Neurocognitive profiles in the prodrome to psychosis in NAPLS-1

SCHIZOPHRENIA RESEARCH

卷:204

Article

Velthorst, Eva^1,2  Meyer, Eric C.^3,4,5  Giuliano, Anthony J.⁶  Addington, Jean⁷  Cadenhead, Kristin S.⁸  Cannon, Tyrone D.^9,10  Cornblattj, Barbara A.¹¹  McGlashan, Thomas H.¹⁰  Perkins, Diana O.¹²  Tsuang, Ming T.⁸  Walker, Elaine F.^13,14  Woods, Scott W.¹⁰  Bearden, Carrie E.^15,16,17  Seidman, Larry J.^18,19 

[1] Icahn Sch Med Mt Sinai, Dept Psychiat, 1425 Madison Ave, New York, NY 10029 USA

[2] Icahn Sch Med Mt Sinai, Seaver Autism Ctr Treatment & Res, New York, NY 10029 USA

[3] Texas A&M Hlth Sci Ctr, Dept Psychiat & Behav Sci, Coll Med, College Stn, TX USA

[4] Cent Texas Vet Healthcare Syst, VA VISN Ctr Excellence Res Returning War Vet 17, Waco, TX USA

[5] Baylor Scott & White Hlth, Warriors Res Inst, Waco, TX USA

[6] Worcester Recovery Ctr & Hosp, Dept Psychol, Worcester, MA USA

[7] Univ Calgary, Dept Psychiat, Calgary, AB, Canada

[8] Univ Calif San Diego, Dept Psychiat, San Diego, CA 92103 USA

[9] Yale Univ, Dept Psychol, New Haven, CT USA

[10] Yale Univ, Dept Psychiat, New Haven, CT 06520 USA

[11] Zucker Hillside Hosp, Dept Psychiat, Long Isl City, NY USA

[12] Univ N Carolina, Dept Psychiat, Chapel Hill, NC 27515 USA

[13] Emory Univ, Dept Psychol, Atlanta, GA 30322 USA

[14] Emory Univ, Dept Psychiat, Atlanta, GA 30322 USA

[15] Univ Calif Los Angeles, Dept Psychiat, Los Angeles, CA USA

[16] Univ Calif Los Angeles, Dept Biobehav Sci, Los Angeles, CA USA

[17] Univ Calif Los Angeles, Dept Psychol, Los Angeles, CA USA

[18] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Psychiat, Boston, MA 02115 USA

[19] Harvard Med Sch, Dept Psychiat, Massachusetts Gen Hosp, Boston, MA 02115 USA

关键词: Heterogeneity;    Clinical High Risk;    Neuropsychology;    Functional outcome;    Cluster analysis;   

DOI  :  10.1016/j.schres.2018.07.038

来源: Elsevier

【 摘 要 】

Background: Most studies of neurocognitive functioning in Clinical High Risk (CHR) cohorts have examined group averages, likely concealing heterogeneous subgroups. We aimed to identify neurocognitive subgroups and to explore associated outcomes. Methods: Data were acquired from 324 participants (mean age 18.4) in the first phase of the North American Prodrome Longitudinal Study (NAPLS-1), a multi-site consortium following individuals for up to 2 1/2 years. We applied Ward's method for hierarchical clustering data to 8 baseline neurocognitive measures, in 166 CHR individuals, 49 non-CHR youth with a family history of psychosis, and 109 healthy controls. We tested whether cluster membership was associated with conversion to psychosis, social and role functioning, and follow-up diagnosis. Analyses were repeated after data were clustered based on independently developed clinical decision rules. Results: Four neurocognitive dusters were identified: Significantly Impaired (n = 33); Mildly Impaired (n = 82): Normal (n = 145) and High (n = 64). The Significantly Impaired subgroup demonstrated the largest deviations on processing speed and memory tasks and had a conversion rate of 58%, a 40% chance of developing a schizophrenia spectrum diagnosis (compared to 24.4% in the Mildly Impaired, and 10.3% in the other two groups combined), and significantly worse functioning at baseline and 12-months. Data clustered using clinical decision rules yielded similar results, pointing to high convergent validity. Conclusion: Neurocognitive profiles vary substantially in their severity and are associated with diagnostic and functional outcome, underscoring neurocognition as a predictor of illness outcomes. These findings, if replicated, are a first step toward personalized treatment for individuals at-risk for psychosis. (C) 2018 Elsevier B.V. All rights reserved.

【 授权许可】

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