Researchers find link between metabolic disorders, cognitive deficits in schizophrenia
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The presence of metabolic disorders appeared significantly linked to cognitive deficits among individuals with schizophrenia, according to results of a systematic review and meta-analysis published in JAMA Psychiatry.
“The aim of this study was to assess whether in people with schizophrenia who have cognitive dysfunction at a degree of one to two standard deviations below the population norm and who have much poorer cardiometabolic health than the general population, metabolic syndrome and its elements would be related to poorer cognition,” Christoph U. Correll, MD, of the Zucker Hillside Hospital at Psychiatry Research, Northwell Health, told Healio Psychiatry. “If this were true, like in the general population, then clinicians would need to focus on physical health monitoring and improvement not only to target improved physical but also psychiatric health outcomes.”
Results of a prior systematic review and meta-analysis of 12 studies that investigated whether metabolic syndrome and diabetes were linked to cognitive impairment in schizophrenia showed these two factors were significantly associated with cognitive deficits. In the current study, Hagi and colleagues searched five databases from inception to Feb. 25, 2020, with terms including synonyms of schizophrenia and metabolic adversities and cognitive function. They also searched conference proceedings, clinical trial registries and reference lists of relevant publications. They included 27 studies that examined cognitive functioning among 10,174 patients with schizophrenia or schizoaffective disorder; assessed the linked between cardiovascular disease risk factors, such as metabolic syndrome, diabetes, obesity, overweight, obesity or overweight, hypertension, dyslipidemia and insulin resistance with outcomes; and compared cognitive performance of patients with schizophrenia or schizoaffective disorder between those with vs. without risk factors for cardiovascular disease. Global cognition, defined as a test score via clinically validated measures of overall cognitive functioning, served as the primary outcome.
Results showed significantly greater global cognitive deficits among patients with schizophrenia who had metabolic syndrome, diabetes or hypertension. Those with obesity, overweight and insulin resistance had insignificantly greater deficits. Further, they noted an association between worse performance in specific cognitive domains and cognitive dysfunction and cardiovascular risk factors regarding five domains among patients with diabetes and four domains with metabolic syndrome and hypertension.
“Results from this study have direct clinical relevance,” Correll said. “Clinicians should prefer antipsychotics with low cardiometabolic risk, educate about and endorse healthy lifestyle behaviors and proactively monitor weight and glucose and lipid parameters as well as adherence to healthy lifestyle in all individuals with schizophrenia in order to enhance not only physical health and wellbeing but also psychiatric outcomes via improving or, at least, not worsening cognitive dysfunction that has been associated with poor functional outcomes.”