Salvi Virginio, Tripodi Beniamino, Cerveri Giancarlo, Migliarese Giovanni, Bertoni Lorenzo, Nibbio Gabriele, Barlati Stefano, Vita Antonio, Mencacci Claudio
Department of Mental Health and Addiction, ASST Crema, L.go Ugo Dossena 2, 26013 Crema, CR, Italy.
Department of Mental Health and Addiction, ASST Crema, L.go Ugo Dossena 2, 26013 Crema, CR, Italy.
Schizophr Res. 2024 Dec;274:78-89. doi: 10.1016/j.schres.2024.09.008. Epub 2024 Sep 11.
Cognitive deficits are difficult to treat and negatively influence quality of life and functional outcomes of persons with schizophrenia. In the last twenty years, extensive literature demonstrated that persons with diabetes and insulin resistance (IR) also display cognitive deficits. Being type 2 diabetes (T2DM) and IR highly frequent in persons with schizophrenia, it is plausible to hypothesize that these conditions might play a role in determining dyscognition. If that is the case, acting on glucose dysmetabolism may eventually improve cognitive functioning. This review aims at: 1. evaluating the association between IR or T2DM and cognitive dysfunction in schizophrenia; 2. reviewing the evidence that pharmacological treatment of IR or T2DM may improve dyscognition in schizophrenia.
Two systematic searches were conducted in PubMed, PsycInfo, and Scopus. We followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.
From the first search we included 17 studies, 8 on the effects of T2DM and 9 on the effects of IR-other prediabetes measures on cognition in persons with schizophrenia. From the second search we included 12 studies investigating the effect on cognition of glucose (4 studies), insulin (2 studies), metformin (2 studies), PPAR-γ agonists (2 studies), GLP-1 agonist (1 study), bromocriptine (1 study).
T2DM was associated with worse cognitive function in persons with schizophrenia, while IR was less strongly associated with cognitive dysfunction. Evidence regarding the efficacy of glucose-lowering medications on cognition in schizophrenia is inconclusive, yet methodological issues likely contribute to explain conflicting results.
认知缺陷难以治疗，且会对精神分裂症患者的生活质量和功能结局产生负面影响。在过去二十年中，大量文献表明糖尿病和胰岛素抵抗（IR）患者也存在认知缺陷。由于2型糖尿病（T2DM）和IR在精神分裂症患者中非常常见，因此可以合理推测这些情况可能在导致认知障碍方面发挥作用。如果是这样，针对葡萄糖代谢异常采取措施最终可能会改善认知功能。本综述旨在：1. 评估IR或T2DM与精神分裂症认知功能障碍之间的关联；2. 综述IR或T2DM的药物治疗可能改善精神分裂症认知障碍的证据。
在PubMed、PsycInfo和Scopus中进行了两项系统检索。我们遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。
第一次检索纳入了17项研究，其中8项研究了T2DM的影响，9项研究了IR及其他糖尿病前期指标对精神分裂症患者认知的影响。第二次检索纳入了12项研究，这些研究调查了葡萄糖（4项研究）、胰岛素（2项研究）、二甲双胍（2项研究）、PPAR-γ激动剂（2项研究）、GLP-1激动剂（1项研究）、溴隐亭（1项研究）对认知的影响。
T2DM与精神分裂症患者较差的认知功能相关，而IR与认知功能障碍的关联较弱。关于降糖药物对精神分裂症认知功能疗效的证据尚无定论，但方法学问题可能有助于解释相互矛盾的结果。
