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Reproducibility of Cognitive Profiles in Psychosis Using Cluster Analysis

Published online by Cambridge University Press:  18 October 2017

Kathryn E. Lewandowski ,
Justin T. Baker ,
Julie M. McCarthy ,
Lesley A. Norris  and
Dost Öngür
Kathryn E. Lewandowski*
Affiliation:
McLean Hospital, Schizophrenia and Bipolar Disorder Program, Belmont, Massachusetts Harvard Medical School, Department of Psychiatry, Boston, Massachusetts
Justin T. Baker
Affiliation:
McLean Hospital, Schizophrenia and Bipolar Disorder Program, Belmont, Massachusetts Harvard Medical School, Department of Psychiatry, Boston, Massachusetts
Julie M. McCarthy
Affiliation:
McLean Hospital, Schizophrenia and Bipolar Disorder Program, Belmont, Massachusetts Harvard Medical School, Department of Psychiatry, Boston, Massachusetts
Lesley A. Norris
Affiliation:
McLean Hospital, Schizophrenia and Bipolar Disorder Program, Belmont, Massachusetts
Dost Öngür
Affiliation:
McLean Hospital, Schizophrenia and Bipolar Disorder Program, Belmont, Massachusetts Harvard Medical School, Department of Psychiatry, Boston, Massachusetts
*
Correspondence and reprint requests to: Kathryn E. Lewandowski, McLean Hospital, 115 Mill Street, AB S349, Belmont, MA 02478. E-mail: klewandowski@mclean.harvard.edu
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Abstract

Objectives: Cognitive dysfunction is a core symptom dimension that cuts across the psychoses. Recent findings support classification of patients along the cognitive dimension using cluster analysis; however, data-derived groupings may be highly determined by sampling characteristics and the measures used to derive the clusters, and so their interpretability must be established. We examined cognitive clusters in a cross-diagnostic sample of patients with psychosis and associations with clinical and functional outcomes. We then compared our findings to a previous report of cognitive clusters in a separate sample using a different cognitive battery. Methods: Participants with affective or non-affective psychosis (n=120) and healthy controls (n=31) were administered the MATRICS Consensus Cognitive Battery, and clinical and community functioning assessments. Cluster analyses were performed on cognitive variables, and clusters were compared on demographic, cognitive, and clinical measures. Results were compared to findings from our previous report. Results: A four-cluster solution provided a good fit to the data; profiles included a neuropsychologically normal cluster, a globally impaired cluster, and two clusters of mixed profiles. Cognitive burden was associated with symptom severity and poorer community functioning. The patterns of cognitive performance by cluster were highly consistent with our previous findings. Conclusions: We found evidence of four cognitive subgroups of patients with psychosis, with cognitive profiles that map closely to those produced in our previous work. Clusters were associated with clinical and community variables and a measure of premorbid functioning, suggesting that they reflect meaningful groupings: replicable, and related to clinical presentation and functional outcomes. (JINS, 2018, 24, 382–390)

Keywords

CognitionClusterSchizophreniaBipolar disorderPsychosisReplication
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 24 , Issue 4 , April 2018 , pp. 382 - 390
Copyright
Copyright © The International Neuropsychological Society 2017 

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References

Allen, D.N., Goldstein, G., & Warnick, E. (2003). A consideration of neuropsychologically normal schizophrenia. Journal of the International Neuropsychological Society, 9(1), 56–63. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12570358 Google Scholar
Baldessarini, R.J. (2012). Chemotherapy in psychiatry. New York: Springer Verlag.Google Scholar
Barker, S., Barron, N., McFarland, B.H., Bigelow, D.A., & Carnahan, T. (1994). A community ability scale for chronically mentally ill consumers: Part II. Applications. Community Mental Health Journal, 30(5), 459–472. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7851100 Google Scholar
Bleuler, E. (1911). Dementia praecox or the group of schizophrenias. Oxford: International Universities Press.Google Scholar
Bonner-Jackson, A., Mahmoud, S., Miller, J., & Banks, S.J. (2015). Verbal and non-verbal memory and hippocampal volumes in a memory clinic population. Alzheimer’s Research and Therapy, 7, 61. doi:10.1186/s13195-015-0147-9 CrossRefGoogle Scholar
Burdick, K.E., Russo, M., Frangou, S., Mahon, K., Braga, R.J., Shanahan, M., & Malhotra, A.K. (2014). Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: Clinical implications. Psychological Medicine, 44(14), 3083–3096. doi:10.1017/S0033291714000439 CrossRefGoogle ScholarPubMed
Butler, P.D., Silverstein, S.M., & Dakin, S.C. (2008). Visual perception and its impairment in schizophrenia. Biological Psychiatry, 64(1), 40–47. doi:10.1016/j.biopsych.2008.03.023 CrossRefGoogle ScholarPubMed
Clementz, B.A., Sweeney, J.A., Hamm, J.P., Ivleva, E.I., Ethridge, L.E., Pearlson, G.D., & Tamminga, C.A. (2016). Identification of distinct psychosis biotypes using brain-based biomarkers. American Journal of Psychiatry, 173(4), 373–384. doi:10.1176/appi.ajp.2015.14091200 Google Scholar
Goldstein, G. (1990). Neuropsychological heterogeneity in schizophrenia: A consideration of abstraction and problem-solving abilities. Archives of Clinical Neuropsychology, 5(3), 251–264. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14589685 CrossRefGoogle ScholarPubMed
Goldstein, G., Allen, D.N., & Seaton, B.E. (1998). A comparison of clustering solutions for cognitive heterogeneity in schizophrenia. Journal of the International Neuropsychological Society, 4, 353–362. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9656609 Google Scholar
Goldstein, G., Beers, S.R., & Shemansky, W.J. (1996). Neuropsychological differences between schizophrenic patients with heterogeneous Wisconsin Card Sorting Test performance. Schizophrenia Research, 21(1), 13–18. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8998271 CrossRefGoogle ScholarPubMed
Goldstein, G., & Shemansky, W.J. (1995). Influences on cognitive heterogeneity in schizophrenia. Schizophrenia Research, 18(1), 59–69. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8929762 CrossRefGoogle ScholarPubMed
Goldstein, G., Shemansky, W.J., & Allen, D.N. (2005). Cognitive function in schizoaffective disorder and clinical subtypes of schizophrenia. Archives of Clinical Neuropsychology, 20(2), 153–159. doi:10.1016/j.acn.2004.03.008 Google Scholar
Heinrichs, R.W., & Awad, A.G. (1993). Neurocognitive subtypes of chronic schizophrenia. Schizophrenia Research, 9(1), 49–58. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8096391 Google Scholar
Heinrichs, R.W., Ruttan, L., Zakzanis, K.K., & Case, D. (1997). Parsing schizophrenia with neurocognitive tests: Evidence of stability and validity. Brain and Cognition, 35(2), 207–224. doi:10.1006/brcg.1997.0938 Google Scholar
Hill, S.K., Ragland, J.D., Gur, R.C., & Gur, R.E. (2002). Neuropsychological profiles delineate distinct profiles of schizophrenia, an interaction between memory and executive function, and uneven distribution of clinical subtypes. Journal of Clinical and Experimental Neuropsychology, 24(6), 765–780. doi:10.1076/jcen.24.6.765.8402 CrossRefGoogle ScholarPubMed
Hill, S.K., Reilly, J.L., Keefe, R.S., Gold, J.M., Bishop, J.R., Gershon, E.S., & Sweeney, J.A. (2013). Neuropsychological impairments in schizophrenia and psychotic bipolar disorder: Findings from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. American Journal of Psychiatry, 170(11), 1275–1284. doi:10.1176/appi.ajp.2013.12101298 Google Scholar
Kay, S.R., Fiszbein, A., & Opler, L.A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3616518 Google Scholar
Keefe, R.S., Mohs, R.C., Losonczy, M.F., Davidson, M., Silverman, J.M., Kendler, K.S., & Davis, K.L. (1987). Characteristics of very poor outcome schizophrenia. American Journal of Psychiatry, 144(7), 889–895.Google Scholar
Kochunov, P., Rowland, L.M., Fieremans, E., Veraart, J., Jahanshad, N., Eskandar, G., & Hong, L.E. (2016). Diffusion-weighted imaging uncovers likely sources of processing-speed deficits in schizophrenia. Proceedings of the National Academy of Sciences of the United States of America, 113(47), 13504–13509.CrossRefGoogle ScholarPubMed
Kraepelin, E. (1919). Dementia praecox and paraphrenia. Edinburgh: E & S Livingstone.Google Scholar
Lawrie, S.M., & Abukmeil, S.S. (1998). Brain abnormality in schizophrenia. A systematic and quantitative review of volumetric magnetic resonance imaging studies. British Journal of Psychiatry, 172, 110–120.Google Scholar
Lewandowski, K.E., Cohen, B.M., Keshavan, M.S., Sperry, S.H., & Ongür, D. (2013). Neuropsychological functioning predicts community outcomes in affective and non-affective psychoses: A 6-month follow-up. Schizophrenia Research, 148(1-3), 34–37. doi:10.1016/j.schres.2013.05.012 Google Scholar
Lewandowski, K.E., Sperry, S.H., Cohen, B.M., & Ongür, D. (2014). Cognitive variability in psychotic disorders: A cross-diagnostic cluster analysis. Psychological Medicine, 44(15), 3239–3248. doi:10.1017/S0033291714000774 Google Scholar
Maxwell, S.E., Lau, M.Y., & Howard, G.S. (2015). Is psychology suffering from a replication crisis? What does “failure to replicate” really mean. American Psychologist, 70(6), 487–498. doi:10.1037/a0039400 CrossRefGoogle ScholarPubMed
Montgomery, S.A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=444788 Google Scholar
Morales-Muñoz, I., Jurado-Barba, R., Fernández-Guinea, S., Álvarez-Alonso, M.J., Rodríguez-Jiménez, R., Jiménez-Arriero, M.A., & Rubio, G. (2017). Cognitive impairments in patients with first episode psychosis: The relationship between neurophysiological and neuropsychological assessments. Journal of Clinical Neuroscience, 36, 80–87. doi:10.1016/j.jocn.2016.10.023 Google Scholar
Nelson, M.D., Saykin, A.J., Flashman, L.A., & Riordan, H.J. (1998). Hippocampal volume reduction in schizophrenia as assessed by magnetic resonance imaging: A meta-analytic study. Archives of General Psychiatry, 55(5), 433–440.Google Scholar
Nuechterlein, K.H., Green, M.F., Kern, R.S., Baade, L.E., Barch, D.M., Cohen, J.D., & Marder, S.R. (2008). The MATRICS Consensus Cognitive Battery, part 1: Test selection, reliability, and validity. American Journal of Psychiatry, 165(2), 203–213. doi:10.1176/appi.ajp.2007.07010042 Google Scholar
Open Science Collaboration. (2015). PSYCHOLOGY. Estimating the reproducibility of psychological science. Science, 349(6251), aac4716. doi:10.1126/science.aac4716 Google Scholar
Palmer, B.W., Heaton, R.K., Paulsen, J.S., Kuck, J., Braff, D., Harris, M.J., & Jeste, D.V. (1997). Is it possible to be schizophrenic yet neuropsychologically normal. Neuropsychology, 11(3), 437–446. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9223148 Google Scholar
Pashler, H., & Harris, C.R. (2012). Is the replicability crisis overblown? Three arguments examined. Perspectives on Psychological Science, 7(6), 531–536. doi:10.1177/1745691612463401 Google Scholar
Reser, M.P., Allott, K.A., Killackey, E., Farhall, J., & Cotton, S.M. (2015). Exploring cognitive heterogeneity in first-episode psychosis: What cluster analysis can reveal. Psychiatry Research, 229(3), 819–827. doi:10.1016/j.psychres.2015.07.084 Google Scholar
Seaton, B.E., Allen, D.N., Goldstein, G., Kelley, M.E., & van Kammen, D.P. (1999). Relations between cognitive and symptom profile heterogeneity in schizophrenia. Journal of Nervous and Mental Disease, 187(7), 414–419. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10426461 Google Scholar
Seaton, B.E., Goldstein, G., & Allen, D.N. (2001). Sources of heterogeneity in schizophrenia: The role of neuropsychological functioning. Neuropsychology Review, 11(1), 45–67. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11392562 Google Scholar
Seitz, J., Zuo, J.X., Lyall, A.E., Makris, N., Kikinis, Z., Bouix, S., & Kubicki, M. (2016). Tractography analysis of 5 white matter bundles and their clinical and cognitive correlates in early-course schizophrenia. Schizophrenia Bulletin, 42(3), 762–771. doi:10.1093/schbul/sbv171 CrossRefGoogle ScholarPubMed
Simmons, J.P., Nelson, L.D., & Simonsohn, U. (2011). False-positive psychology: Undisclosed flexibility in data collection and analysis allows presenting anything as significant. Psychological Science, 22(11), 1359–1366. doi:10.1177/0956797611417632 Google Scholar
Sperry, S.H., O’Connor, L.K., Öngür, D., Cohen, B.M., Keshavan, M.S., & Lewandowski, K.E. (2015). Measuring cognition in bipolar disorder with psychosis using the MATRICS Consensus Cognitive Battery. Journal of the International Neuropsychological Society, 21(6), 468–472. doi:10.1017/S1355617715000442 Google Scholar
Stroebe, W., & Strack, F. (2014). The alleged crisis and the illusion of exact replication. Perspectives on Psychological Science, 9(1), 59–71. doi:10.1177/1745691613514450 Google Scholar
Uttl, B. (2002). North American Adult Reading Test: Age norms, reliability, and validity. Journal of Clinical and Experimental Neuropsychology, 24(8), 1123–1137. doi:10.1076/jcen.24.8.1123.8375 Google Scholar
Van Rheenen, T.E., Lewandowski, K.E., Tan, E.J., Ospina, L.H., Ongur, D., Neill, E., & Burdick, K.E. (2017). Characterizing cognitive heterogeneity on the schizophrenia-bipolar disorder spectrum. Psychological Medicine, 28, 1–17. doi:10.1017/S0033291717000307 Google Scholar
Woodward, N.D., & Heckers, S. (2015). Brain structure in neuropsychologically defined subgroups of schizophrenia and psychotic bipolar disorder. Schizophrenia Bulletin, 41(6), 1349–1359. doi:10.1093/schbul/sbv048 Google Scholar
Young, R.C., Biggs, J.T., Ziegler, V.E., & Meyer, D.A. (1978). A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429–435. Retrieved from https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=728692 Google Scholar