Increased Risk Factors For Cognitive Impairment In Schizophrenia Patients With Metabolic Syndrome

Objective: Severe cognitive impairment is prevalent in patients with Schizophrenia（SCZ）,which is unknown in pathogenesis and involves cognitive impairment in various fields,significantly affecting patients’ prognosis and quality of life,and causing huge economic and social burden.Adverse cardiovascular events are one of the leading causes of death in patients with SCZ.Metabolic syndrome（Met S）is widely believed to be associated with impaired cognitive ability and significantly shorten patients’ life span.Second generation antipsychotics（SGAs）,a clear risk factor for an increased prevalence of metabolic syndrome,have become the leading side effect,severely limiting their clinical use.Our objective was to identify the association between Met S and cognitive impairment in SCZ and to explore its predictive risk factors.Method: From October 2019 to July 2021,according to the Diagnostic and Statistical Manual of Mental Disorders（DSM-5）and the Guidelines for the Prevention and Treatment of Metabolic Syndrome in Adults in China（2007）,we screened 280 patients and health people,in the end,a total of 153 schizophrenic patients and healthy subjects were recruited in the closed ward of the Fourth People’s Hospital of Hefei and the surrounding communities and divided into three groups: healthy control group（n=47）;Non-mets group（n=58）;Metabolic syndrome group（n=48）.Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale.Cognitive function and automatic thinking were estimated using the Montreal Cognitive Assessment Scale,Verbal Fluency Test,and Automatic Thoughts Questionnaire.Serum biochemical parameters were measured by automatic biochemistry analyzer.All data were analyzed by SPSS 22.0.Results: There were no significant differences in age,sex,education,occupation,residence style,diet and other general background information among the three groups（P>0.05）,there were no significant differences in medication status and mental symptoms among patients.One-way ANOVA analysis found differential impairment in the function of orientation,negative automatic thinking,and language fluency barriers at the beginning of the word “self ”（F = 8.32,P <0.001;F = 12.40,P <0.001;F = 5.24,P= 0.006）.Results of multiple comparisons showed that more serious barriers in orientation,language fluency,and negative automatic thinking existed in the Met S group than in the healthy and non-Met S groups（P<0.05）.Spearman correlation and stepwise linear regression analyses showed that psychopathological symptoms,high waist circumference,and high triglyceride were the predictive factors for ATQ,orientation,and language fluency（β = 0.228,t = 2.469,P = 0.015;β =-0.262,t =-3.011,P = 0.003;β = 0.200,t =2.165,P = 0.033）.Predictive analysis results revealed that the dysbiosis parameters of TG,waist circumference,PANSS total scores,psychopathological score of PANSS,negative symptom score of PANSS,and times of meat intake had high validity and effectiveness in predicting the cognitive function impairment of the Met S group.Conclusion: We analyzed the patients with/without Met S SCZ with cognitive ability and automatic level of thinking,the results strongly support the Met S may increase a patient’s risk of cognitive impairment and negative automatic thinking SCZ point of view,and metabolic disturbance factors in the cause of the increased risk of cardiovascular events and at the same time may cause cognitive impairment in patients with aggravating and negative automatic thinking.Therefore,SCZ patients taking SGAs should receive regular monitoring and appropriate treatment for cardiometabolic risk factors,and clinicians should include Met S in their assessment of treatment regimens to reduce the risk of Met S as much as possible.