Medical Affairs, Sumitomo Dainippon Pharma, Tokyo, Japan.
Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
JAMA Psychiatry. 2021 May 1;78(5):510-518. doi: 10.1001/jamapsychiatry.2021.0015.
Schizophrenia is associated with cognitive dysfunction and cardiovascular risk factors, including metabolic syndrome (MetS) and its constituent criteria. Cognitive dysfunction and cardiovascular risk factors can worsen cognition in the general population and may contribute to cognitive impairment in schizophrenia.
To study the association between cognitive dysfunction and cardiovascular risk factors and cognitive impairment in individuals with schizophrenia.
A search was conducted of Embase, Scopus, MEDLINE, PubMed, and Cochrane databases from inception to February 25, 2020, using terms that included synonyms of schizophrenia AND metabolic adversities AND cognitive function. Conference proceedings, clinical trial registries, and reference lists of relevant publications were also searched.
Studies were included that (1) examined cognitive functioning in patients with schizophrenia or schizoaffective disorder; (2) investigated the association of cardiovascular disease risk factors, including MetS, diabetes, obesity, overweight, obesity or overweight, hypertension, dyslipidemia, and insulin resistance with outcomes; and (3) compared cognitive performance of patients with schizophrenia/schizoaffective disorder between those with vs without cardiovascular disease risk factors.
Extraction of data was conducted by 2 to 3 independent reviewers per article. Data were meta-analyzed using a random-effects model.
The primary outcome was global cognition, defined as a test score using clinically validated measures of overall cognitive functioning.
Twenty-seven studies involving 10 174 individuals with schizophrenia were included. Significantly greater global cognitive deficits were present in patients with schizophrenia who had MetS (13 studies; n = 2800; effect size [ES] = 0.31; 95% CI, 0.13-0.50; P = .001), diabetes (8 studies; n = 2976; ES = 0.32; 95% CI, 0.23-0.42; P < .001), or hypertension (5 studies; n = 1899; ES = 0.21; 95% CI, 0.11-0.31; P < .001); nonsignificantly greater deficits were present in patients with obesity (8 studies; n = 2779; P = .20), overweight (8 studies; n = 2825; P = .41), and insulin resistance (1 study; n = 193; P = .18). Worse performance in specific cognitive domains was associated with cognitive dysfunction and cardiovascular risk factors regarding 5 domains in patients with diabetes (ES range, 0.23 [95% CI, 0.12-0.33] to 0.40 [95% CI, 0.20-0.61]) and 4 domains with MetS (ES range, 0.15 [95% CI, 0.03-0.28] to 0.40 [95% CI, 0.20-0.61]) and hypertension (ES range, 0.15 [95% CI, 0.04-0.26] to 0.27 [95% CI, 0.15-0.39]).
In this systematic review and meta-analysis, MetS, diabetes, and hypertension were significantly associated with global cognitive impairment in people with schizophrenia.
精神分裂症与认知功能障碍和心血管危险因素相关，包括代谢综合征（MetS）及其组成标准。认知功能障碍和心血管危险因素会加重一般人群的认知功能，并且可能导致精神分裂症患者的认知障碍恶化。
研究个体精神分裂症患者认知功能障碍与心血管危险因素和认知障碍之间的关联。
从建库至 2020 年 2 月 25 日，通过包括精神分裂症和代谢不良以及认知功能同义词的术语，对 Embase、Scopus、MEDLINE、PubMed 和 Cochrane 数据库进行了检索。还对相关文献的会议记录、临床试验登记处和参考文献进行了检索。
研究包括 (1) 检查精神分裂症或分裂情感障碍患者的认知功能；(2) 研究心血管疾病危险因素，包括代谢综合征、糖尿病、肥胖、超重、肥胖或超重、高血压、血脂异常和胰岛素抵抗与结果之间的关系；以及 (3) 比较伴有或不伴有心血管疾病危险因素的精神分裂症/分裂情感障碍患者的认知表现。
每位作者对每篇文章进行 2 到 3 次独立的数据提取。使用随机效应模型对数据进行荟萃分析。
主要结果是总体认知，定义为使用临床验证的整体认知功能测试评分。
纳入了 27 项涉及 10174 名精神分裂症患者的研究。患有代谢综合征（13 项研究；n=2800；效应量[ES]为 0.31；95%置信区间，0.13-0.50；P=0.001）、糖尿病（8 项研究；n=2976；ES 为 0.32；95%置信区间，0.23-0.42；P<0.001）或高血压（5 项研究；n=1899；ES 为 0.21；95%置信区间，0.11-0.31；P<0.001）的精神分裂症患者的整体认知缺陷明显更大；患有肥胖症（8 项研究；n=2779；P=0.20）、超重（8 项研究；n=2825；P=0.41）和胰岛素抵抗（1 项研究；n=193；P=0.18）的患者的缺陷不明显。患有糖尿病的患者在 5 个认知领域（ES 范围为 0.23 [95%置信区间，0.12-0.33]至 0.40 [95%置信区间，0.20-0.61]）和代谢综合征（ES 范围为 0.15 [95%置信区间，0.03-0.28]至 0.40 [95%置信区间，0.20-0.61]）和高血压（ES 范围为 0.15 [95%置信区间，0.04-0.26]至 0.27 [95%置信区间，0.15-0.39]）的认知功能障碍和心血管危险因素与特定认知领域的表现更差相关。
在这项系统评价和荟萃分析中，代谢综合征、糖尿病和高血压与精神分裂症患者的总体认知障碍显著相关。
