Four distinct cognitive subgroups in schizophrenia were identified based on executive function and morphologic brain features, providing a new framework for understanding the heterogeneity of cognitive impairments in the disorder.

In a recent study, published in BMC Medicine, investigators analyzed data from 920 patients with schizophrenia and 169 healthy controls using the MATRICS Consensus Cognitive Battery (MCCB). They employed latent profile and latent transition analysis to define subgroups and examined cortical thickness and gray matter volume to identify morphologic differences.

The investigators identified four subgroups in schizophrenia:

• Multidomain-intact: preserved cognition and brain morphology most similar to healthy controls
• Executive-preserved: intermediate cognition with relative preservation of executive functions
• Executive-deteriorated: intermediate cognition with significant deficits in executive function and posterior cingulate cortex morphology
• Multidomain-deteriorated: severe cognitive impairments across domains and extensive morphological decline, even in younger patients.

Based on the findings, the patients in three of the four subgroups exhibited stable cognitive characteristics over a 12-week follow-up period. However, in the multidomain-deteriorated subgroup, 48.8% of patients showed cognitive improvement and transitioned into the executive-deteriorated subgroup.

Meanwhile, statistically significant differences in cortical thickness and gray matter volume were observed, with gradient changes across frontotemporal regions, hippocampus, and insula.

Despite their younger age, the patients in the multidomain-deteriorated subgroup demonstrated the most extensive morphologic decline, highlighting the severity of this cognitive phenotype.

Lead study author Yuyan Huang, of the Department of Psychiatry at the National Clinical Research Center for Mental Disorders and National Center for Mental Disorders at The Second Xiangya Hospital of Central South University in China, and colleagues analyzed the role of executive function in distinguishing cognitive subtypes and their associated neurobiological characteristics.

"Our study provides novel insights into the heterogeneity of cognitive impairments in schizophrenia and the morphological features from cross-sectional and longitudinal levels, which could advance our understanding of complex cognition-morphology relationships and guide personalized interventions," the study authors noted. 

These insights could guide the development of tailored interventions, targeting specific cognitive profiles. For instance, early identification of the patients in the multidomain-deteriorated subgroup might allow for aggressive therapeutic strategies to mitigate morphologic decline.

Meanwhile, the investigators acknowledged the absence of data on functional outcomes and the reliance on MCCB for cognitive assessment. Future studies may be needed to explore the relationship between these cognitive subtypes and clinical or functional recovery in schizophrenia.

No conflicts of interest were reported.