The relationship between blood–brain barrier dysfunction and neurocognitive impairments in first-episode psychosis: findings from a retrospective chart analysis
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany
Lukas Roell
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany
Johanna Strauss
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany
Piyumi Fernando
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Germany
Susanne Muenz
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany
Peter Eichhorn
Institute of Laboratory Medicine, University Hospital, Ludwig Maximilian University of Munich, Germany
Andrea Schmitt
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany; and Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, Brazil
Susanne Karch
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany
Oliver Pogarell
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany
Rolf R. Engel
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany
Peter Falkai
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany; and Max Planck Institute of Psychiatry, Germany
Alkomiet Hasan
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Germany
Elias Wagner
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Germany
Background Even before the onset of psychotic symptoms, individuals with schizophrenia display cognitive impairments. Simultaneously, increasing amounts of individuals exhibit dysfunction of the blood–brain barrier (BBB). However, the impact of BBB dysfunction on neurocognitive impairment in people with first-episode psychosis has not yet been investigated. Aims To advance understanding of said relationship, we considered one of the largest first-episode psychosis cohorts with cerebrospinal fluid parameters available, and investigated whether BBB dysfunction is related to working memory, working speed and attention. Method We conducted a retrospective chart review of 121 in-patients diagnosed with a first episode of a schizophrenia spectrum disorder. Patients underwent neurocognitive testing and a lumbar puncture within routine clinical care. To define BBB dysfunction, albumin cerebrospinal fluid/serum quotients, immunoglobulin G ratios and oligoclonal band types were evaluated, and gender-specific differences investigated. Neurocognitive functioning was assessed by the Wechsler Adult Intelligence Scale, Test of Attentional Performance and Repeatable Battery for the Assessment of Neuropsychological Status. We performed simple and multiple linear regression analyses to interpret associations of interest. Results Of those tested, 16% showed an alteration in albumin quotients and 12% had an oligoclonal band type indicating BBB dysfunction. Notably, male patients were more likely to have an increased albumin quotient and a higher immunoglobulin G ratio than female patients. We found no significant association between BBB dysfunction and neurocognitive assessments. Conclusions The hypothesised relationship between BBB and neurocognitive impairments was not detectable in our retrospective cohort. Further cerebrospinal fluid-based studies with a longitudinal assessment of cognitive functioning and disease trajectory are urgently needed.
