Alkan Erkan, L H Evans Simon
Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.
Schizophrenia (Heidelb). 2022 Apr 4;8(1):33. doi: 10.1038/s41537-022-00243-x.
Impairments in cognitive performance are common in schizophrenia, and these contribute to poor awareness of symptoms and treatment ('clinical insight'), which is an important predictor of functional outcome. Although relationships between cognitive impairment and reductions in regional brain volumes in patients are relatively well characterised, less is known about the brain structural correlates of clinical insight. To address this gap, we aimed to explore brain structural correlates of cognitive performance and clinical insight in the same sample. 108 patients with schizophrenia (SZH) and 94 age and gender-matched controls (CON) (from the Northwestern University Schizophrenia Data and Software Tool (NUSDAST) database) were included. SZH had smaller grey matter volume across most fronto-temporal regions and significantly poorer performance on all cognitive domains. Multiple regression showed that higher positive symptoms and poorer attention were significant predictors of insight in SZH; however, no significant correlations were seen between clinical insight and regional brain volumes. In contrast, symptomology did not contribute to cognitive performance, but robust positive relationships were found between regional grey matter volumes in fronto-temporal regions and cognitive performance (particularly executive function). Many of these appeared to be unique to SZH as they were not observed in CON. Findings suggest that while there exists a tight link between cognitive functioning and neuropathological processes affecting gross brain anatomy in SZH, this is not the case for clinical insight. Instead, clinical insight levels seem to be influenced by symptomology, attentional performance and other subject-specific variables.
认知功能损害在精神分裂症中很常见，这些损害会导致对症状和治疗的认识不足（“临床洞察力”），而临床洞察力是功能预后的重要预测指标。虽然患者认知障碍与脑区体积减小之间的关系已得到较好的描述，但对于临床洞察力的脑结构相关性了解较少。为了填补这一空白，我们旨在探索同一组样本中认知功能和临床洞察力的脑结构相关性。研究纳入了108例精神分裂症患者（SZH）和94例年龄及性别匹配的对照者（CON）（来自西北大学精神分裂症数据与软件工具（NUSDAST）数据库）。SZH在大多数额颞区域的灰质体积较小，且在所有认知领域的表现明显较差。多元回归分析显示，较高的阳性症状和较差的注意力是SZH洞察力的显著预测因素；然而，临床洞察力与脑区体积之间未发现显著相关性。相比之下，症状表现对认知功能没有影响，但在额颞区域的灰质体积与认知功能（尤其是执行功能）之间发现了显著的正相关关系。其中许多关系似乎是SZH所特有的，因为在CON中未观察到。研究结果表明，虽然在SZH中认知功能与影响大脑大体解剖结构的神经病理过程之间存在紧密联系，但临床洞察力并非如此。相反，临床洞察力水平似乎受症状表现、注意力表现和其他个体特异性变量的影响。
