0.186-point increase in the NCS T-score. Among the demographic variables, only age correlated significantly with cognition (10-year increase in age corresponded to 1.1-point decrease in NCS T-score) in a multiple regression model. Conclusion: Improved cognition was associated with beneficial changes in functional status and clinical symptoms (particularly disorganization symptoms) in subjects with schizophrenia/schizoaffective disorder. Older subjects showed less overall cognitive improvement. Improved cognitive and functional outcome is correlated with symptom improvements in RLAI-treated patients with schizophrenia.
    • "However, its main limitation [14] is an undifferentiated assessment of psychopathological symptoms (total score), which does not reveal changes of certain PANSS items that obviously modify different stages of psychosis and in remission, often in parallel with changes in cognitive functioning. At the same time, in a recent study of Pandina et al. [80] , the authors underscored significant relationships not only between neurocognitive composite score and PANSS total score, but also with PANSS disorganized thoughts factor score: a 1-point decrease on PANSS total score and PANSS disorganized thoughts factor score corresponded to an increase in neurocognitive composite score of 0.126-point, and 0.81-point increases, respectively. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Cognitive disturbances are widely pronounced in schizophrenia and schizophrenia spectrum disorders. Whilst cognitive deficits are well established in the prodromal phase and are known to deteriorate at the onset of schizophrenia, there is a certain discrepancy of findings regarding the cognitive alterations over the course of the illness. Methods We bring together the results of the longitudinal studies identified through PubMed which have covered more than 3 years follow-up and to reflect on the potential factors, such as sample characteristics and stage of the illness which may contribute to the various trajectories of cognitive changes. Results A summary of recent findings comprising the changes of the cognitive functioning in schizophrenia patients along the longitudinal course of the illness is provided. The potential approaches for addressing cognition in the course of schizophrenia are discussed. Conclusions Given the existing controversies on the course of cognitive changes in schizophrenia, differentiated approaches specifically focusing on the peculiarities of the clinical features and changes in specific cognitive domains could shed light on the trajectories of cognitive deficits in schizophrenia and spectrum disorders.
    Full-text · Article · Nov 2015
    • "Theme identification seems to be important in social life because it represents the ability to extract crucial information from social situations . Considering that an impaired ability in theme identification is related to social anhedonia (Oh et al., 2014), which leads to social dysfunctions (Pandina et al., 2013), theme identification may be a useful tool for measuring the ability for abstract thinking during social situations. Therefore, our identification of the neural basis of abnormal abstract thinking is important because it could explain the impaired social behavior during real life situations in patients with schizophrenia. "
    [Show abstract] [Hide abstract] ABSTRACT: Abnormal abstract thinking is a major cause of social dysfunction in patients with schizophrenia, but little is known about its neural basis. In this study, we aimed to determine the characteristic abstract thinking-related brain responses in patients using a task reflecting social situations. We conducted functional magnetic resonance imaging while 16 patients with schizophrenia and 16 healthy controls performed a theme-identification task, in which various emotional pictures depicting social situations were presented. Compared with healthy controls, the patients showed significantly decreased activity in the left frontopolar and right orbitofrontal cortices during theme identification. Activity in these two regions correlated well in the controls, but not in patients. Instead, the patients exhibited a close correlation between activity in both sides of the frontopolar cortex, and a positive correlation between the right orbitofrontal cortex activity and degrees of theme identification. Reduced activity in the left frontopolar and right orbitofrontal cortices and the underlying aberrant connectivity may be implicated in the patients' deficits in abstract thinking. These newly identified features of the neural basis of abnormal abstract thinking are important as they have implications for the impaired social behavior of patients with schizophrenia during real-life situations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Aug 2015
    • "Subjects with schizophrenia and other psychotic disorders may suffer from negative, positive, affective and cognitive symptoms, which may coexist in a multidimensional syndrome (Van Os et al 2010). Of all the different symptom dimensions of psychosis, cognitive impairment plays a crucial role in the functional outcome of the illness (Pandina et al., 2013). Alterations in cognitive functioning appear before the onset of psychotic symptoms (Davidson et al., 1999; Reichenberg et al., 2005). "
    [Show abstract] [Hide abstract] ABSTRACT: Subjects with a psychotic disorder show mild to moderate cognitive impairment, which is an important determinant of functional outcome. The underlying biological process of cognitive impairment in psychosis is unclear. We aimed to explore whether hypothalamic-pituitary-thyroid axis hormones or thyroid autoimmunity modulate cognitive functioning in subjects with early psychosis. We studied 70 patients with a psychotic disorder (<3years of illness) and a control group of 37 healthy subjects (HS). Plasma levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and thyroid-peroxidase (TPO-Abs) and thyroglobulin antibodies (TG-Abs) were determined. Cognitive assessment was performed with the MATRICS Cognitive Consensus Cognitive Battery. We also explored the relationship between thyroid variables and cognition in three subgroups of psychotic patients: psychosis not otherwise specified, affective psychosis (bipolar disorder or schizoaffective disorder) and non-affective psychosis (schizophrenia or schizophreniphorm disorder). In patients with early psychosis, higher FT4 levels (but not TSH or thyroid antibodies) were associated with better cognitive performance in attention/vigilance and overall cognition. The relationship between FT4 levels and the attention/vigilance domain remained significant in a multivariate analysis after adjusting for education level, age, gender, substance use, and benzodiazepine and antipsychotic treatments. We did not find a significant association between FT4 and cognitive performance in HS. In the exploratory analysis by psychotic subtypes, subjects with affective psychosis had increased FT4 levels and better cognitive profile than those with non-affective psychosis. Our study suggests that FT4 levels are associated with cognitive abilities (attention/vigilance and overall cognition) in individuals with early psychosis. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · May 2015
Show more