Cognitive deficits, clinical variables, and white matter microstructure in schizophrenia: a multisite harmonization study

Johanna Seitz-Holland, Joanne D. Wojcik, Suheyla Cetin-Karayumak, Amanda E. Lyall, Ofer Pasternak, Yogesh Rathi, Mark Vangel, Godfrey Pearlson, Carol Tamminga, John A. Sweeney, Brett A. Clementz, David A. Schretlen, Petra Verena Viher, Katharina Stegmayer, Sebastian Walther, Jungsun Lee, Tim Crow, Anthony James, Aristotle Voineskos, Robert W. BuchananPhilip R. Szeszko, Anil K. Malhotra, Sinead Kelly, Martha E. Shenton, Matcheri S. Keshavan, Raquelle I. Mesholam-Gately, Marek Kubicki

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Cognitive deficits are among the best predictors of real-world functioning in schizophrenia. However, our understanding of how cognitive deficits relate to neuropathology and clinical presentation over the disease lifespan is limited. Here, we combine multi-site, harmonized cognitive, imaging, demographic, and clinical data from over 900 individuals to characterize a) cognitive deficits across the schizophrenia lifespan and b) the association between cognitive deficits, clinical presentation, and white matter (WM) microstructure. Multimodal harmonization was accomplished using T-scores for cognitive data, previously reported standardization methods for demographic and clinical data, and an established harmonization method for imaging data. We applied t-tests and correlation analysis to describe cognitive deficits in individuals with schizophrenia. We then calculated whole-brain WM fractional anisotropy (FA) and utilized regression-mediation analyses to model the association between diagnosis, FA, and cognitive deficits. We observed pronounced cognitive deficits in individuals with schizophrenia (p < 0.006), associated with more positive symptoms and medication dosage. Regression-mediation analyses showed that WM microstructure mediated the association between schizophrenia and language/processing speed/working memory/non-verbal memory. In addition, processing speed mediated the influence of diagnosis and WM microstructure on the other cognitive domains. Our study highlights the critical role of cognitive deficits in schizophrenia. We further show that WM is crucial when trying to understand the role of cognitive deficits, given that it explains the association between schizophrenia and cognitive deficits (directly and via processing speed).

Original languageEnglish (US)
Pages (from-to)3719-3730
Number of pages12
JournalMolecular psychiatry
Issue number9
StatePublished - Sep 2022

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Molecular Biology


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