Neurocognitive and Functional Heterogeneity in Depressed Youth

ABSTRACT OBJECTIVE Depression is a common psychiatric illness that often begins in youth, and is associated with cognitive symptoms. However, there is significant variability in the cognitive burden, likely reflecting biological heterogeneity. This study sought to identify neurocognitive subtypes in a large sample of depressed youth, and evaluated the neural signatures of these subtypes. METHODS Participants were drawn from the Philadelphia Neurodevelopmental Cohort, including 712 youth with a lifetime history of a major depressive episode and 712 typically developing (TD) youth matched on age and sex. A subset (n=368, TD=200) also completed neuroimaging. Cognition was assessed with the Penn Computerized Neurocognitive Battery. A semi-supervised machine-learning algorithm, HYDRA (Heterogeneity through Discriminative Analysis), was used to delineate neurocognitive subtypes. Subtypes were evaluated for differences in both clinical psychopathology and brain activation during an n -back working memory fMRI task. RESULTS HYDRA identified three neurocognitive subtypes in the depressed group. Overall, Subtype 1 had better performance than TD comparators across many cognitive tasks (high accuracy, moderate speed), Subtype 2 was cognitively impaired (low accuracy, slow speed), whereas Subtype 3 was impulsive (low accuracy, fast speed). While subtypes did not differ in clinical psychopathology, they diverged in their activation profiles in regions critical for executive function, which mirrored differences in cognition. CONCLUSIONS Using a data-driven approach, three neurocognitive subtypes of depression were identified that differed in neural signatures despite similar clinical psychopathology. These data suggest disparate mechanisms of cognitive vulnerability and resilience in depression, which may inform the identification of biomarkers for prognosis and treatment response.