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The relationship between cognitive impairment in schizophrenia and metabolic syndrome: a systematic review and meta-analysis

Published online by Cambridge University Press:  29 December 2016

E. Bora*
Affiliation:
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia Department of Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
B. B. Akdede
Affiliation:
Department of Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
K. Alptekin
Affiliation:
Department of Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
*
*Address for correspondence: Dr E. Bora, Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Alan Gilbert Building NNF level 3, Carlton 3053, Australia. (Email: [email protected]; [email protected])

Abstract

Background

Individuals with schizophrenia are at greater risk for metabolic syndrome (MetS) which is associated with cognitive deficits in the general population. MetS might be potentially an important contributing factor to cognitive impairment in schizophrenia.

Method

In the current systematic review and meta-analysis, the findings of 18 studies investigating the association between MetS (and its components) with cognitive impairment in schizophrenia are reviewed.

Results

Co-morbidity of MetS (d = 0.28) and diabetes mellitus (d = 0.28) were both associated with more severe cognitive deficits in schizophrenia. There was also evidence for a significant relationship between cognitive impairment in schizophrenia and each of the components of MetS including hypertension, dyslipidemia, abdominal obesity and diabetes.

Conclusions

MetS is significantly associated with cognitive impairment in schizophrenia and can potentially contribute to functional decline observed in some patients with schizophrenia throughout the course of illness.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2016 

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References

Beltrán-Sánchez, H, Harhay, MO, Harhay, MM, McElligott, S (2013). Prevalence and trends of metabolic syndrome in the adult U.S. population, 1999–2010. Journal of American College of Cardiology 62, 697703.Google Scholar
Biessels, GJ, Staekenborg, S, Brunner, E, Brayne, C, Scheltens, P (2006). Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurology 5, 6474.Google Scholar
Bora, E (2015). Neurodevelopmental origin of cognitive impairment in schizophrenia. Psychological Medicine 45, 19.CrossRefGoogle ScholarPubMed
Bora, E, Murray, RM (2014). Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis? Schizophrenia Bulletin 40, 744755.Google Scholar
Bora, E, Pantelis, C (2013). Theory of mind impairments in first-episode psychosis, individuals at ultra-high risk for psychosis and in first-degree relatives of schizophrenia: systematic review and meta-analysis. Schizophrenia Research 144, 3136.Google Scholar
Bora, E, Yucel, M, Pantelis, C (2009). Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: meta-analytic study. British Journal of Psychiatry 195, 475482.CrossRefGoogle ScholarPubMed
Bora, E, Yücel, M, Pantelis, C (2010). Cognitive impairment in schizophrenia and affective psychoses: implications for DSM-V criteria and beyond. Schizophrenia Bulletin 36, 3642.Google Scholar
Botis, AC, Miclutia, I, Vlasin, N (2016). Cognitive function in female patients with schizophrenia and metabolic syndrome. European Psychiatry 33 (Suppl.), S99.Google Scholar
Boyer, L, Richieri, R, Dassa, D, Boucekine, M, Fernandez, J, Vaillant, F, Padovani, R, Auquier, P, Lancon, C (2013). Association of metabolic syndrome and inflammation with neurocognition in patients with schizophrenia. Psychiatry Research 210, 381386.CrossRefGoogle ScholarPubMed
Boyer, L, Testart, J, Michel, P, Richieri, R, Faget-Agius, C, Vanoye, V, Auquier, P, Lancon, C, Guedj, E (2014). Neurophysiological correlates of metabolic syndrome and cognitive impairment in schizophrenia: a structural equation modeling approach. Psychoneuroendocrinology 50, 95105.CrossRefGoogle ScholarPubMed
de Nijs, J, Pet, MA, GROUP Investigators (2016). Metabolic syndrome in schizophrenia patients associated with poor premorbid school performance in early adolescence. Acta Psychiatrica Scandinavica 133, 289297.Google Scholar
Depp, CA, Strassnig, M, Mausbach, BT, Bowie, CR, Wolyniec, P, Thornquist, MH, Luke, JR, McGrath, JA, Pulver, AE, Patterson, TL, Harvey, PD (2014). Association of obesity and treated hypertension and diabetes with cognitive ability in bipolar disorder and schizophrenia. Bipolar Disorders 16, 422431.CrossRefGoogle Scholar
Farr, OM, Tsoukas, MA, Mantzoros, CS (2015). Leptin and the brain: influences on brain development, cognitive functioning and psychiatric disorders. Metabolism 64, 114130.CrossRefGoogle ScholarPubMed
Friedman, JI, Tang, CY, de Haas, HJ, Changchien, L, Goliasch, G, Dabas, P, Wang, V, Fayad, ZA, Fuster, V, Narula, J (2014). Brain imaging changes associated with risk factors for cardiovascular and cerebrovascular disease in asymptomatic patients. JACC Cardiovascular Imaging 7, 10391053.Google Scholar
Friedman, JI, Wallenstein, S, Moshier, E, Parrella, M, White, L, Bowler, S, Gottlieb, S, Harvey, PD, McGinn, TG, Flanagan, L, Davis, KL (2010). The effects of hypertension and body mass index on cognition in schizophrenia. American Journal of Psychiatry 167, 12321239.Google Scholar
Goughari, AS, Mazhari, S, Pourrahimi, AM, Sadeghi, MM, Nakhaee, N (2015). Associations between components of metabolic syndrome and cognition in patients with schizophrenia. Journal of Psychiatric Practice 21, 190197.CrossRefGoogle ScholarPubMed
Green, MF (2016). Impact of cognitive and social cognitive impairment on functional outcomes in patients with schizophrenia. Journal of Clinical Psychiatry 77 (Suppl.), 811.CrossRefGoogle ScholarPubMed
Grundy, SM, Cleeman, JI, Daniels, SR, Donato, KA, Eckel, RH, Franklin, BA, Gordon, DJ, Krauss, RM, Savage, PJ, Smith, SC Jr., Spertus, JA, Fernando Costa (2005). Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 112, 27352752.CrossRefGoogle ScholarPubMed
Guo, X, Zhang, Z, Wei, Q, Lv, H, Wu, R, Zhao, J (2013). The relationship between obesity and neurocognitive function in Chinese patients with schizophrenia. BMC Psychiatry 13, 109.CrossRefGoogle ScholarPubMed
Guo, X, Zhang, Z, Zhu, W, Lian, N, Lu, H, Zhao, J (2011). Cognitive functioning in schizophrenia with or without diabetes. Zhong Nan Da Xue Xue Bao Yi Xue Ban 36, 724727.Google Scholar
Hadhoud, KM, Fouad, AA (2013). Effect of diabetes and schizophrenia on cognitive function in Egyptians. Zagazig University Medical Journal 19, 619627.CrossRefGoogle Scholar
Han, M, Huang, XF, Chen da, C, Xiu, M, Kosten, TR, Zhang, XY (2013). Diabetes and cognitive deficits in chronic schizophrenia: a case-control study. PLoS ONE 8, e66299.Google ScholarPubMed
Handley, JD, Williams, DM, Caplin, S, Stephens, JW, Barry, J (2016). Changes in cognitive function following bariatric surgery: a systematic review. Obesity Surgery 26, 25302537.CrossRefGoogle ScholarPubMed
Lancon, C, Dassa, D, Fernandez, J, Richieri, R, Padovani, R, Boyer, L (2012). Are cardiovascular risk factors associated with verbal learning and memory impairment in patients with schizophrenia? A cross-sectional study. Cardiovascular Psychiatry Neurology 2012, 204043.Google Scholar
Laursen, TM, Munk-Olsen, T, Vestergaard, M (2012). Life expectancy and cardiovascular mortality in persons with schizophrenia. Current Opinion in Psychiatry 25, 8388.Google Scholar
Leung, A, Chue, P (2000). Sex differences in schizophrenia, a review of the literature. Acta Psychiatrica Scandinavica Suppl 401, 338.CrossRefGoogle ScholarPubMed
Li, C, Zhan, G, Rao, S, Zhang, H (2014). Metabolic syndrome and its factors affect cognitive function in chronic schizophrenia complicated by metabolic syndrome. Journal of Nervous and Mental Disease 202, 313318.Google Scholar
Lindenmayer, JP, Khan, A, Kaushik, S, Thanju, A, Praveen, R, Hoffman, L, Cherath, L, Valdez, G, Wance, D (2012). Relationship between metabolic syndrome and cognition in patients with schizophrenia. Schizophrenia Research 142, 171176.Google Scholar
McEvoy, JP (2005). Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research 80, 1932.CrossRefGoogle ScholarPubMed
McGlashan, TH, Fenton, WS (1993). Subtype progression and pathophysiologic deterioration in early schizophrenia. Schizophrenia Bulletin 19, 7184.Google Scholar
Mesholam-Gately, RI, Giuliano, AJ, Goff, KP, Faraone, SV, Seidman, LJ (2009). Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology 23, 315336.CrossRefGoogle ScholarPubMed
Meyer, JM, Nasrallah, HA, McEvoy, JP, Goff, DC, Davis, SM, Chakos, M, Patel, JK, Keefe, RSE, Stroup, TS, Lieberman, JA (2005). The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial: clinical comparison of subgroups with and without the metabolic syndrome. Schizophrenia Research 80, 918.Google Scholar
Micoulaud-Franchi, JA, Faugere, M, Boyer, L, Cermolacce, M, Richieri, R, Faget, C, Philip, P, Vion-Dury, J, Lancon, C (2015). Association of metabolic syndrome with sensory gating deficits in patients with chronic schizophrenia. Psychoneuroendocrinology 57, 125133.Google Scholar
Mitchell, AJ, Vancampfort, D, De Herdt, A, Yu, W, De Hert, M (2013 b). Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Schizophrenia Bulletin 239, 295305.CrossRefGoogle Scholar
Mitchell, AJ, Vancampfort, D, Sweers, K, van Winkel, R, Yu, W, De Hert, M (2013 a). Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders–a systematic review and meta-analysis. Schizophrenia Bulletin 39, 306318.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal 339, b2535.Google Scholar
Morgan, VA, McGrath, JJ, Jablensky, A, Badcock, JC, Waterreus, A, Bush, R, Carr, V, Castle, D, Cohen, M, Galletly, C, Harvey, C, Hocking, B, McGorry, P, Neil, AL, Saw, S, Shah, S, Stain, HJ, Mackinnon, A (2014). Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychological Medicine 44, 21632176.Google Scholar
Nasrallah, H (2015). Elevated cholesterol and triglycerides are associated with better cognitive functioning in schizophrenia data from the CATIE study. Poster presented at the 168th Meeting of the American Psychiatric Association, Toronto.Google Scholar
NCEP (2001). Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults 285, 24862497.Google Scholar
Qiu, C, Fratiglioni, L (2015). A major role for cardiovascular burden in age-related cognitive decline. Nature Reviews Cardiology 12, 267277.Google Scholar
Rashid, NA, Lim, J, Lam, M, Chong, SA, Keefe, RS, Lee, J (2013). Unraveling the relationship between obesity, schizophrenia and cognition. Schizophrenia Research 151, 107112.Google Scholar
Savla, GN, Vella, L, Armstrong, CC, Penn, DL, Twamley, EW (2013). Deficits in domains of social cognition in schizophrenia: a meta-analysis of the empirical evidence. Schizophrenia Bulletin 39, 979992.Google Scholar
Siervo, M, Arnold, R, Wells, JC, Tagliabue, A, Colantuoni, A, Albanese, E, Brayne, C, Stephan, BC (2011). Intentional weight loss in overweight and obese individuals and cognitive function: a systematic review and meta-analysis. Obesity Review 12, 968983.CrossRefGoogle ScholarPubMed
Stubbs, B, Vancampfort, D, De Hert, M, Mitchell, AJ (2015). The prevalence and predictors of type two diabetes mellitus in people with schizophrenia: a systematic review and comparative meta-analysis. Acta Psychiatrica Scandinavica 132, 144157.Google Scholar
Szöke, A, Trandafir, A, Dupont, ME, Méary, A, Schürhoff, F, Leboyer, M (2008). Longitudinal studies of cognition in schizophrenia: meta-analysis. British Journal of Psychiatry 192, 248257.Google Scholar
Takayanagi, Y, Cascella, NG, Sawa, A, Eaton, WW (2012). Diabetes is associated with lower global cognitive function in schizophrenia. Schizophrenia Research 142, 183187.CrossRefGoogle ScholarPubMed
van den Berg, E, Kloppenborg, RP, Kessels, RP, Kappelle, LJ, Biessels, GJ (2009). Type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity: a systematic comparison of their impact on cognition. Biochimica et Biophysica Acta 1792, 470481.Google Scholar
Viechtbauer, W (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software 36, 148.Google Scholar
Wallace, BC, Dahabreh, IJ, Trikalinos, TA, Lau, J, Trow, P, Schmid, CH (2012). Closing the gap between methodologists and end-users: r as a computational back-end. Journal of Statistical Software 49, 115.Google Scholar
Wysokiński, A, Dzienniak, M, Kłoszewska, I (2013). Effect of metabolic abnormalities on cognitive performance and clinical symptoms in schizophrenia . Archives of Psychiatry and Psychotherapy 4, 1325.Google Scholar
Yaffe, K (2007). Metabolic syndrome and cognitive decline. Current Alzheimer Research 4, 123126.Google Scholar
Zhang, BH, Han, M, Zhang, XY, Hui, L, Jiang, SR, Yang, FD, Tan, YL, Wang, ZR, Li, J, Huang, XF (2015). Gender differences in cognitive deficits in schizophrenia with and without diabetes. Comprehensive Psychiatry 63, 19.Google Scholar
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