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. 2015 Dec;169(1-3):121-127.
doi: 10.1016/j.schres.2015.09.017. Epub 2015 Oct 1.

Improving the understanding of the link between cognition and functional capacity in schizophrenia and bipolar disorder

Raeanne C Moore  1 , Alexandrea L Harmell  2 , Philip D Harvey  3 , Christopher R Bowie  4 , Colin A Depp  5 , Ann E Pulver  6 , John A McGrath  7 , Thomas L Patterson  8 , Veronica Cardenas  9 , Paula Wolyniec  10 , Mary H Thornquist  11 , James R Luke  12 , Barton W Palmer  13 , Dilip V Jeste  14 , Brent T Mausbach  15
Affiliations

Improving the understanding of the link between cognition and functional capacity in schizophrenia and bipolar disorder

Raeanne C Moore et al. Schizophr Res. 2015 Dec.

Abstract

Objective: Deficits in cognitive functioning are related to functional disability in people with serious mental illness. Measures of functional capacity are commonly used as a proxy for functional disabilities for cognitive remediation programs, and robust linear relationships between functional capacity and cognitive deficits are frequently observed. This study aimed to determine whether a curvilinear relationship better approximates the association between cognitive functioning and functional capacity.

Method: Two independent samples were studied. Study 1: participants with schizophrenia (n=435) and bipolar disorder (n=390) aged 18-83 completed a neuropsychological battery and a performance-based measure of functional capacity. Study 2: 205 participants with schizophrenia (age range=39-72) completed a brief neuropsychological screening battery and a performance-based measure of functional capacity. For both studies, linear and quadratic curve estimations were conducted with cognitive performance predicting functional capacity scores.

Results: Significant linear and quadratic trends were observed for both studies. Study 1: in both the schizophrenia and bipolar participants, when cognitive composite z-scores were >0 (indicating normal to above normal performance), cognition was not related to functional capacity. Study 2: when neuropsychological screening battery z-scores were >-1 (indicating low average to average performance), cognition was not related to functional capacity.

Conclusions: These results illustrate that in cognitively normal adults with serious mental illness, the relationship between cognitive function and functional capacity is relatively weak. These findings may aid clinicians and researchers determine who may optimally benefit from cognitive remediation programs, with greater benefits possibly being achieved for individuals with cognitive deficits relative to individuals with normal cognition.

Keywords: Cognitive remediation; Disability; Functional capacity; Functioning; Neuropsychological assessment; Serious mental illness.

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Conflict of interest statement

Statement of Conflicts of Interest

Dr. Bowie has served on a scientific advisory board and as a consultant for Abbott Pharmaceuticals. Dr. Harvey has served as a consultant to Abbott, Dainippon Sumitomo Pharma America, Eli Lilly, Johnson & Johnson, Merck, Shire Pharma, and Solvay and has received grant support from AstraZeneca. All other authors report no financial relationships with commercial interests.

Figures

Figure 1
Figure 1
Linear and Quadratic Trend for Study 1, Schizophrenia Participants (N=435), Study 1, Bipolar Participants (N=390), and Schizophrenia Participants (N=205). Note. UPSA-B = UCSD Performance-Based Skills Assessment-Brief; For Study 1, Neurocognition is the Neurocognitive Composite Score, comprised of tests designed to measure executive functions, attention, verbal working memory, episodic learning, verbal fluency, and information processing speed. For Study 2, Neurocognition is Repeatable Battery of the Assessment of Neuropsychological Status Total Scores. Z-scores are reported for Neurocognition. Z-scores are only included up to the z-value representative of the study.
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