TY - JOUR
T1 - A subtype of institutionalized patients with schizophrenia characterized by pronounced subcortical and cognitive deficits
AU - Zhao, Qiannan
AU - Cao, Hengyi
AU - Zhang, Wenjing
AU - Li, Siyi
AU - Xiao, Yuan
AU - Tamminga, Carol A.
AU - Keshavan, Matcheri S.
AU - Pearlson, Godfrey D.
AU - Clementz, Brett A.
AU - Gershon, Elliot S.
AU - Hill, Scot Kristian
AU - Keedy, Sarah K.
AU - Ivleva, Elena I.
AU - Lencer, Rebekka
AU - Sweeney, John A.
AU - Gong, Qiyong
AU - Lui, Su
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to American College of Neuropsychopharmacology.
PY - 2022/11
Y1 - 2022/11
N2 - Some patients with schizophrenia have severe cognitive impairment and functional deficits that require long-term institutional care. The patterns of brain-behavior alterations in these individuals, and their differences from patients living successfully in the community, remain poorly understood. Previous cognition-based studies for stratifying schizophrenia patients highlight the importance of subcortical structures in the context of illness heterogeneity. In the present study, subcortical volumes from 96 institutionalized patients with long-term schizophrenia were evaluated using cluster analysis to test for heterogeneity. These data were compared to those from two groups of community-dwelling individuals with schizophrenia for comparison purposes, including 68 long-term ill and 126 first-episode individuals. A total of 290 demographically matched healthy participants were included as normative references at a 1:1 ratio for each patient sample. A subtype of institutionalized patients was identified based on their pattern of subcortical alterations. Using a machine learning algorithm developed to discriminate the two groups of institutionalized patients, all three patient samples were found to have similar rates of patients assigned to the two subtypes (approximately 50% each). In institutionalized patients, only the subtype with the identified pattern of subcortical alterations had greater neocortical and cognitive abnormalities than those in the similarity classified community-dwelling patients with long-term illness. Thus, for the subtype of patients with a distinctive pattern of subcortical alterations, when the distinct pattern of subcortical alterations is present and particularly severe, it is associated with cognitive impairments that may contribute to persistent disability and institutionalization.
AB - Some patients with schizophrenia have severe cognitive impairment and functional deficits that require long-term institutional care. The patterns of brain-behavior alterations in these individuals, and their differences from patients living successfully in the community, remain poorly understood. Previous cognition-based studies for stratifying schizophrenia patients highlight the importance of subcortical structures in the context of illness heterogeneity. In the present study, subcortical volumes from 96 institutionalized patients with long-term schizophrenia were evaluated using cluster analysis to test for heterogeneity. These data were compared to those from two groups of community-dwelling individuals with schizophrenia for comparison purposes, including 68 long-term ill and 126 first-episode individuals. A total of 290 demographically matched healthy participants were included as normative references at a 1:1 ratio for each patient sample. A subtype of institutionalized patients was identified based on their pattern of subcortical alterations. Using a machine learning algorithm developed to discriminate the two groups of institutionalized patients, all three patient samples were found to have similar rates of patients assigned to the two subtypes (approximately 50% each). In institutionalized patients, only the subtype with the identified pattern of subcortical alterations had greater neocortical and cognitive abnormalities than those in the similarity classified community-dwelling patients with long-term illness. Thus, for the subtype of patients with a distinctive pattern of subcortical alterations, when the distinct pattern of subcortical alterations is present and particularly severe, it is associated with cognitive impairments that may contribute to persistent disability and institutionalization.
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U2 - 10.1038/s41386-022-01300-w
DO - 10.1038/s41386-022-01300-w
M3 - Article
C2 - 35260788
AN - SCOPUS:85127114745
SN - 0893-133X
VL - 47
SP - 2024
EP - 2032
JO - Neuropsychopharmacology
JF - Neuropsychopharmacology
IS - 12
ER -