Elsevier

Biological Psychiatry

Volume 70, Issue 1, 1 July 2011, Pages 88-96
Biological Psychiatry

Archival Report
Are There Progressive Brain Changes in Schizophrenia? A Meta-Analysis of Structural Magnetic Resonance Imaging Studies

https://doi.org/10.1016/j.biopsych.2011.01.032Get rights and content

Background

It is well established that schizophrenia is associated with structural brain abnormalities, but whether these are static or progress over time remains controversial.

Methods

A systematic review of longitudinal volumetric studies using region-of-interest structural magnetic resonance imaging in patients with schizophrenia and healthy control subjects. The percentage change in volume between scans for each brain region of interest was obtained, and data were combined using random effects meta-analysis.

Results

Twenty-seven studies were included in the meta-analysis, with 928 patients and 867 control subjects, and 32 different brain regions of interest. Subjects with schizophrenia showed significantly greater decreases over time in whole brain volume, whole brain gray matter, frontal gray and white matter, parietal white matter, and temporal white matter volume, as well as larger increases in lateral ventricular volume, than healthy control subjects. The time between baseline and follow-up magnetic resonance imaging scans ranged from 1 to 10 years. The differences between patients and control subjects in annualized percentage volume change were −.07% for whole brain volume, −.59% for whole brain gray matter, −.32% for frontal white matter, −.32% for parietal white matter, −.39% for temporal white matter, and +.36% for bilateral lateral ventricles.

Conclusions

These findings suggest that schizophrenia is associated with progressive structural brain abnormalities, affecting both gray and white matter. We found no evidence to suggest progressive medial temporal lobe involvement but did find evidence that this may be partly explained by heterogeneity between studies in patient age and illness duration. The causes and clinical correlates of these progressive brain changes should now be the focus of investigation.

Section snippets

Literature Search

A comprehensive search of the electronic databases EMBASE (from 1980), PsycINFO (from 1801), and Ovid MEDLINE (from 1950) was conducted using the following search strategy: ([Magnetic Resonance Imaging] OR [MRI]) AND ([Schizophrenia] OR [schizo*]) AND ([Cohort] OR [Prospective] OR [Longitudinal] OR [Follow-up] OR [Follow adj2 up] OR [Repeat] OR [Reassessed] OR [Change adj2 time]). Both free-text and expanded medical subject headings were used. The search strategy was supplemented using a cited

Results

The electronic literature search of the three databases yielded 486 articles, of which 151 were retrieved in full-text format (Figure S1 in Supplement 1). Fifty-three studies were identified as being potentially appropriate to be included in the meta-analysis. However, seven of these studies concerned regions that were not examined in any other paper and so were not suitable for meta-analysis. Several studies did not report means and standard deviations of brain volume changes over time, in

Progressive Brain Changes in Schizophrenia

Findings from this systematic review and meta-analysis suggest that patients with schizophrenia in comparison with healthy control subjects exhibit statistically significant progressive reductions in whole brain, whole brain gray matter, and frontal lobe volumes, as well as frontal, parietal, and temporal lobe white matter decrements and lateral ventricular volume enlargement over time. In contrast, no progressive volumetric changes were detected in medial temporal lobe subregions, namely the

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