Confirmatory factor analysis reveals a latent cognitive structure common to bipolar disorder, schizophrenia, and normal controls

Authors

  • David J Schretlen,

    Corresponding author
    1. Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
    • Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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  • Javier Peña,

    1. Department of Psychology, Universidad de Deusto, Bilbao, Bizkaia, Spain
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  • Eleni Aretouli,

    1. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
    2. Department of Psychology, Universidad de Deusto, Bilbao, Bizkaia, Spain
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  • Izaskun Orue,

    1. Department of Psychology, Universidad de Deusto, Bilbao, Bizkaia, Spain
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  • Nicola G Cascella,

    1. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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  • Godfrey D Pearlson,

    1. Olin Neuropsychiatry Research Center, Hartford Hospital/Institute of Living, Hartford, CT, USA
    2. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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  • Natalia Ojeda

    1. Department of Psychology, Universidad de Deusto, Bilbao, Bizkaia, Spain
    2. CIBERSAM, Centro de Salud Biomédica en Red de Salud Mental, Madrid, Spain
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Corresponding author:

David J. Schretlen, Ph.D.

Department of Psychiatry and Behavioral Sciences

The Johns Hopkins Hospital

600 North Wolfe Street, Meyer 218

Baltimore, MD 21287-7218

USA

Fax: 410-955-0504

E-mail: dschret@jhmi.edu

Abstract

Objective

We sought to determine whether a single hypothesized latent factor structure would characterize cognitive functioning in three distinct groups.

Methods

We assessed 576 adults (340 community controls, 126 adults with bipolar disorder, and 110 adults with schizophrenia) using 15 measures derived from nine cognitive tests. Confirmatory factor analysis (CFA) was conducted to examine the fit of a hypothesized six-factor model. The hypothesized factors included attention, psychomotor speed, verbal memory, visual memory, ideational fluency, and executive functioning.

Results

The six-factor model provided an excellent fit for all three groups [for community controls, root mean square error of approximation (RMSEA) <0.048 and comparative fit index (CFI) = 0.99; for adults with bipolar disorder, RMSEA = 0.071 and CFI = 0.99; and for adults with schizophrenia, RMSEA = 0.06 and CFI = 0.98]. Alternate models that combined fluency with processing speed or verbal and visual memory reduced the goodness of fit. Multi-group CFA results supported factor invariance across the three groups.

Conclusions

Confirmatory factor analysis supported a single six-factor structure of cognitive functioning among patients with schizophrenia or bipolar disorder and community controls. While the three groups clearly differ in level of performance, they share a common underlying architecture of information processing abilities. These cognitive factors could provide useful targets for clinical trials of treatments that aim to enhance information processing in persons with neurological and neuropsychiatric disorders.

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