Liam Davenport

April 06, 2016

FLORENCE, Italy — Impaired cognition in first-episode psychosis appears to be associated with expression of inflammatory markers, say Spanish researchers in findings that could point to the eventual targeting of therapies to patient subgroups.

Research results showed not only that levels of an inflammatory inhibitor were significantly associated with psychosis severity scores but also that individual performance on cognitive domains were significantly predicted by specific inflammatory mediators.

Bibiana Cabrera, from the Barcelona Clinic Schizophrenia Unit at the Hospital Clinic Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Spain, presented the research here at the Schizophrenia International Research Society (SIRS) 2016 Biennial Meeting.

She told Medscape Medical News that, following further investigations, she hopes that eventually the findings could be used to develop biomarkers to assess cognition in first-episode psychosis.

Bibiana Cabrera

These could be used to stratify patients and potentially identify subgroups that would allow both targeted, personalized interventions and the monitoring of the course of cognitive impairment and therapeutic response.

Noting that the current investigation is a cross-sectional analysis, Cabrera said: "We have longitudinal data also, so now we can do a new study, with the same variables at baseline and 2 years later."

The aim will be to determine whether the biomarkers are stable over time or change with clinical outcomes.

Noting that there is increasing evidence to link cognitive function and inflammatory processes and that cognitive deficits are present from the onset of psychosis, the team examined connections between cognition and inflammatory markers in first-episode psychosis.

They conducted a case-control study of 92 patients with first-episode psychosis and 80 matched control persons. Participants completed a neurocognitive assessment that focused on verbal ability, sustained attention, verbal memory, working memory, and executive function.

In addition, the team measured the expression of a panel of nine pro- and anti-inflammatory mediators of intracellular inflammation in peripheral blood mononuclear cells, as well as blood plasma.

As expected, patients with first-episode psychosis performed worse than control persons on all cognitive domains. In addition, patients had increased expression of proinflammatory mediators and reduced expression of anti-inflammatory compounds.

There was also a significant association between expression of IκBα, which inhibits the proinflammatory transcription factor NF-κB, and scores on the positive scale, the negative scale, the general psychopathology scale, as well as the total score on the Positive and Negative Syndrome Scale. This, the team suggests, indicates that measuring IκBα expression early in psychosis may give insights into clinical severity.

The researchers then used hierarchical regression analysis to determine the impact of inflammatory markers on sustained attention and executive function, taking into account age, sex, body mass index, tobacco and cannabis use, and chlorpromazine-equivalent antipsychotic treatment.

They found that expression of the anti-inflammatory prostaglandin 15d-PGJ2 was significantly inversely associated with sustained attention, at a beta value of -0.312 (P = .004). In contrast, expression of cyclooxygenase-2 was significantly positively associated with executive function, at a beta value of 0.350 (P = .007).

The authors have disclosed no relevant financial relationships.

Schizophrenia International Research Society (SIRS) 2016 Biennial Meeting: Poster T17, presented April 5, 2016.

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