Glutamate Networks Implicate Cognitive Impairments in Schizophrenia: Genome-Wide Association Studies of 52 Cognitive Phenotypes

Estimated cognitive decline in patients with schizophrenia: A multicenter study

AIM

Studies have reported that cognitive decline occurs after the onset of schizophrenia despite heterogeneity in cognitive function among patients. The aim of this study was to investigate the degree of estimated cognitive decline in patients with schizophrenia by comparing estimated premorbid intellectual functioning and current intellectual functioning.

METHODS

A total of 446 patients with schizophrenia (228 male, 218 female), consisting of three sample sets obtained from 11 psychiatric facilities, and 686 healthy controls participated in this study. The Wechsler Adult Intelligence Scale-III (WAIS-III) was used to measure the participants' current full-scale IQ (FSIQ). The premorbid IQ was estimated using the Japanese Adult Reading Test-25. Estimated cognitive decline (difference score) was defined as the difference between the estimated premorbid IQ and the current FSIQ.

RESULTS

Patients with schizophrenia showed greater estimated cognitive decline, a lower FSIQ, and a lower premorbid IQ compared with the healthy controls. The mean difference score, FSIQ, and estimated premorbid IQ were -16.3, 84.2, and 100.5, respectively, in patients with schizophrenia. Furthermore, 39.7% of the patients had a difference score of 20 points or greater decline. A discriminant analysis showed that the difference score accurately predicted 81.6% of the patients and healthy controls.

CONCLUSION

These results show the distribution of difference score in patients with schizophrenia. These findings may contribute to assessing the severity of estimated cognitive decline and identifying patients with schizophrenia who suffer from cognitive decline.

Animal models in psychiatric research: The RDoC system as a new framework for endophenotype-oriented translational neuroscience

The recently proposed Research Domain Criteria (RDoC) system defines psychopathologies as phenomena of multilevel neurobiological existence and assigns them to 5 behavioural domains characterizing a brain in action. We performed an analysis on this contemporary concept of psychopathologies in respect to a brain phylogeny and biological substrates of psychiatric diseases. We found that the RDoC system uses biological determinism to explain the pathogenesis of distinct psychiatric symptoms and emphasises exploration of endophenotypes but not of complex diseases. Therefore, as a possible framework for experimental studies it allows one to evade a major challenge of translational studies of strict disease-to-model correspondence. The system conforms with the concept of a normality and pathology continuum, therefore, supports basic studies. The units of analysis of the RDoC system appear as a novel matrix for model validation. The general regulation and arousal, positive valence, negative valence, and social interactions behavioural domains of the RDoC system show basic construct, network, and phenomenological homologies between human and experimental animals. The nature and complexity of the cognitive behavioural domain of the RDoC system deserve further clarification. These homologies in the 4 domains justifies the validity, reliably and translatability of animal models appearing as endophenotypes of the negative and positive affect, social interaction and general regulation and arousal systems’ dysfunction.

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The RDoC system encourages endophenotype-oriented experimental studies in human and animals.

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The system conforms with the normality-pathology continuum concept.

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The RDoC system appears to be a suitable framework for basic research.

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Four RDoC domains show construct and phenomenological homology in human and animals.

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Endophenotype-based models of affective psychopathologies appear most reliable.

Vulnerability to omega-3 deprivation in a mouse model of NMDA receptor hypofunction

Several studies have found decreased levels of ω-3 polyunsaturated fatty acids in the brain and blood of schizophrenia patients. Furthermore, dietary ω-3 supplements may improve schizophrenia symptoms and delay the onset of first-episode psychosis. We used an animal model of NMDA receptor hypofunction, NR1KD mice, to understand whether changes in glutamate neurotransmission could lead to changes in brain and serum fatty acids. We further asked whether dietary manipulations of ω-3, either depletion or supplementation, would affect schizophrenia-relevant behaviors of NR1KD mice. We discovered that NR1KD mice have elevated brain levels of ω-6 fatty acids regardless of their diet. While ω-3 supplementation did not improve any of the NR1KD behavioral abnormalities, ω-3 depletion exacerbated their deficits in executive function. Omega-3 depletion also caused extreme mortality among male mutant mice, with 75% mortality rate by 12 weeks of age. Our studies show that alterations in NMDAR function alter serum and brain lipid composition and make the brain more vulnerable to dietary ω-3 deprivation.

Depletion of omega-3 fatty acids in a mouse model of schizophrenia with altered glutamate transmission has a lethal effect in males. Previous studies have suggested that omega-3 supplements may improve the symptoms of schizophrenia. Amy Ramsey and colleagues at the University of Toronto, Canada, show in an established genetic mouse model of the disease that omega-3 dietary supplementation increased brain omega-3 levels, but did not have any beneficial effects on features that mirror symptoms of patients with schizophrenia such as increased locomotor activity or reduced social behavior. Interestingly, omega-3 dietary depletion worsened the cognitive performance and drastically increased the mortality rate of male mutant mice. The mechanisms responsible for these effects remain to be determined, but the findings highlight a potentially serious vulnerability of patients to dietary omega-3 deficits.

Usefulness of the Wechsler Intelligence Scale short form for assessing functional outcomes in patients with schizophrenia

The Wechsler Adult Intelligence Scale (WAIS) has been widely used to assess intellectual functioning not only in healthy adults but also people with psychiatric disorders. The purpose of the study was to develop an optimal WAIS-3 short form (SF) to evaluate intellectual status in patients with schizophrenia. One hundred and fifty patients with schizophrenia and 221 healthy controls entered the study. To select subtests for SFs, following criteria were considered: 1) predictability for the full IQ (FIQ), 2) representativeness for the IQ structure, 3) consistency of subtests across versions, 4) sensitivity to functional outcome measures, 5) conciseness in administration time. First, exploratory factor analysis (EFA) and multiple regression analysis were conducted to select subtests satisfying the first and the second criteria. Then, candidate SFs were nominated based on the third criterion and the coverage of verbal IQ and performance IQ. Finally, the optimality of candidate SFs was evaluated in terms of the fourth and fifth criteria. The results suggest that the dyad of Similarities and Symbol Search was the most optimal satisfying the above criteria.

Predicting employment status and subjective quality of life in patients with schizophrenia

Although impaired social functioning, particularly poor employment status, is a cardinal feature of patients with schizophrenia and leads to decreased quality of life (QOL), few studies have addressed the relationship between these two clinical issues. The aim of this study was to determine whether employment status predicts subjective QOL and to evaluate a model in which functional capacity mediates the relationship between general cognitive performance and employment status. Ninety-three patients with schizophrenia were administered a comprehensive battery of cognitive tests, the UCSD Performance-based Skills Assessment-Brief version (UPSA-B), the Social Functioning Scale (SFS), and the Subjective Quality of Life Scale (SQLS). First, we evaluated a model for predicting the employment/occupation subscale score of the SFS using path analysis, and the model fitted well (χ2 (4) = 3.6, p = 0.46; CFI = 1.0; RMSEA < 0.001, with 90% CIs: 0-0.152). Employment status was predicted by negative symptoms and functional capacity, which was in turn predicted by general cognitive performance. Second, we added subjective QOL to this model. In a final path model, QOL was predicted by negative symptoms and employment status. This model also satisfied good fit criteria (χ2 (7) = 10.3, p = 0.17; CFI = 0.987; RMSEA = 0.072, with 90% CIs: 0-0.159). The UPSA-B and SFS scores were moderately correlated with most measures of cognitive performance. These results support the notion that better employment status enhances subjective QOL in patients with schizophrenia.

Genetic assessment of additional endophenotypes from the Consortium on the Genetics of Schizophrenia Family Study

The Consortium on the Genetics of Schizophrenia Family Study (COGS-1) has previously reported our efforts to characterize the genetic architecture of 12 primary endophenotypes for schizophrenia. We now report the characterization of 13 additional measures derived from the same endophenotype test paradigms in the COGS-1 families. Nine of the measures were found to discriminate between schizophrenia patients and controls, were significantly heritable (31 to 62%), and were sufficiently independent of previously assessed endophenotypes, demonstrating utility as additional endophenotypes. Genotyping via a custom array of 1536 SNPs from 94 candidate genes identified associations for CTNNA2, ERBB4, GRID1, GRID2, GRIK3, GRIK4, GRIN2B, NOS1AP, NRG1, and RELN across multiple endophenotypes. An experiment-wide p value of 0.003 suggested that the associations across all SNPs and endophenotypes collectively exceeded chance. Linkage analyses performed using a genome-wide SNP array further identified significant or suggestive linkage for six of the candidate endophenotypes, with several genes of interest located beneath the linkage peaks (e.g., CSMD1, DISC1, DLGAP2, GRIK2, GRIN3A, and SLC6A3). While the partial convergence of the association and linkage likely reflects differences in density of gene coverage provided by the distinct genotyping platforms, it is also likely an indication of the differential contribution of rare and common variants for some genes and methodological differences in detection ability. Still, many of the genes implicated by COGS through endophenotypes have been identified by independent studies of common, rare, and de novo variation in schizophrenia, all converging on a functional genetic network related to glutamatergic neurotransmission that warrants further investigation.

Synaptic activity: An emerging player in schizophrenia

Schizophrenia is a polygenic disorder with a complex etiology. While the genetic and molecular underpinnings of the disease are poorly understood, variations in genes encoding synaptic pathways are consistently implicated. Although its impact is still an open question, a deficit in synaptic activity provides an attractive model to explain the cognitive etiology of schizophrenia. Recent advances in high-throughput imaging and functional studies bring new hope for the application of in vitro disease modeling with patient-derived neurons to empirically ascertain the extent to which these synaptic pathways are involved in the disease. In addition, the emergent avenue of research targeted to probe neuronal connections is revealing critical insight into circuitry and may influence how we think about psychiatric disorders in the near future. This article is part of a Special Issue entitled SI: Exploiting human neurons.

Glutamate synapses in human cognitive disorders

Accumulating data, including those from large genetic association studies, indicate that alterations in glutamatergic synapse structure and function represent a common underlying pathology in many symptomatically distinct cognitive disorders. In this review, we discuss evidence from human genetic studies and data from animal models supporting a role for aberrant glutamatergic synapse function in the etiology of intellectual disability (ID), autism spectrum disorder (ASD), and schizophrenia (SCZ), neurodevelopmental disorders that comprise a significant proportion of human cognitive disease and exact a substantial financial and social burden. The varied manifestations of impaired perceptual processing, executive function, social interaction, communication, and/or intellectual ability in ID, ASD, and SCZ appear to emerge from altered neural microstructure, function, and/or wiring rather than gross changes in neuron number or morphology. Here, we review evidence that these disorders may share a common underlying neuropathy: altered excitatory synapse function. We focus on the most promising candidate genes affecting glutamatergic synapse function, highlighting the likely disease-relevant functional consequences of each. We first present a brief overview of glutamatergic synapses and then explore the genetic and phenotypic evidence for altered glutamate signaling in ID, ASD, and SCZ.