Kancsev Alexander, Virág-Tulassay Eszter Éva, Engh Marie Anne, Kiss-Dala Szilvia, Horváth András Attila, Hegyi Péter, Kéri Szabolcs
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Department of Psychiatry and Psychotherapy, András Jósa Hospital, Nyíregyháza, Hungary.
Sci Rep. 2025 Jul 2;15(1):22898. doi: 10.1038/s41598-025-06225-0.
Schizophrenia is a lifelong mental disorder associated with cognitive dysfunctions. Comorbid metabolic dysregulations, such as diabetes and insulin resistance, may further deteriorate cognitive functions. It is therefore essential to investigate the effects of these metabolic disturbances on cognition in this population. A systematic review and meta-analysis following PRISMA guidelines was conducted using data from five databases: Medline, Embase, CENTRAL, Scopus, and Web of science. Of the 26 studies included, 9 were meta-analyzed with random effects model. The search was completed on November 23, 2023 and updated on April 2, 2025. We examined the cognitive functions of schizophrenia patients with and without diabetes or insulin resistance, using standardized mean differences (SMD) or mean differences (MD) as outcomes. The review section provides an overview of the literature on the relationship between glucose homeostasis and cognitive functions. The risk of bias was assessed using the QUIPS tool. There is a clear trend suggesting that diabetes exacerbates cognitive dysfunction in schizophrenia (global cognition: SMD=-0.26; P = 0.1087; 95% CI, -0.59 to 0.08), particularly in domains such as reasoning (SMD=-0.40; P = 0.0109, 95% CI -0.58 to -0.22) and processing speed (SMD=-0.43; P = 0.0005, 95% CI -0.52 to -0.35). Conflicting results were observed in studies on insulin resistance (global cognition: SMD=-0.12; P = 0.5890; 95% CI -0.91 to 0.68). Our findings suggest that glucose metabolism dysregulations might worsen cognitive dysfunctions in schizophrenia. However, further research is needed with larger samples and less heterogeneous studies to investigate if the effect is statistically significant. Addressing these metabolic issues could help improve cognitive and functional outcomes in schizophrenia patients.
精神分裂症是一种与认知功能障碍相关的终身性精神障碍。合并的代谢失调，如糖尿病和胰岛素抵抗，可能会进一步使认知功能恶化。因此，研究这些代谢紊乱对该人群认知的影响至关重要。按照PRISMA指南进行了一项系统综述和荟萃分析，使用了来自五个数据库的数据：Medline、Embase、CENTRAL、Scopus和Web of science。在纳入的26项研究中，9项使用随机效应模型进行了荟萃分析。检索于2023年11月23日完成，并于2025年4月2日更新。我们使用标准化均数差（SMD）或均数差（MD）作为结果，研究了有或没有糖尿病或胰岛素抵抗的精神分裂症患者的认知功能。综述部分概述了关于葡萄糖稳态与认知功能之间关系的文献。使用QUIPS工具评估偏倚风险。有一个明显的趋势表明，糖尿病会加剧精神分裂症患者的认知功能障碍（整体认知：SMD=-0.26；P = 0.1087；95% CI，-0.59至0.08），特别是在推理（SMD=-0.40；P = 0.0109，95% CI -0.58至-0.22）和处理速度（SMD=-0.43；P = 0.0005，95% CI -0.52至-0.35）等领域。在关于胰岛素抵抗的研究中观察到了相互矛盾的结果（整体认知：SMD=-0.12；P = 0.5890；95% CI -0.91至0.68）。我们的研究结果表明，葡萄糖代谢失调可能会使精神分裂症患者的认知功能障碍恶化。然而，需要进一步开展更大样本量和异质性较小的研究，以调查这种影响在统计学上是否显著。解决这些代谢问题可能有助于改善精神分裂症患者的认知和功能结局。
