Abstract
This study investigated the clinical and neuropsychological correlates of N-acetyl aspartate (NAA) concentration in the anterior cingulate cortex (ACC) in schizophrenia, and explored whether ACC NAA concentration is sensitive to symptom change following cognitive behaviour therapy for psychosis (CBTp). Participants comprised 30 patients and 15 healthy controls who underwent magnetic resonance spectroscopy of the ACC and were assessed on frontal lobe based neuropsychological tasks. Twenty-four (of 30) patients were followed-up; 11 subsequently received 8–9months of CBTp in addition to standard care (CBTp+SC) and 13 received SC only. At baseline (i) NAA and Cr concentrations were lower in patients compared to controls, (ii) in patients, NAA concentration correlated inversely with positive symptoms and general psychopathology (positive symptoms explained 21% of the variance; total variance explained=25%) and Cho concentration correlated inversely with positive symptoms, and (iii) in controls, NAA concentration correlated positively with working and short-term memory and Cr concentration inversely with executive function. NAA concentration tended to increase in CBTp+SC patients at follow-up (n=7 with usable data) concomitant with improvement in positive symptoms. NAA concentration may be more closely associated with symptoms and symptom change than frontal lobe based neuropsychological function in schizophrenia, perhaps because the latter is relatively stable during the long-term illness course.
Highlights
Schizophrenia is often characterised by a profile of clinical and neuropsychological impairment that is consistent with a frontal lobe-based pathology (Weinberger et al, 1994)
Group differences in metabolite concentration in the anterior cingulate cortex (ACC) - N-acetyl aspartate (NAA), Cr and grey matter (GM) concentrations were lower in the patient compared to healthy participant group (Table 3)
Clinical correlates of metabolite concentration n NAA concentration correlated inversely with positive symptoms, general t psychopathology and total symptoms (Table 4). These correlations remained significant after controlling for GM
Summary
Schizophrenia is often characterised by a profile of clinical and neuropsychological impairment that is consistent with a frontal lobe-based pathology (Weinberger et al, 1994). N-acetyl aspartate (NAA) loss and impaired mitochondrial function are characteristic of several neurodegenerative diseases, including eAlzheimer's Disease and multiple sclerosis (Perry et al, 2002; Rutten et al, 2003). These findings suggest that NAA concentration may be an indicator of mitochondrial. N-methyl D-aspartate (NMDA) receptor activation coupled with Ca2+
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