[Brain functional and cognitive features in schizophrenia patients with positive and negative symptom features based...

Objective: To explore the brain functional and cognitive characteristics of schizophrenia (SZ) patients with predominant positive or negative symptoms using resting-state functional magnetic resonance imaging (rs-fMRI). Methods: SZ patients who visited the Second Affiliated Hospital of Henan Medical University from March 2021 to June 2024 were prospectively included and evaluated with the Positive and Negative Syndrome Scale (PANSS). They were then divided into the positive symptom-dominant SZ group (SZ-Ⅰ group) and the negative symptom-dominant SZ group (SZ-Ⅱ group) based on the results. Healthy individuals were recruited from the surrounding communities as the control group. The cognitive function of SZ patients was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Whole-brain rs-fMRI data was collected from all subjects, and low-frequency amplitude (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) were calculated. Brain regions with significant differences among the three groups were identified through inter-group comparisons and used as regions of interest (ROI) to calculate the whole-brain functional connectivity (FC) and perform inter-group comparisons. Partial correlation analysis was conducted to explore the correlations between rs-fMRI and MCCB subscale scores among the three groups. Results: The SZ-Ⅰ group included 18 males and 20 females, with an average age of (28.2±7.8) years; the SZ-Ⅱ group included 19 males and 18 females, with an average age of (30.9±6.4) years; and the control group included 16 males and 20 females, with an average age of (32.6±9.3) years. There were no significant differences in gender and age among the three groups (all P>0.05). The fALFF value of the right caudate nucleus showed significant differences among the three groups, with the SZ-Ⅰ group having a higher fALFF value than the SZ-Ⅱ group, and both SZ groups having higher fALFF values than the control group (all P<0.05, FDR corrected). The FC values from the right caudate nucleus to the right angular gyrus and the right caudate nucleus to the right inferior parietal lobule were higher in the SZ-Ⅱ group than in the SZ-Ⅰ group (all P<0.05, GRF corrected). In the SZ-Ⅰ group, the fALFF value of the right caudate nucleus was potentially negatively correlated with the maze test score (r=-0.388, P_FDR=0.340), and in the SZ-Ⅱ group, the fALFF value of the right caudate nucleus was potentially negatively correlated with the spatial span test (r=-0.479, P_FDR=0.100). Conclusions: There are differences in the brain functional activities and connections related to the right caudate nucleus in SZ patients with predominant positive or negative symptoms. The abnormal brain functional activities are associated with the specific cognitive impairments in SZ patients with different symptom characteristics, suggesting that the right caudate nucleus can be a potential functional imaging biomarker for differentiating SZ patients with different symptom characteristics.