Abstract
Background
Neurocognitive and functional heterogeneity is common in schizophrenia (SZ), and functioning is notoriously difficult to measure. Ecological Momentary Assessment (EMA) may help overcome the retrospective recall and subjective biases associated with standard self-report measures; however, how EMA-measured real-world functioning indicators align with other neurocognitive and functional capacity indicators is not well established. The current study aimed to characterize individuals with schizophrenia-spectrum disorders based upon their objective global neurocognitive functioning and functional capacity, and examine differences in EMA-measured functioning.
Methods
The study included 100 outpatient, English-speaking adults with SZ (n=82) or schizoaffective disorder (n=18). All participants completed EMA surveys administered at stratified random intervals 7 times per day for 7 days to assess self-rated proficiency in performing activities within home-care, self-care, leisure, work/school, and treatment engagement dimensions, as well as need for assistance/prompting to complete the tasks. Moreover, participants completed an in-lab comprehensive neuropsychological assessment battery (MATRICS Consensus Cognitive Battery) and a performance-based measure of functional capacity (UCSD Performance-Based Skills Assessment-Brief [UPSA-B]). Latent profile analyses (LPA) were used to derive categorical latent variables that represent profiles of individuals who have similar global neurocognitive functioning and UPSA-B performance. The optimal number of profiles for the sample was determined by evaluating models using the Akaike information criteria (AIC; Akaike, 1974), sample size-adjusted Bayesian information criteria (sBIC; Schwarz, 1978), and the Lo–Mendell–Rubin Adjusted Likelihood Ratio Test (LMRT; Lo, Mendell, & Rubin, 2001). Independent samples t-tests were used to examine group differences between the identified latent profile groups on EMA-reported outcomes.
Results
LPA identified a 2-profile solution with the best fit; participants in profile 1 (n=43) demonstrated mild-to-moderate global cognitive impairment and lower UPSA-B scores (Low functioning; LF), whereas participants in profile 2 (n=57) demonstrated average cognitive functioning and higher UPSA-B performance (High functioning; HF). The groups did not significantly differ on number of EMA surveys answered (p=.12). Compared to the HF group, the LF group reported poorer proficiency in overall reported activities (p=.001), which was driven by lower reported proficiency in home-care, self-care, and leisure activities (ps<.003). Compared to the HF group, the LF group also indicated requiring more assistance and/or prompting in performing productive activities (p=.02), specifically within the life domains of home-care, self-care, and in-home leisure activities (ps<.03).
Discussion
Compared to HF participants, LF participants rated their performance in activities within various life dimensions as less proficient and reported receiving greater assistance and/or prompting to do the activities. Future research should investigate the utility of the EMA paradigm to provide psychosocial interventions that appreciate the role of cognition and functional capacity in daily functioning.
Can we use Ecological Momentary Assessment for real-world patients with schizophrenia? A study of acceptability of the passive smartphone-based app Evidence-Based Behavior (eB2). (Preprint)