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25 February 2020

Modelling associations between neurocognition and functional course in young people with emerging mental disorders: a longitudinal cohort study

We caught up with Jacob Crouse from the University of Sydney’s Brain and Mind Centre to discuss his research into key factors that underpin mental health disorders in young people, with a view to improving outcomes. 

Can you tell us more about yourself?

I am a postdoctoral research fellow with the Youth Mental Health and Technology Team at the University of Sydney’s Brain and Mind Centre. I am interested in extending our knowledge of the complex evolution of mental health disorders and the powerful collateral impacts these conditions have on work, study, and relationships. Through my research, I hope to improve the lives of young people now, into their adult lives, and for generations to come.

Can you tell us some background information about the study, the methods used and why you used them?

Most mental health disorders emerge during youth, and it is during adolescence and early adulthood that these disorders can have real and long-lasting impacts on people’s capacity to lead productive and contributing lives with respect to work, study, and relationships. My team is interested in understanding what factors underlie this huge disability burden among young people, so that we can improve the ability of mental health services to optimally personalise interventions to individual needs.

One key factor contributing to the disability burden associated with mental disorders is neurocognitive impairment. Previous research has revealed robust relationships between impairments in neurocognitive functions such as memory, and difficulties with work, study, and relationships. Little attention however has been given to these relationships in young people with recent-onset mental health problems. The powerful idea here is that an improved understanding of the early phases of mental health problems and disorders may help us to identify key factors that we can target to improve outcomes, prior to the expression and elaboration of secondary problems.

In our recent publication in Translational Psychiatry, we examined data from a large cohort of young people who have sought help from mental health services (such as ‘headspace’) in Sydney, Australia, over the last 10 years. Many of these young people underwent detailed neurocognitive assessments and had their social and occupational functioning rated over a number of years. This longitudinal cohort design allowed us to examine the relationship between neurocognition at baseline, and social and occupational functioning over time.

How would you summarise your finding and their implications?

Scores on one particular neurocognitive test were associated with social and occupational functioning over time. This test—the Trail Making Test Part B—measures the ability to flexibly shift between two mental ‘rules’, which in this assessment entailed drawing a line between consecutive and alternating numbers and letters  (e.g. 1→A, A→2, 2→B, B→3, and so on). We found that young people who scored more poorly on this measure also had less improvement in their social and occupational functioning over time, despite continued contact with youth mental health services. This observation has two important implications. First, young people who do more poorly on this task may need extra supports in areas such as work, study, and social relationships (in addition to standard mental health care). Second, performance on this and related ‘executive’ tasks may represent good targets for ‘cognitive training’ and other similar rehabilitation-type interventions. It is possible that improving these neurocognitive functions may have flow-on effects into real-world work, study, and relationships.

What future areas of investigation could follow on from your research?

It is always important to attempt to replicate the findings of one study to see how it generalises to different groups in different conditions. So, future research should first attempt to replicate our findings to see if this effect is robust. Second, future studies might try to improve this type of neurocognitive ability in young people with mental health problems to determine whether improvements in real-world social and occupational functioning follows from improvements to this neurocognitive ability. This type of research is fundamental for improving our capacity to more optimally tailor interventions to individuals, early in the course of illness.

Why did you choose CANTAB for your study?

We chose to use CANTAB - including tasks such as Paired Associates Learning, Spatial Span Task, and Intra-Extra Dimensional Set-Shift - as it represents a very appealing and accessible assessment modality to young people. CANTAB is the gold-standard for neurocognitive assessment and is a reliable, valid, and accurate means of capturing neurocognitive abilities across a range of domains. These types of digital data capture technologies will be increasingly important for improving our capacity as clinicians and researchers to track the emergence and evolution of mental health disorders in individuals over time.

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Author portrait

Jacob Crouse - University of Sydney’s Brain and Mind Centre