Sex differences in the association of overweight with cognitive performance in individuals with first-episode psychosis

Abstract

Cognitive deficits and overweight are prominent challenges in the treatment of psychosis, which have a direct impact on patients' quality of life. We aim to determine whether there is an association of overweight with cognitive performance and whether there are sex differences in this association. We included 170 individuals with first-episode psychosis (FEP) (mean age 23.08 years, 32.9% females) attending an early intervention service who underwent clinical, biometric, and cognitive assessments by the MATRICS Consensus Cognitive Battery. A set of two-way analyses of covariance (ANCOVAs) were conducted for each cognitive test. Sex, overweight, and their interaction were included as factors. Nearly 34% of the participants were overweight without differences between males and females. The excess of weight did not exert any main effect on cognition; however, overweight females performed significantly worse than non-overweight females in processing speed, verbal learning and memory, reasoning and problem-solving, and global cognitive function, whereas in males, there were no differences. Our findings highlight that sex matters in the study of metabolic and cognitive factors in FEP to develop targeted interventions based on sex perspectives.

Fig. 1. Comparison of normalized cognitive tests z-scores according to overweight status.

TMT-A Trail-Making Test Part A, BACS-SC Brief Assessment of Cognition in Schizophrenia-Symbol Coding, HVLT-R Hopkins Verbal Learning Test-Revised, WMSIII-SS Weschler Memory Scale III-Spatial Span, LNS Letter-Number Sequencing, NAB-Mazes Neuropsychological Assessment Battery-Mazes, BVMT-R Brief Visual Memory Test-Revised, Fluency Verbal Fluency Test, MSCEIT-ME Mayer-Salovey-Caruso Emotional Intelligence Test-Managing Emotions, CPT-IP Continuous Performance Test-Identical Pairs.

Fig. 2. Comparison of normalized cognitive tests z-scores according to sex.

*p-value < 0.05, **p-value < 0.001. TMT-A Trail-Making Test Part A, BACS-SC Brief Assessment of Cognition in Schizophrenia-symbol Coding, HVLT-R Hopkins Verbal Learning Test-revised, WMSIII-SS Weschler Memory Scale III-Spatial Span, LNS Letter-number Sequencing, NAB-Mazes Neuropsychological Assessment Battery-mazes, BVMT-R Brief Visual Memory Test-revised, fluency Verbal Fluency Test, MSCEIT-ME Mayer-salovey-caruso Emotional Intelligence Test-managing Emotions, CPT-IP Continuous Performance Test-identical Pairs.

Fig. 3. Comparison of estimated marginal means from cognitive test z-scores by overweight status and sex, obtained by the individual ANCOVAs for each cognitive test.

*p-value < 0.05, **p-value < 0.001. BACS-SC Brief Assessment of Cognition in Schizophrenia-symbol Coding, HVLT-R Hopkins Verbal Learning Test-revised, NABMazes Neuropsychological Assessment Battery-Mazes.