The Research On Metabolic Syndrome And Cognitive Dysfunction Of Schizophrenia Patients Under Olanzapine Treatment And Other Effect Of Correlative Factor

Background: Schizophrenia is a severe mental illness with high prevalence and unclear causes,which may lead to functional impairments of perception,thinking,memory,attention,emotion and behavior,causing severely impairment of daily living,cognitive function,social function and long-term prognosis of patients.There is evidence that olanzapine causing the metabolic syndrome(MetS)can increase cognitive dysfunction in schizophrenics.The results show that there is an internal relationship between metabolic disorders and cognitive dysfunction in schizophrenic patients with metabolic syndrome.Therefore,it is a great significance to explore the relationship among cognitive function,metabolic disorder and clinical symptoms in patients with olanzapine.Furthermore,analyze the risk factors of cognitive impairment in patients with metabolic syndrome,which is helpful to effectively improve the recognition,and promote the overall prognosis and reduce the burden of disease of patients with schizophrenia.The hypotheses of study are as follow:(1)The prevalence of cognitive impairment in patients with schizophrenia is mainly reflected in memory,attention,language,and visual spatial structure;(2)The olanzapine causing drug-induced cognitive impairment is affected by the severity of the clinical symptoms,abnormal glucose metabolism and lipid metabolism.Methods: ICD-10 diagnosis of schizophrenia was established for 180 patients by using olanzapine for more than 12 weeks.At the same time,44 healthy people whose age,gender,education and marital status matched with patients were recruited.According to the diagnostic criteria of ATP III(2005)for metabolic syndrome,these patients were divided into MetS and non-MetS.The case group was tested by biochemical examination for fasting blood glucose,triglyceride,high-density lipoprotein and other biochemical indicators.Cognitive function was assessed by Repeatable Battery for the Assessment of Neuropsychological Status(RBANS),and clinical symptoms was assessed by Positive And Negative Syndrome Scale(PANSS)and Scale for the Assessment of Negative Symptoms(SANS).Results:(1)Schizophrenia case group had higher levels of BMI(P = 0.001)and lower levels of the total score and 5 factor scores of RBANS than control group(P < 0.001 or P < 0.05).(2)The total score,negative score and general psychopathological score of PANSS in MetS were significantly higher than non-MetS(P < 0.001).(3)The total score,immediate memory,visual spatial structure,attention,and delayed memory score of RBANS in MetS were significantly lower than non-MetS(P < 0.001).(4)The positive score of PANSS was significantly positively correlated with the total score of RBANS,immediate memory,attention,and time-lapse memory(P < 0.001);The total score of PANSS,negative score,general psychopathological score had significantly negative correlation with the total score of the total,immediate memory,visual spatial structure,attention,and time-delayed memory of RBANS(P < 0.001).Moreover,emotional sluggishness,lack of will,lack of interest or socialization,and attention deficits of SANS had significantly correlation with cognitive function(P < 0.001 or P < 0.05).(5)There was a significantly negative correlation between the waist circumference and the total score of RBANS,immediate memory,visual spatial structure,attention,and time-delayed memory(P < 0.001).The fasting blood glucose had significantly negative correlation with the total score of RBANS,immediate memory,attention,and time-lapse memory(P < 0.001).Triglyceride had significantly negative correlation with total score of RBANS,immediate memory,visual spatial structure,attention,and time-lapse memory(P < 0.001).Total score of high-density lipoprotein and RBANS,immediate memory,visual spatial structure,attention,and timelapse memory(P < 0.001).Hypertension had significantly negative correlation with total score of RBANS,immediate memory,attention,time-delay memory(P < 0.001),and a slight negative correlation with visual spatial structure(P < 0.001).Hypotension had significantly negative correlation with total score of RBANS,visual spatial structure(P < 0.001),and was slight negative correlated with immediate memory and attention(P < 0.05).(6)The group of abnormal fasting blood glucose,triglyceride and high-density lipoprotein were significantly different from the group of normal fasting blood glucose,triglyceride and high-density lipoprotein in immediate memory,attention and time-delay memory(P < 0.001 or P < 0.05).(7)Stepwise multiple linear regression analysis showed that the total score of RBANS had negative correlation with the negative score of PANSS(t=9.651,P<0.001),the general psychopathological score(t=4.137,P<0.001),hypotension(t=2.010,P<0.05),fasting blood glucose(t=2.630,P<0.05),and hypertension(t=2.094,P<0.05).Conclusion:(1)Patients with schizophrenia have high BMI and common cognitive impairment compared with healthy people.The defects are mainly reflected by poor memory,reduction of visual ability,language dysfunction and attention disorder.(2)Patients with MetS had more severe cognitive impairment than non-MetS.(3)Aggravation of negative symptoms and general psychopathological symptoms,especially interest or social deficiencies and attention disorders in negative symptoms,may aggravate the cognitive impairment of patients.(4)Metabolic disorders can impair the function of immediate memory,attention and delayed memory of cognitive function.(5)Fasting blood glucose,high-density lipoprotein,and triglyceride in the glucose and lipid metabolism have significant effects on the patient's immediate memory,attention,and timelapse memory.(6)Fasting blood glucose is a risk factor for cognitive impairment in glycolipid metabolism;Elevated blood pressure,severe negative symptoms and general pathological symptoms are also risk factors for cognitive impairment.