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Characterising Demographic, Clinical and Functional Features of Cognitive Subgroups in Schizophrenia Spectrum Disorders: A Systematic Review

Abstract

Considerable cognitive heterogeneity is present within the schizophrenia spectrum disorder (SSD) population. Several subgroups characterised by more homogenous cognitive profiles have been identified. It is not yet clear however, whether these subgroups represent different points along a continuum of cognitive symptom severity, or whether they reflect unique profiles of the disorder. One way to determine this is by comparing subgroups on their non-cognitive characteristics. The aim of the present review was to systematically summarise our current understanding of the non-cognitive features of the cognitive subgroups of schizophrenia spectrum disorder (SSD). Thirty-five relevant studies were identified from January 1980 to March 2020. Cognitive subgroups were consistently compared on age, sex, education, age of illness onset, illness duration, positive, negative and disorganised symptoms, depression and psychosocial functioning. It was revealed that subgroups were consistently distinguished by education, negative symptom severity and degree of functional impairment; with subgroups characterised by worse cognitive functioning performing/rated worse on these characteristics. The lack of consistent subgroup differences for the majority of the non-cognitive characteristics provides partial support for the notion that cognitive subgrouping in SSD is not simply reflecting a rehash of previously identified clinical subtypes. However, as subgroups were consistently distinguished by three characteristics known to be associated with cognition, our understanding of the extent to which the cognitive subgrouping approach is representing separate subtypes versus subdivisions along a continuum of symptom severity is still not definitive.

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Acknowledgements

This work was supported by the Australian National Health and Medical Research Council (NHMRC; Project grant to Rossell, S., [GNT1060664], Early Career Fellowships to Van Rheenen, T [GNT1088785]), and a Senior Research Fellowship to Rossell, S [GNT154651]).

Funding

This work was supported by the Australian National Health and Medical Research Council (NHMRC; Project grant to Rossell, S., [GNT1060664], Early Career Fellowships to Van Rheenen, T [GNT1088785]), and a Senior Research Fellowship to Rossell, S [GNT154651]).

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Scopus Search Syntax

(TITLE-ABS-KEY (schizo* OR psychosis) AND TITLE-ABS-KEY (cognit* AND cluster) OR TITLE-ABS-KEY (cognit* AND heterogeneity) OR TITLE-ABS-KEY (cognit* AND "neuropsychologically normal") OR TITLE-ABS-KEY (cognit* AND subgroup)) AND DOCTYPE (ar) AND PUBYEAR> 1979

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((schizophrenia spectrum and other psychotic disorders[MeSH Terms])) AND (cognition[Title/Abstract] OR cognitive[Title/Abstract] OR neuropsychology[Title/Abstract] OR neuropsychologically[Title/Abstract] OR intelligence[Title/Abstract] OR intellect[Title/Abstract] OR memory[Title/Abstract] OR learning[Title/Abstract] OR attention[Title/Abstract] OR vigilance[Title/Abstract] OR speed of processing[Title/Abstract] OR executive[Title/Abstract] OR flexibility[Title/Abstract] OR reasoning[Title/Abstract] OR problem solving[Title/Abstract]) AND (cluster[Title/Abstract] OR subgroup[Title/Abstract] OR subtyp[Title/Abstract] OR heterogeneity[Title/Abstract])) AND ("1980/01/01"[Date - Publication] : "3000"[Date - Publication]))

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((TS=(schizo* OR psychosis) AND (TS=(cognit* AND cluster) OR TS=(cognit* AND subgroup) OR TS=(cognit* AND subtype) OR TS=(cognit* AND heterogeneity) or TS=(cognit* AND "neuropsychologically normal"))) OR (TI=(schizo* OR psychosis) AND (TI=(cognit* AND cluster) OR TI=(cognit* AND subgroup) OR TI=(cognit* AND subtype) OR TI=(cognit* AND heterogeneity) or TI=(cognit* AND "neuropsychologically normal")))) AND LANGUAGE:(English) AND DOCUMENT TYPES: (Article)

Table 5 Summary of method reportedly used to age-adjust performance on subgrouping variables prior to subgrouping.
Table 6 Summary of method reportedly used to adjust for sex prior to subgrouping
Table 7 Summary of method reportedly used to adjust for education prior to subgrouping

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Carruthers, S.P., Van Rheenen, T.E., Karantonis, J.A. et al. Characterising Demographic, Clinical and Functional Features of Cognitive Subgroups in Schizophrenia Spectrum Disorders: A Systematic Review. Neuropsychol Rev (2021). https://doi.org/10.1007/s11065-021-09525-0

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Keywords

  • Psychosis
  • Schizoaffective disorder
  • Cognitive heterogeneity
  • Cluster analysis
  • Cognitive trajectory