Abstract
Cognitive impairment, typically more severe in treatment resistant patients, is considered a hallmark of schizophrenia and the prime driver of functional disability. Recent evidence suggests that metabolic syndrome may contribute to cognitive deficits in schizophrenia, possibly through shared underlying mechanisms. However, results are still contradictory and no study has so far examined the influence of metabolic syndrome on cognitive outcome after cognitive remediation therapy (CRT). Based on these premises, this study aims to investigate the relationship between metabolic syndrome and cognition, specifically considering cognitive outcome after treatment. Secondary objectives include the analysis of the association between cognitive impairment and psychopathological status and, in a subgroup of patients, the evaluation of the effect of Sterol Regulatory Element Binding Transcription Factor 1 (SREBF-1) rs11868035 genetic polymorphism, previously associated with metabolic alterations, on both cognition and metabolic syndrome. One-hundred seventy-two outpatients with schizophrenia were assessed for metabolic parameters and neurocognitive measures and 138 patients, who completed CRT, were re-evaluated for cognition. A subsample of 51 patients was also genotyped for rs11868035 from peripheral blood sample. Results show a negative impact of metabolic syndrome on executive functions and global cognitive outcome after CRT. Data also revealed a significant effect of SREBF-1 polymorphism, with a higher prevalence of metabolic syndrome and worse processing speed performance among G/G homozygous subjects, compared the A allele carriers. Overall these findings support the hypothesis that metabolic alterations may hamper the capacity to restore cognitive deficits, as well as they highlight the need to further explore possible converging mechanisms underlying both cognitive and metabolic dysfunction. At the clinical level, results point to the importance of a comprehensive assessment including the metabolic status of patients and of individualized strategies addressing metabolic dysfunction in order to potentiate treatment outcome in schizophrenia.
Highlights
Cognitive deficits are core features of schizophrenia, detectable in at least 75% of patients [1]
This study aims at investigating the effect of metabolic syndrome (MetS) on cognitive abilities and, innovatively with respect to previous literature, on cognitive outcome after cognitive remediation therapy (CRT)
Clinical and Socio-Demographic Variables In the whole sample analyzed, composed by 172 subjects, of which 107 males and 65 females, we observed a prevalence of Metabolic Syndrome of 22%
Summary
Cognitive deficits are core features of schizophrenia, detectable in at least 75% of patients [1]. Identifying factors affecting cognitive performance and putative predictors of cognitive remediation is of major importance in order to personalize interventions and improve outcome In this view, recent literature suggested a role of metabolic syndrome (MetS). It is important to note that the relationship between cognitive deficits and metabolic alterations might be bidirectional, since impaired neurocognitive abilities (which lead to poor decision making and unhealthy lifestyle) may contribute to the higher prevalence of MetS among patients with schizophrenia. Despite this evidence, the effect of MetS on the outcome of CRT in patients affected by schizophrenia, has never been investigated
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