Kathryn Lewandowski1,2, Dost Ongur1,2; 1McLean Hospital, 2Harvard Medical School
Cognitive dysfunction is a core symptom dimension in psychosis and associated with poor functioning even by the early phase of illness. However, considerable cognitive heterogeneity exists; some findings suggest cognitive stability after the first episode, and others show continued cognitive change. One possible explanation is that patients may follow heterogeneous cognitive trajectories. Cluster analysis has identified profiles of cognition in psychosis, which map to clinical, functional and neurobiological measures. How these clusters predict cognitive trajectories is unclear. Thus, we aimed to evaluate cognitive subtypes in FEP at baseline and over a one-year follow up. Patients within one year of an initial episode of psychosis (n=75) were assessed at baseline and at 1-year follow up (n=35) using the MATRICS battery, clinical and functional measures. Cluster analytic techniques were run on baseline cognitive data. Clusters were then compared on baseline and follow-up clinical and functional measures, and cognitive trajectory. A 3-cluster solution best fit the data, reflecting Intact (T=55), Moderately Impaired (T=39) and Significantly Impaired (T=28) groups. Groups differed in terms of clinical and functional measures at baseline; diagnoses were distributed across all three clusters. Clusters 1 and 3 showed relatively stable cognitive course (Intact and Significantly Impaired, respectively). Cluster 2 showed cognitive improvement from baseline to follow up. Cognitive trajectories were associated with functional outcomes. Cognitive heterogeneity is evident at the time of a first episode and associated with clinical and functional measures, and cognitive trajectories. Leveraging cognitive heterogeneity may inform individualized prediction and treatment implementation for patients with psychosis.
