npj Schizophrenia (Jun 2021)

The progression of disorder-specific brain pattern expression in schizophrenia over 9 years

  • Johannes Lieslehto,
  • Erika Jääskeläinen,
  • Vesa Kiviniemi,
  • Marianne Haapea,
  • Peter B. Jones,
  • Graham K. Murray,
  • Juha Veijola,
  • Udo Dannlowski,
  • Dominik Grotegerd,
  • Susanne Meinert,
  • Tim Hahn,
  • Anne Ruef,
  • Matti Isohanni,
  • Peter Falkai,
  • Jouko Miettunen,
  • Dominic B. Dwyer,
  • Nikolaos Koutsouleris

DOI
https://doi.org/10.1038/s41537-021-00157-0
Journal volume & issue
Vol. 7, no. 1
pp. 1 – 11

Abstract

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Abstract Age plays a crucial role in the performance of schizophrenia vs. controls (SZ-HC) neuroimaging-based machine learning (ML) models as the accuracy of identifying first-episode psychosis from controls is poor compared to chronic patients. Resolving whether this finding reflects longitudinal progression in a disorder-specific brain pattern or a systematic but non-disorder-specific deviation from a normal brain aging (BA) trajectory in schizophrenia would help the clinical translation of diagnostic ML models. We trained two ML models on structural MRI data: an SZ-HC model based on 70 schizophrenia patients and 74 controls and a BA model (based on 561 healthy individuals, age range = 66 years). We then investigated the two models’ predictions in the naturalistic longitudinal Northern Finland Birth Cohort 1966 (NFBC1966) following 29 schizophrenia and 61 controls for nine years. The SZ-HC model’s schizophrenia-specificity was further assessed by utilizing independent validation (62 schizophrenia, 95 controls) and depression samples (203 depression, 203 controls). We found better performance at the NFBC1966 follow-up (sensitivity = 75.9%, specificity = 83.6%) compared to the baseline (sensitivity = 58.6%, specificity = 86.9%). This finding resulted from progression in disorder-specific pattern expression in schizophrenia and was not explained by concomitant acceleration of brain aging. The disorder-specific pattern’s progression reflected longitudinal changes in cognition, outcomes, and local brain changes, while BA captured treatment-related and global brain alterations. The SZ-HC model was also generalizable to independent schizophrenia validation samples but classified depression as control subjects. Our research underlines the importance of taking account of longitudinal progression in a disorder-specific pattern in schizophrenia when developing ML classifiers for different age groups.