Intra-Individual Neuropsychological Test Variability : A Comparison of Patients with Schizophrenia, Their Siblings, and Healthy Controls

Hyeji Oh; Kounseok Lee; Seunghyong Ryu; Jihae Noh; Juhyun Park; Hong Choi; Ji-Hae Kim; Kyung Sue Hong

doi:10.4306/jknpa.2014.53.6.379

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Oh, Lee, Ryu, Noh, Park, Choi, Kim, and Hong: Intra-Individual Neuropsychological Test Variability : A Comparison of Patients with Schizophrenia, Their Siblings, and Healthy Controls

Original Article

Journal of Korean Neuropsychiatric Association 2014; 53(6): 379-385.

Published online: 30 November 2014

DOI: https://doi.org/10.4306/jknpa.2014.53.6.379

Intra-Individual Neuropsychological Test Variability : A Comparison of Patients with Schizophrenia, Their Siblings, and Healthy Controls

Hyeji Oh, MA¹, Kounseok Lee, MD², Seunghyong Ryu, MD², Jihae Noh, MA¹, Juhyun Park, MA¹, Hong Choi, MD, PhD², Ji-Hae Kim, PhD², Kyung Sue Hong, MD, PhD^1,²

¹Samsung Biomedical Research Institute, Seoul, Korea.

²Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.

Address for correspondence: Kyung Sue Hong, MD, PhD. Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel +82-2-3410-3584, Fax +82-2-3410-0050, hongks@skku.edu

Received 2 August 2014 Revised 19 August 2014 Accepted 30 September 2014

Abstract

Objectives

Intra-individual variability of cognitive performance across different tests or domains has been reported as an important index of cognitive function. The aim of the current study is to examine the intra-individual variability across different cognitive domains and tests in patients with schizophrenia, their unaffected siblings, and normal controls. We also compared the variability among three patient sub-groups divided according to the duration of illness.

Methods

Comprehensive neurocognitive tests were administered in order to stabilize patients with schizophrenia (n=129), healthy siblings (n=38) of the patients, and normal controls (n=110). Intra-individual variability was computed from the variance of the scores of six cognitive domains of the Measurement and Treatment Research to Improve Cognition in Schizophrenia consensus battery. We examined intra-individual variability across six factor-based cognitive scores and individual test scores of each cognitive domain.

Results

Compared to the normal control and sibling groups, patients showed significantly increased intra-individual variability across six cognitive domains and individual cognitive tests of each domain. Compared to the normal control, siblings showed significantly increased intra-individual variability only across individual tests of the processing of speed domain. Among patient sub-groups, those with the longest duration of illness (≥11 years) showed significantly higher intra- individual variability across six cognitive domains and across individual tests of the processing of speed domain compared to the other two groups.

Conclusion

This study identified cognitive dissonances across six cognitive domain schizophrenia patients. These cognitive characteristics were not observed in the sibling groups and seemed to progress during the course of illness.

Keywords: Schizophrenia, Intra-individual variability, Neuropsychological tests

Figures and Tables

Table 1

Cognitive domains and tests used

^*: The Korean version of the Wechsler Adult Intelligence Scale (K-WAIS),34) ^†: The Trail Making Test materials and guidelines used in this study art parts of Korean version of the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological assessment battery,35) ^‡: The Korean version of Controlled Oral Word Association Test including the categories of "animal" and "supermarket list" and the letters of three Korean consonant alphabets,36) ^§: Working Memory Task V1.06, ^∥: Korean version of the Rey-Auditory Verbal Learning Test,37) ^¶: Korean version of the Rey Complex Figure Test,37) ^**: Degraded Stimulus-Continuous Performance Test (DS-CPT; UCLA CPT version 8.12),38) ^††: Span of apprehension39)

Table 2

Demographic and clinical characteristic of the participants

Patients were assigned into three duration of illness-derived groups, A : ≤5 years, B : ≥6 years and ≤10 years, C : ≥11 years. Comparison of sex, age, and education years : among patients total, siblings, and controls. Comparison of age of onset, number of hospitalization, and CGI score : among patients sub-groups (A : B : C). ^*: Chi-square test, ^†: Kruskal-Wallis test, ^‡: Post-hoc test : patients>siblings, healthy controls, ^§: Post-hoc test : patients<siblings<healthy controls, ^∥: Post-hoc test : A, B<C. CGI : Clinical Global Impression

Table 3

Comparison of neuropsychological tests scores and intra-individual variability among patient, sibling, and control groups

1=patients, 2=siblings, 3=controls. Analysis of covariance was done using age and education as covariates. ^*: p<0.05

Table 4

Comparison of neuropsychological tests scores and intra-individual variability among three patients groups divided according to the duration of illness

Patients were assigned into three duration of illness-derived groups, A : ≤5 years, B : ≥6 years and ≤10 years, C : ≥11 years. ^*: p<0.05

Notes

The authors have no financial conflicts of interest.

References

1. Heaton RK, Gladsjo JA, Palmer BW, Kuck J, Marcotte TD, Jeste DV. Stability and course of neuropsychological deficits in schizophrenia. Arch Gen Psychiatry. 2001; 58:24–32.

2. Nam HJ, Kim N, Park T, Oh S, Jeon HO, Yoon SC, et al. Cognitive profiles of healthy siblings of schizophrenia patients: application of the cognitive domains of the MATRICS consensus battery. World J Biol Psychiatry. 2009; 10(4 Pt 2):452–460.

3. Dollfus S, Lombardo C, Bénali K, Halbecq I, Abadie P, Marié RM, et al. Executive/attentional cognitive functions in schizophrenic patients and their parents: a preliminary study. Schizophr Res. 2002; 53:93–99.

4. Saoud M, d'Amato T, Gutknecht C, Triboulet P, Bertaud JP, Marie-Cardine M, et al. Neuropsychological deficit in siblings discordant for schizophrenia. Schizophr Bull. 2000; 26:893–902.

5. Hill SK, Ragland JD, Gur RC, Gur RE. Neuropsychological profiles delineate distinct profiles of schizophrenia, an interaction between memory and executive function, and uneven distribution of clinical subtypes. J Clin Exp Neuropsychol. 2002; 24:765–780.

6. Snitz BE, Macdonald AW 3rd, Carter CS. Cognitive deficits in unaffected first-degree relatives of schizophrenia patients: a meta-analytic review of putative endophenotypes. Schizophr Bull. 2006; 32:179–194.

7. Cole VT, Weinberger DR, Dickinson D. Intra-individual variability across neuropsychological tasks in schizophrenia: a comparison of patients, their siblings, and healthy controls. Schizophr Res. 2011; 129:91–93.

8. Rentrop M, Rodewald K, Roth A, Simon J, Walther S, Fiedler P, et al. Intra-individual variability in high-functioning patients with schizophrenia. Psychiatry Res. 2010; 178:27–32.

9. Roalf DR, Gur RC, Almasy L, Richard J, Gallagher RS, Prasad K, et al. Neurocognitive performance stability in a multiplex multigenerational study of schizophrenia. Schizophr Bull. 2013; 39:1008–1017.

10. MacDonald SW, Nyberg L, Bäckman L. Intra-individual variability in behavior: links to brain structure, neurotransmission and neuronal activity. Trends Neurosci. 2006; 29:474–480.

11. Hultsch DF, MacDonald SW, Dixon RA. Variability in reaction time performance of younger and older adults. J Gerontol B Psychol Sci Soc Sci. 2002; 57:P101–P115.

12. Olch DR. Psychometric pattern of schizophrenics on the Wechsler-Bellevue intelligence test. J Consult Psychol. 1948; 12:127–136.

13. Trehub A, Scherer IW. Wechsler-Bellevue scatter as an index of schizophrenia. J Consult Psychol. 1958; 22:147–149.

14. Erlenmeyer-Kimling L. Neurobehavioral deficits in offspring of schizophrenic parents: liability indicators and predictors of illness. Am J Med Genet. 2000; 97:65–71.

15. Ott SL, Spinelli S, Rock D, Roberts S, Amminger GP, Erlenmeyer-Kimling L. The New York High-Risk Project: social and general intelligence in children at risk for schizophrenia. Schizophr Res. 1998; 31:1–11.

16. Bilder RM, Lipschutz-Broch L, Reiter G, Geisler SH, Mayerhoff DI, Lieberman JA. Intellectual deficits in first-episode schizophrenia: evidence for progressive deterioration. Schizophr Bull. 1992; 18:437–448.

17. Weinberger DR. Implications of normal brain development for the pathogenesis of schizophrenia. Arch Gen Psychiatry. 1987; 44:660–669.

18. Rund BR. A review of longitudinal studies of cognitive functions in schizophrenia patients. Schizophr Bull. 1998; 24:425–435.

19. Guy W. ECDEU assessment manual for psychopharmacology. Rockville: National Institute of Mental Health (US) Psychopharmacology Research Branch;1976.

20. Noh J, Kim JH, Hong KS, Kim N, Nam HJ, Lee D, et al. Factor structure of the neurocognitive tests: an application of the confirmative factor analysis in stabilized schizophrenia patients. J Korean Med Sci. 2010; 25:276–282.

21. Holtzer R, Verghese J, Wang C, Hall CB, Lipton RB. Within-person across-neuropsychological test variability and incident dementia. JAMA. 2008; 300:823–830.

22. Shin YS, Kim SN, Shin NY, Jung WH, Hur JW, Byun MS, et al. Increased intra-individual variability of cognitive processing in subjects at risk mental state and schizophrenia patients. PLoS One. 2013; 8:e78354.

23. Hultsch DF, MacDonald SW, Hunter MA, Levy-Bencheton J, Strauss E. Intraindividual variability in cognitive performance in older adults: comparison of adults with mild dementia, adults with arthritis, and healthy adults. Neuropsychology. 2000; 14:588–598.

24. Murtha S, Cismaru R, Waechter R, Chertkow H. Increased variability accompanies frontal lobe damage in dementia. J Int Neuropsychol Soc. 2002; 8:360–372.

25. Vaurio RG, Simmonds DJ, Mostofsky SH. Increased intra-individual reaction time variability in attention-deficit/hyperactivity disorder across response inhibition tasks with different cognitive demands. Neuropsychologia. 2009; 47:2389–2396.

26. Castellanos FX, Sonuga-Barke EJ, Scheres A, Di Martino A, Hyde C, Walters JR. Varieties of attention-deficit/hyperactivity disorder-related intra-individual variability. Biol Psychiatry. 2005; 57:1416–1423.

27. Hughes C, Kumari V, Das M, Zachariah E, Ettinger U, Sumich A, et al. Cognitive functioning in siblings discordant for schizophrenia. Acta Psychiatr Scand. 2005; 111:185–192.

28. Chen YL, Chen YH, Lieh-Mak F. Semantic verbal fluency deficit as a familial trait marker in schizophrenia. Psychiatry Res. 2000; 95:133–148.

29. Cannon TD, Zorrilla LE, Shtasel D, Gur RE, Gur RC, Marco EJ, et al. Neuropsychological functioning in siblings discordant for schizophrenia and healthy volunteers. Arch Gen Psychiatry. 1994; 51:651–661.

30. Bonner-Jackson A, Grossman LS, Harrow M, Rosen C. Neurocognition in schizophrenia: a 20-year multi-follow-up of the course of processing speed and stored knowledge. Compr Psychiatry. 2010; 51:471–479.

31. Kliegel M, Sliwinski M. MMSE cross-domain variability predicts cognitive decline in centenarians. Gerontology. 2004; 50:39–43.

32. Dickinson D, Ragland JD, Gold JM, Gur RC. General and specific cognitive deficits in schizophrenia: Goliath defeats David? Biol Psychiatry. 2008; 64:823–827.

33. Gold S, Arndt S, Nopoulos P, O'Leary DS, Andreasen NC. Longitudinal study of cognitive function in first-episode and recent-onset schizophrenia. Am J Psychiatry. 1999; 156:1342–1348.

34. Yeom T, Park Y, Oh K, Kim J, Lee Y. K-Wechsler Adult Intelligence Scale. Seoul: Korea Guidance;1992.

35. Lee JH, Lee KU, Lee DY, Kim KW, Jhoo JH, Kim JH, et al. Development of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K): clinical and neuropsychological assessment batteries. J Gerontol B Psychol Sci Soc Sci. 2002; 57:P47–P53.

36. Kang Y, Chin J, Na D, Lee J, Park J. Brief Report: a normative study of the Korean version of Controlled Oral Word Association Test (COWAT) in the elderly. Korean J Clin Psychol. 2005; 19:385–392.

37. Kim H. Assessment of memory disorders. Daegu: Neuropsy;2001.

38. Nuechterlein KH, Asarnow RF. Degraded Stimulus Continuous Performance Test (DS-CPT): Program for IBM-Compatible Micro-Computers, Version 8.12 [Computer software]. Los Angeles, CA: Authors;1999.

39. Asarnow RF, Nuechterlein KH. Directions for Use of the UCLA Span of Apprehension Program, Version 3.5 for Arrays 3 and 12 Letters, on IBM AT and Fully Compatible Microcomputers. Los Angeles, CA: UCLA Department of Psychiatry and Biobehavioral Sciences;1994.

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