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Neuropsychological Clustering Highlights Cognitive Differences In Young People Presenting With Depressive Symptoms

  • Daniel F. Hermens (a1), M. Antoinette Redoblado Hodge (a1), Sharon L. Naismith (a1), Manreena Kaur (a1), Elizabeth Scott (a1) and Ian B. Hickie (a1)...

Abstract

Early stages of affective or psychotic disorders may be accompanied by neuropsychological changes that help to predict risk of developing more severe disorders. A comprehensive set of neuropsychological measures was collected in 109 help-seeking young people (16 to 30 years; 54 females), recently diagnosed with an affective or psychotic disorder and presenting with current depression. Hierarchical cluster analysis determined three clusters: one deemed to have a “poor memory” profile (n = 40); another with a “poor mental flexibility” profile (n = 38) and a third with widespread difficulties plus “impaired attention and memory” (n = 31). In general, the three clusters were comparable in demographic, functional and clinical factors suggesting some unique role for neurocognitive impairments. A discriminant function analysis confirmed that the clusters were best characterized by performance in “attentional” versus “learning/memory” measures. Furthermore, profiles of independent neuropsychological variables validated the original solution for two of the clusters, distinguishing all cluster-groups on an attentional measure. The findings of this study suggest that despite presenting with very similar levels of current depressive symptomatology, young help-seeking individuals in the early stages of illness have underlying neuropsychological heterogeneity. Distinct neuropsychological profiling may help to predict later psychiatric outcomes and enhance individually-tailored early intervention strategies. (JINS, 2011, 17, 267–276)

Copyright

Corresponding author

Correspondence and reprint requests to: Daniel F. Hermens, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallet Street, Camperdown, NSW 2050, Australia. E-mail: daniel.hermens@sydney.edu.au

References

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American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed. text revision ed.). Washington DC: American Psychiatric Association Press.
American Psychiatric Association Task Force (2000). Handbook of psychiatric measures. Washington, DC: American Psychiatric Association Press.
Andrews, G., Goldberg, D.P., Krueger, R.F., Carpenter, W.T., Hyman, S.E., Sachdev, P., Pine, D.S. (2009). Exploring the feasibility of a meta-structure for DSM-V and ICD-11: Could it improve utility and validity? Psychological Medicine, 39, 19932000.
Andrews, G., Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian & New Zealand Journal of Public Health, 25, 494497.
Berrettini, W.H. (2000). Susceptibility loci for bipolar disorder: Overlap with inherited vulnerability to schizophrenia. Biological Psychiatry, 47, 245251.
Bilder, R.M., Wu, H., Bogerts, B., Ashtari, M., Robinson, D., Woerner, M., Degreef, G. (1999). Cerebral volume asymmetries in schizophrenia and mood disorders: A quantitative magnetic resonance imaging study. International Journal of Psychophysiology, 34, 197205.
Boks, M.P.M., Leask, S., Vermunt, J.K., Kahn, R.S. (2007). The structure of psychosis revisited: The role of mood symptoms. Schizophrenia Research, 93, 178185.
Borgen, F.H., Barnett, D.C. (1987). Applying cluster analysis in counseling psychology research. Journal of Counseling Psychology, 34, 456458.
Brewer, W.J., Francey, S.M., Wood, S.J., Jackson, H.J., Pantelis, C., Phillips, L.J., McGorry, P.D. (2005). Memory impairments identified in people at ultra-high risk for psychosis who later develop first-episode psychosis. American Journal of Psychiatry, 162, 7178.
Burmeister, M., McInnis, M.G., Zollner, S. (2008). Psychiatric genetics: Progress amid controversy. Nature Reviews Genetics, 9, 527540.
Burt, D.B., Zembar, M.J., Niederehe, G. (1995). Depression and memory impairment: A meta-analysis of the association, its pattern, and specificity. Psychological Bulletin, 117, 285305.
Castaneda, A.E., Tuulio-Henriksson, A., Marttunen, M., Suvisaari, J., Lonnqvist, J. (2008). A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults. Journal of Affective Disorders, 106, 127.
Danion, J., Huron, C., Vidailhet, P., Berna, F. (2007). Functional Mechanisms of Episodic Memory Impairment in Schizophrenia. Canadian Journal of Psychiatry, 52, 693.
Delano-Wood, L., Bondi, M.W., Sacco, J., Abeles, N., Jak, A.J., Libon, D.J., Bozoki, A. (2009). Heterogeneity in mild cognitive impairment: Differences in neuropsychological profile and associated white matter lesion pathology. Journal of the International Neuropsychological Society, 15, 906914.
Elvevag, B., Goldberg, T.E. (2000). Cognitive impairment in schizophrenia is the core of the disorder. Critical Reviews in Neurobiology, 14, 121.
Goldberg, D.P., Andrews, G., Hobbs, M.J. (2009). Where should bipolar disorder appear in the meta-structure? Psychological Medicine, 39, 20712081.
Goldman, H.H., Skodol, A.E., Lave, T.R. (1992). Revising axis V for DSM-IV: A review of measures of social functioning. American Journal of Psychiatry, 149, 11481156.
Goldstein, G. (1990). Neuropsychological heterogeneity in schizophrenia: A consideration of abstraction and problem-solving abilities. Archives of Clinical Neuropsychology, 5, 251264.
Hafner, H., an der Heiden, W., Maurer, K. (2008). Evidence for separate diseases? Stages of one disease or different combinations of symptom dimensions? European Archives of Psychiatry & Clinical Neuroscience, 258(Suppl 2), 8596.
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social & Clinical Psychology, 6, 278296.
Hasler, G., Drevets, W.C., Manji, H.K., Charney, D.S. (2004). Discovering endophenotypes for major depression. Neuropsychopharmacology, 29, 17651781.
Hermann, B., Seidenberg, M., Lee, E.-J., Chan, F., Rutecki, P. (2007). Cognitive phenotypes in temporal lobe epilepsy. Journal of the International Neuropsychological Society, 13, 1220.
Hermens, D.F., Naismith, S.L., Redoblado Hodge, M.A., Scott, E.M., Hickie, I.B. (2010). Impaired verbal memory in young adults with unipolar and bipolar depression. Early Intervention in Psychiatry, 4, 227233.
Hetrick, S.E., Parker, A.G., Hickie, I.B., Purcell, R., Yung, A.R., McGorry, P.D. (2008). Early identification and intervention in depressive disorders: Towards a clinical staging model. Psychotherapy & Psychosomatics, 77, 263270.
Hickie, I., Naismith, S., Ward, P.B., Turner, K., Scott, E., Mitchell, P., Parker, G. (2005). Reduced hippocampal volumes and memory loss in patients with early- and late-onset depression. British Journal of Psychiatry, 186, 197202.
Hickie, I., Scott, E., Naismith, S., Ward, P.B., Turner, K., Parker, G., Wilhelm, K. (2001). Late-onset depression: Genetic, vascular and clinical contributions. Psychological Medicine, 31, 14031412.
Hickie, I., Ward, P., Scott, E., Haindl, W., Walker, B., Dixon, J., Turner, K. (1999). Neo-striatal rCBF correlates of psychomotor slowing in patients with major depression. Psychiatry Research, 92, 7581.
Hickie, I.B., Naismith, S.L., Ward, P.B., Little, C.L., Pearson, M., Scott, E.M., Parker, G. (2007). Psychomotor slowing in older patients with major depression: Relationships with blood flow in the caudate nucleus and white matter lesions. Psychiatry Research, 155, 211220.
Hill, S.K., Harris, M.S.H., Herbener, E.S., Pavuluri, M., Sweeney, J.A. (2008). Neurocognitive Allied Phenotypes for Schizophrenia and Bipolar Disorder. Schizophrenia Bulletin, 34, 743759.
Hoff, A.L., Sakuma, M., Wieneke, M., Horon, R., Kushner, M., DeLisi, L.E. (1999). Longitudinal neuropsychological follow-up study of patients with first-episode schizophrenia. American Journal of Psychiatry, 156, 13361341.
Jablensky, A. (2009). A meta-commentary on the proposal for a meta-structure for DSM-V and ICD-11. Psychological Medicine, 39, 20992103.
Keller, M.B. (2003). Past, present, and future directions for defining optimal treatment outcome in depression: Remission and beyond. JAMA, 289, 31523160.
Kessler, R.C., Andrews, G., Colpe, L.J., Hiripi, E., Mroczek, D.K., Normand, S.L., Zaslavsky, A.M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959976.
Landro, N.I., Stiles, T.C., Sletvold, H. (2001). Neuropsychological function in nonpsychotic unipolar major depression. Neuropsychiatry, Neuropsychology, & Behavioral Neurology, 14, 233240.
Leucht, S., Kane, J.M., Kissling, W., Hamann, J., Etschel, E., Engel, R. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry, 187, 366371.
Lewinsohn, P.M., Solomon, A., Seeley, J.R., Zeiss, A. (2000). Clinical implications of “subthreshold” depressive symptoms. Journal of Abnormal Psychology, 109, 345351.
Lewis, C.M., Levinson, D.F., Wise, L.H., DeLisi, L.E., Straub, R.E., Hovatta, I., Helgason, T. (2003). Genome Scan Meta-Analysis of Schizophrenia and Bipolar Disorder, Part II: Schizophrenia. The American Journal of Human Genetics, 73, 3448.
Lovibond, P.F., Lovibond, S.H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research & Therapy, 33, 335343.
Maier, W., Lichtermann, D., Minges, J., Hallmayer, J., Heun, R., Benkert, O., Douglas, F.L. (1993). Continuity and Discontinuity of Affective Disorders and Schizophrenia: Results of a Controlled Family Study. Archives of General Psychiatry, 50, 871883.
McDermott, L.M., Ebmeier, K.P. (2009). A meta-analysis of depression severity and cognitive function. Journal of Affective Disorders, 119, 18.
McGorry, P.D., Hickie, I.B., Yung, A.R., Pantelis, C., Jackson, H.J. (2006). Clinical staging of psychiatric disorders: A heuristic framework for choosing earlier, safer and more effective interventions. Australian & New Zealand Journal of Psychiatry, 40, 616622.
Meyers, J., Meyers, K. (1995). Rey Complex Figure Test and Recognition Trial: Professional Manual. Odessa: Psychological Association Resources, Inc.
Mohamed, S., Paulsen, J.S., O'Leary, D., Arndt, S., Andreasen, N. (1999). Generalized cognitive deficits in schizophrenia: A study of first-episode patients. Archives of General Psychiatry, 56, 749754.
Naismith, S., Hickie, I., Ward, P.B., Turner, K., Scott, E., Little, C., Parker, G. (2002). Caudate nucleus volumes and genetic determinants of homocysteine metabolism in the prediction of psychomotor speed in older persons with depression. American Journal of Psychiatry, 159, 20962098.
Naismith, S.L., Hickie, I.B., Turner, K., Little, C.L., Winter, V., Ward, P.B., Parker, G. (2003). Neuropsychological performance in patients with depression is associated with clinical, etiological and genetic risk factors. Journal of Clinical & Experimental Neuropsychology, 25, 866877.
Naismith, S.L., Hickie, I.B., Ward, P.B., Scott, E., Little, C. (2006). Impaired implicit sequence learning in depression: A probe for frontostriatal dysfunction? Psychological Medicine, 36, 313323.
Naismith, S.L., Lagopoulos, J., Ward, P.B., Davey, C.G., Little, C., Hickie, I.B. (2010). Fronto-striatal correlates of impaired implicit sequence learning in major depression: An fMRI study. Journal of Affective Disorders, 125, 256261.
Naismith, S.L., Longley, W.A., Scott, E.M., Hickie, I.B. (2007). Disability in major depression related to self-rated and objectively-measured cognitive deficits: A preliminary study. BMC Psychiatry, 7, doi:10.1186/1471-244X-7-32.
Naismith, S.L., Redoblado-Hodge, M.A., Lewis, S.J.G., Scott, E.M., Hickie, I.B. (2010). Cognitive training in affective disorders improves memory: A preliminary study using the NEAR approach. Journal of Affective Disorders, 121, 258262.
Norusis, M.J. (2010). PASW Statistics 18 Guide to Data Analysis. New Jersey: Prentice Hall.
Ottowitz, W.E., Dougherty, D.D., Savage, C.R. (2002). The neural network basis for abnormalities of attention and executive function in major depressive disorder: Implications for application of the medical disease model to psychiatric disorders. Harvard Review of Psychiatry, 10, 8699.
Overall, J.E., Gorham, D.R. (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799812.
Paelecke-Habermann, Y., Pohl, J., Leplow, B. (2005). Attention and executive functions in remitted major depression patients. Journal of Affective Disorders, 89, 125135.
Quraishi, S., Frangou, S. (2002). Neuropsychology of bipolar disorder: A review. Journal of Affective Disorders, 72, 209226.
Redoblado Hodge, M.A., Siciliano, D., Withey, P., Moss, B., Moore, G., Judd, G., Harris, A. (2010). A Randomized Controlled Trial of Cognitive Remediation in Schizophrenia. Schizophrenia Bulletin, 36, 419427.
Rickert, P., Senior, G. (1998, October). WMS-III list learning test and the Rey auditory verbal learning test: Comparisons and Australian normative data. 4th Annual Conference of the College of Clinical Neuropsychologists Loren, Victoria, Australia.
Sahakian, B.J., Owen, A.M. (1992). Computerized assessment in neuropsychiatry using CANTAB: Discussion paper. Journal of the Royal Society of Medicine, 85, 399402.
Scott, E., Naismith, S.L., Whitwell, B.G., Hamilton, B., Chudleigh, C., Hickie, I.B. (2009). Delivering youth-specific mental health services: The advantages of a collaborative, multi-disciplinary system. Australasian Psychiatry, 17, 189194.
Sheline, Y.I., Sanghavi, M., Mintun, M.A., Gado, M.H. (1999). Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression. Journal of Neuroscience, 19, 50345043.
Shenal, B.V., Harrison, D.W., Demaree, H.A. (2003). The neuropsychology of depression: A literature review and preliminary model. Neuropsychology Review, 13, 3342.
Simon, A.E., Cattapan-Ludewig, K., Zmilacher, S., Arbach, D., Gruber, K., Dvorsky, D.N., Umbricht, D. (2007). Cognitive functioning in the schizophrenia prodrome. Schizophrenia Bulletin, 33, 761771.
Sobin, C., Sackeim, H.A. (1997). Psychomotor symptoms of depression. American Journal of Psychiatry, 154, 417.
Strauss, E., Sherman, E.M.S., Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (3rd ed.). New York: Oxford University Press.
Taylor Tavares, J.V., Drevets, W.C., Sahakian, B.J. (2003). Cognition in mania and depression. Psychological Medicine, 33, 959967.
Tombaugh, T.N., Kozak, J., Rees, L. (1998). Normative data for the controlled oral word association test (1996). In E. Strauss & O. Spreen (Eds.), A compendium of neuropsychological tests. New York: Oxford University Press.
Tsourtos, G., Thompson, J.C., Stough, C. (2002). Evidence of an early information processing speed deficit in unipolar major depression. Psychological Medicine, 32, 259265.
Wechsler, D. (1997). Manual for the Wechsler Adult Intelligence Scale (3rd ed.). San Antonio, TX: Psychological Corporation.
Wechsler, D. (2002). Wechsler Test of Adult Reading. San Antonio, TX: Psychological Corporation.

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