Association between baseline cognition and clinical response in first-episode schizophrenia

Background This study aimed to investigate the association between baseline cognitive performance and the clinical response to antipsychotics in first-episode schizophrenia (FES) patients. Methods This study examined 769 patients from a multi-center research cohort. Neurocognition was measured using the MATRICS Consensus Cognitive Battery (MCCB) in schizophrenia at baseline. Clinical response was defined as ≥ 50% reduction in PANSS total score from baseline to week 8. Pearson correlation analysis was performed for preliminary exploratory assessment. Multivariable logistic regression models (response: yes/no) were fitted with each cognitive domain as dependent variable, adjusted confounding factors. To test effect modification, we added interaction terms: (i) cognition × antipsychotic type and (ii) cognition × baseline illness severity. For domains with significant interactions ( P < 0.05), stratified analyses were performed within each drug group and severity stratum. Results Logistic regression analysis demonstrated that all baseline neurocognitive domains were significantly associated with clinical response (All P < 0.05). Significant interactions between neurocognitive performance and antipsychotics were observed across all domains except Working Memory and Reasoning/problem solving. Similarly, significant interactions between neurocognition and baseline illness severity were found for all domains except Visual and Verbal learning. Further stratified analyses revealed that baseline cognitive performance was associated to clinical response to amisulpride and risperidone. Additionally, significant associations between neurocognition and clinical response were consistently observed in patients with moderate-to-severe illness severity across all domains, with the exception of Visual and Verbal Learning. Conclusions The association between baseline cognitive performance and treatment response is contingent on medication regimen and baseline illness severity. Trial registration The study was registered on ClinicalTrials.gov (NCT03451734) with a registration date of January 23, 2018.