Glymphatic system dysfunction in chronic schizophrenia: A comparison between risperidone combined with clozapine and...

Area of Science:

• Neuroscience
• Radiology
• Psychiatry

Background:

• Schizophrenia is associated with brain alterations, but the impact of different antipsychotic treatments on glymphatic function is not well understood.
• Glymphatic system dysfunction may contribute to neurobiological changes in schizophrenia.
• This study investigates glymphatic function differences in schizophrenia patients on combined risperidone-clozapine versus risperidone monotherapy.

Purpose of the Study:

• To compare glymphatic function, assessed by the Diffusion Tensor Imaging-based Aquaporin-4 Lumbar Puncture Score (DTI-ALPS) index, between chronic schizophrenia patients on risperidone combined with clozapine (RCT-SZ) and risperidone monotherapy (RT-SZ).
• To explore the association between glymphatic function and clinical characteristics in these patient groups.
• To establish a non-invasive imaging method for evaluating glymphatic function in patients undergoing different antipsychotic regimens.

Main Methods:

• Diffusion Tensor Imaging (DTI) was used to calculate the DTI-ALPS index in 37 RCT-SZ patients, 30 RT-SZ patients, and 36 healthy controls (HC).
• Analysis of covariance (ANCOVA) with age, sex, education, smoking status, and BMI as covariates was performed to compare ALPS indices across groups.
• General linear models examined group-clinical variable interactions, and correlation analyses assessed the relationship between ALPS indices and clinical characteristics.

Main Results:

• Both RCT-SZ and RT-SZ groups exhibited significantly decreased DTI-ALPS indices compared to HC.
• The RCT-SZ group showed significantly lower bilateral mean and left hemisphere ALPS indices than the RT-SZ group.
• Negative correlations were found between bilateral mean and left hemisphere ALPS indices and cognitive function.

Conclusions:

• Combined risperidone and clozapine treatment in schizophrenia is associated with reduced glymphatic function compared to risperidone monotherapy.
• The DTI-ALPS index, a measure of glymphatic function, is linked to cognitive performance in schizophrenia patients.
• This imaging approach offers a potential method for assessing glymphatic function in patients on varied antipsychotic treatments.