Multivariate associations between cognition and neighborhood geospatial characteristics in schizophrenia

• Published in: Asian journal of psychiatry Vol. 84; p. 103593
• Main Authors: Ibrahim, Ferose Azeez, Mehta, Urvakhsh Meherwan, Thekkumkara, Sreekanth N., Rakesh, KR, Swetha, G., Kumar, C.Naveen, Kumar, Keshav J., Narayana, Aishwarya, Ravisundar, Shashwath, Satyanarayana, Padmashree, Thirthalli, Jagadisha
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-06-2023
• Subjects: Cognition; Cognitive Dysfunction - complications; Cognitive Dysfunction - etiology; Environment; Geographical information systems; Humans; Living environment; Neighborhood attributes; Neurocognition; Psychosis; Residence Characteristics; Schizophrenia - complications; Schizophrenia - epidemiology; Social cognition; Urban exposome; Psychosis; Urban exposome; Neighborhood attributes; Geographical information systems; Neurocognition; Living environment; Social cognition
• DOI: 10.1016/j.ajp.2023.103593
• EISSN: 1876-2026
• ISSN: 1876-2018

Cognitive impairment contributes to functional impairment in schizophrenia. Yet, little is known about how environmental characteristics are related to cognition in schizophrenia. By examining how cognition and the environment are intertwined, it may be possible to identify modifiable risk and protective factors that can improve cognitive outcomes in schizophrenia. We aimed to identify multivariate associations between cognition and three geospatial characteristics (built-space density, habitable green spaces, and public spaces for social interaction) within one’s immediate neighborhood among individuals with schizophrenia. We recruited participants with schizophrenia from three sites – an urban metropolitan and two towns in southern India. We administered standard cognitive assessments and performed a principal axis factoring to identify episodic memory, cognitive control, and social inference-making factors for use in further analyses. We estimated geospatial characteristics of an individual’s neighborhood, i.e., up to 1 km2 around the residence, by sourcing data from Google Earth. We performed unconditional and conditional (to examine the effect of clinical covariates) canonical correlation analyses to understand the multivariate relationship between cognition and geospatial characteristics. We analyzed data from 208 participants; the first canonical cognitive variate (higher social inference-making and poorer cognitive control) shared 24% of the variance (r = 0.49; P < 0.001) with the first geospatial variate (lower built density and poorer access to public spaces). Years of education, age at onset, and place of residence significantly modulated this relationship. We observe differential associations of the built environment with social and non-social cognition in schizophrenia, and highlight the clinical and demographic characteristics that shape these associations.
•The multivariate relationship between cognition and neighborhood geospatial characteristics in schizophrenia was examined.•Lower built density and public spaces were associated with higher social inference-making and poorer cognitive control.•Years of education, age at onset, and place of residence significantly modulated this multivariate relationship.•The neighborhood built environment has differential associations with social and non-social cognition in schizophrenia.