Case Control Study
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World J Psychiatry. Mar 19, 2025; 15(3): 101494
Published online Mar 19, 2025. doi: 10.5498/wjp.v15.i3.101494
Voxel-based alterations in spontaneous brain activity among very-late-onset schizophrenia-like psychosis: A preliminary resting-state functional magnetic resonance imaging study
Dan-Ting Yang, Ping Ji, Jiao-Jiao Sun, Yan-Sha Gan, Shuai-Yi Guo, Zhen-He Zhou, Xue-Zheng Gao
Dan-Ting Yang, Ping Ji, Zhen-He Zhou, Xue-Zheng Gao, Department of Geriatric Psychiatry, The Affiliated Mental Health Center of Nanjing Medical University, Wuxi 214151, Jiangsu Province, China
Ping Ji, Yan-Sha Gan, Zhen-He Zhou, Xue-Zheng Gao, Department of Geriatric Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi 214151, Jiangsu Province, China
Jiao-Jiao Sun, Department of Psychiatry, The Affiliated Wutaishan Hospital of Yangzhou University, Yangzhou 225003, Jiangsu Province, China
Shuai-Yi Guo, Department of General Psychiatry, Nantong Zilang Hospital, Nantong 226006, Jiangsu Province, China
Co-first authors: Dan-Ting Yang and Ping Ji.
Co-corresponding authors: Zhen-He Zhou and Xue-Zheng Gao.
Author contributions: Zhou ZH and Gao XZ designed the study and contributed equally as co-corresponding authors; Yang DT, Ji P and Sun JJ recruited participants and collected the data; Yang DT and Ji P contributed equally as co-first authors; Yang DT, Sun JJ, Gan YS, and Guo SY analyzed data; Yang DT, Zhou ZH, and Gao XZ drafted the manuscript; and all the authors contributed to the interpretation of the results, manuscript revision, and approved the final version of the manuscript.
Supported by Wuxi Municipal Health Commission Major Project, No. 202107; and Wuxi Taihu Talent Project, No. WXTTP 2021.
Institutional review board statement: This study was approved by the Ethics Committee of the Wuxi Mental Health Center, No. WXMHCIRB2023 LLky001.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data used in this study can be obtained from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-He Zhou, MD, PhD, Professor, Department of Geriatric Psychiatry, The Affiliated Mental Health Center of Nanjing Medical University, No. 156 Qianrong Road, Wuxi 214151, Jiangsu Province, China. zhouzh@njmu.edu.cn
Received: September 16, 2024
Revised: December 17, 2024
Accepted: January 21, 2025
Published online: March 19, 2025
Processing time: 162 Days and 14.7 Hours
Abstract
BACKGROUND

Very late-onset schizophrenia-like psychosis (VLOSLP) is a subtype of schizophrenia spectrum disorders in which individuals experience psychotic symptoms for the first time after the age of 60. The incidence of VLOSLP shows a linear relationship with increasing age. However, no studies have reported alterations in spontaneous brain activity among VLOSLP patients and their correlation with cognitive function and clinical symptoms.

AIM

To explore VLOSLP brain activity and correlations with cognitive function and clinical symptoms using resting-state functional magnetic resonance imaging.

METHODS

This study included 33 VLOSLP patients and 34 healthy controls. The cognitive assessment utilized the Mini Mental State Examination, Montreal Cognitive Assessment, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Clinical characteristic acquisition was performed via the Positive and Negative Syndrome Scale (PANSS). All participants were scanned via resting-state functional magnetic resonance imaging, and the data were processed using amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity, and voxel-mirrored homotopic connectivity (VMHC).

RESULTS

The VLOSLP group presented decreased ALFF values in the left cuneus, right precuneus, right precentral gyrus, and left paracentral lobule; increased fALFF values in the left caudate nucleus; decreased fALFF values in the right calcarine fissure and surrounding cortex (CAL) and right precuneus; increased regional homogeneity values in the right putamen; and decreased VMHC values in the bilateral CAL, bilateral superior temporal gyrus, and bilateral cuneus. In the VLOSLP group, ALFF values in the right precuneus were negatively correlated with Mini Mental State Examination score and PANSS positive subscale score, and VMHC values in the bilateral CAL were negatively correlated with the RBANS total score, RBANS delayed memory score, and PANSS positive subscale score.

CONCLUSION

The changes of brain activity in VLOSLP are concentrated in the right precuneus and bilateral CAL regions, which may be associated with cognitive impairment and clinically positive symptoms.

Keywords: Very-late-onset schizophrenia-like psychosis; Schizophrenia; Resting-state functional magnetic resonance imaging; Amplitude of low-frequency fluctuations; Fractional amplitude of low-frequency fluctuations; Regional homogeneity; Voxel-mirrored homotopic connectivity

Core Tip: The incidence of very-late-onset schizophrenia-like psychosis (VLOSLP) tends to increase linearly with age, and most of these patients exhibit prominent positive symptoms as well as cognitive impairments. This study explored the changes in spontaneous brain activity in VLOSLP patients and their correlations with cognitive functions and clinical symptoms by resting-state functional magnetic resonance imaging. The results indicated that the alterations in the brain activity indices of VLOSLP patients were mainly concentrated in specific brain regions, and that the changes in these regions may lead to cognitive impairment and the emergence of positive symptoms in VLOSLP patients.