Brain metabolite abnormalities in the white matter of elderly schizophrenic subjects: Implication for glial dysfunction

Background: Abnormalities in the white matter of the brain may occur in individuals with schizophrenia as well as with normal aging. Therefore, elderly schizophrenic patients may suffer further cognitive decline as they age. This study determined whether elderly schizophrenia participants, especially those with declined cognitive function (Clinical Dementia Rating score > 1), show white matter metabolite abnormalities on proton magnetic resonance spectroscopy and whether there are group differences in age-dependent changes in these brain metabolites. Method: Twenty-three elderly schizophrenia and twenty-two comparison participants fulfilling study criteria were enrolled. Localized, short echo-time H-1 MRS at 4 Tesla was used to assess neurometabolite concentrations in several white matter regions. Results: Compared with healthy subjects, schizophrenia participants had lower N-acetyl compounds (- 12.6%, p =.0008), lower myoinositol (-16.4%, p =.026), and higher glutamate + glutamine (+28.7%, p =.0016) concentrations across brain regions. Schizophrenia participants with Clinical Dementia Rating >= 1 showed the lowest NA in the frontal and temporal regions compared with control subjects. Interactions between age and schizophrenia status on total creatine and choline-containing compounds were observed; only schizophrenia participants showed age-related decreases of these metabolites in the right frontal region. Conclusions: Decreased NA in these white matter brain regions likely reflects reduced neuronal content associated with decreased synapses and neuronal cell volumes. The elevated glutamate + glutamine, if reflecting elevated glutamate, could result from excess neuronal glutamate release or glial dysfunction in glutamate reuptake. The decreased myo-inositol in participants with schizophrenia suggests decreased glial content or dysfunctional glia, which might result from glutamate-mediated toxicity.