Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: A cohort study
Publication Details
Crouse, J.,
Chitty, K.,
Iorfino, F.,
Carpenter, J.,
White, D.,
Nichles, A.,
Zmicerevska, N.,
Tickell, A.,
Lee, R.,
Naismith, S.,
Scott, E. M.,
Scott, J.,
Hermens, D.,
&
Hickie, I.
(2020).
Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: A cohort study.
BJPsych Open, 6 (2).
Abstract
Background: Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries.
Aims: To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course.
Method: Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder. Results Cluster analysis of neurocognitive test scores derived three subgroups described as ‘normal range’ (n = 243, 38.6%), ‘intermediate impairment’ (n = 252, 40.1%), and ‘global impairment’ (n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up; however, neither the global impairment (B = 0.26, 95% CI −0.67 to 1.20; P = 0.581) or intermediate impairment (B = 0.46, 95% CI −0.26 to 1.19; P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time.
Conclusions: Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with datadriven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with
Keywords
Social functioning; outcome studies; psychotic disorders; anxiety disorders; depressive disorders
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