Brain glucose metabolism in schizophrenia: a systematic review and meta-analysis of 18FDG-PET studies in schizophrenia
Open Access
- 22 June 2022
- journal article
- review article
- Published by Cambridge University Press (CUP) in Psychological Medicine
- Vol. 53 (11), 4880-4897
- https://doi.org/10.1017/s003329172200174x
Abstract
BackgroundImpaired brain metabolism may be central to schizophrenia pathophysiology, but the magnitude and consistency of metabolic dysfunction is unknown.MethodsWe searched MEDLINE, PsychINFO and EMBASE between 01/01/1980 and 13/05/2021 for studies comparing regional brain glucose metabolism using 18FDG-PET, in schizophrenia/first-episode psychosis v. controls. Effect sizes (Hedges g) were pooled using a random-effects model. Primary measures were regional absolute and relative CMRGlu in frontal, temporal, parietal and occipital lobes, basal ganglia and thalamus.ResultsThirty-six studies (1335 subjects) were included. Frontal absolute glucose metabolism (Hedge's g = −0.74 ± 0.54, p = 0.01; I2 = 67%) and metabolism relative to whole brain (g = −0.44 ± 0.34, p = 0.01; I2 = 55%) were lower in schizophrenia v. controls with moderate heterogeneity. Absolute frontal metabolism was lower in chronic (g = −1.18 ± 0.73) v. first-episode patients (g = −0.09 ± 0.88) and controls. Medicated patients showed frontal hypometabolism relative to controls (−1.04 ± 0.26) while metabolism in drug-free patients did not differ significantly from controls. There were no differences in parietal, temporal or occipital lobe or thalamic metabolism in schizophrenia v. controls. Excluding outliers, absolute basal ganglia metabolism was lower in schizophrenia v. controls (−0.25 ± 0.24, p = 0.049; I2 = 5%). Studies identified reporting voxel-based morphometry measures of absolute 18FDG uptake (eight studies) were also analysed using signed differential mapping analysis, finding lower 18FDG uptake in the left anterior cingulate gyrus (Z = −4.143; p = 0.007) and the left inferior orbital frontal gyrus (Z = −4.239; p = 0.02) in schizophrenia.ConclusionsWe report evidence for hypometabolism with large effect sizes in the frontal cortex in schizophrenia without consistent evidence for alterations in other brain regions. Our findings support the hypothesis of hypofrontality in schizophrenia.Funding Information
- National Institute for Health and Care Research
- Wellcome Trust (094849/Z/10/Z)
- Brain and Behavior Research Foundation
- Maudsley Charity (666)
This publication has 105 references indexed in Scilit:
- Antipsychotic Drugs Rapidly Induce Dopamine Neuron Depolarization Block in a Developmental Rat Model of SchizophreniaJournal of Neuroscience, 2011
- Characterization of the anterior cingulate's role in the at-risk mental state using graph theoryNeuroImage, 2011
- Meta-analysis of 41 Functional Neuroimaging Studies of Executive Function in SchizophreniaArchives of General Psychiatry, 2009
- How to Select, Calculate, and Interpret Effect SizesJournal of Pediatric Psychology, 2009
- Left inferior frontal gyrus is critical for response inhibitionBMC Neuroscience, 2008
- Amiloride-sensitive channels in type I fungiform taste cells in mouseBMC Neuroscience, 2008
- Marked Hypofrontality in Clozapine-responsive PatientsPharmacopsychiatry, 2007
- The Brain Metabolic Patterns of Clozapine- and Fluphenazine-Treated Female Patients with Schizophrenia Evidence of a Sex EffectNeuropsychopharmacology, 1999
- Limbic Dysfunction in Schizophrenia and ManiaThe British Journal of Psychiatry, 1996