Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: a cohort study

Jacob J. Crouse, Kate M Chitty, Frank Iorfino, Joanne S. Carpenter, Django White, Alissa Nichles, Natalia Zmicerevska, Ashleigh M. Tickell, Rico S.C. Lee, Sharon Linda Naismith, Elizabeth M. Scott, Jan Scott, Daniel F. Hermens, Ian B. Hickie

Research output: Contribution to journalArticleResearchpeer-review

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 data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services.
Original languageEnglish
Article numbere31
Number of pages9
JournalBJPsych Open
Volume6
Issue number2
DOIs
Publication statusPublished - 2020

Keywords

  • social functioning
  • outcome studies
  • psychotic disorders
  • anxiety disorders
  • depressive disorders

Cite this

Crouse, J. J., Chitty, K. M., Iorfino, F., Carpenter, J. S., White, D., Nichles, A., Zmicerevska, N., Tickell, A. M., Lee, R. S. C., Naismith, S. L., Scott, E. M., Scott, J., Hermens, D. F., & Hickie, I. B. (2020). Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: a cohort study. BJPsych Open, 6(2), [e31]. https://doi.org/10.1192/bjo.2020.12