Autism Spectrum Disorders and Schizophrenia: Meta-Analysis of the Neural Correlates of Social Cognition

ContextImpaired social cognition is a cardinal feature of Autism Spectrum Disorders (ASD) and Schizophrenia (SZ). However, the functional neuroanatomy of social cognition in either disorder remains unclear due to variability in primary literature. Additionally, it is not known whether deficits in ASD and SZ arise from similar or disease-specific disruption of the social cognition network.
ObjectiveTo identify regions most robustly implicated in social cognition processing in SZ and ASD.
Data SourcesSystematic review of English language articles using MEDLINE (1995–2010) and reference lists.
Study SelectionStudies were required to use fMRI to compare ASD or SZ subjects to a matched healthy control group, provide coordinates in standard stereotactic space, and employ standardized facial emotion recognition (FER) or theory of mind (TOM) paradigms.
Data ExtractionActivation foci from studies meeting inclusion criteria (n = 33) were subjected to a quantitative voxel-based meta-analysis using activation likelihood estimation, and encompassed 146 subjects with ASD, 336 SZ patients and 492 healthy controls.
ResultsBoth SZ and ASD showed medial prefrontal hypoactivation, which was more pronounced in ASD, while ventrolateral prefrontal dysfunction was associated mostly with SZ. Amygdala hypoactivation was observed in SZ patients during FER and in ASD during more complex ToM tasks. Both disorders were associated with hypoactivation within the Superior Temporal Sulcus (STS) during ToM tasks, but activation in these regions was increased in ASD during affect processing. Disease-specific differences were noted in somatosensory engagement, which was increased in SZ and decreased in ASD. Reduced thalamic activation was uniquely seen in SZ.
ConclusionsReduced frontolimbic and STS engagement emerged as a shared feature of social cognition deficits in SZ and ASD. However, there were disease- and stimulus-specific differences. These findings may aid future studies on SZ and ASD and facilitate the formulation of new hypotheses regarding their pathophysiology.

背景 社会认知受损是孤独症谱系障碍（Autism Spectrum Disorders，ASD）与精神分裂症（Schizophrenia，SZ）的核心临床特征。然而，受限于原始研究的异质性，目前仍未明确两类疾病中社会认知的功能性神经解剖基础。此外，学界尚未明确ASD与SZ的认知缺损究竟源于社会认知网络的相似紊乱，还是疾病特异性的神经破坏。
研究目的 明确在SZ与ASD患者中，与社会认知加工过程关联最为紧密的脑区。
数据来源 系统回顾1995年至2010年MEDLINE数据库收录的英文文献及相关参考文献列表。
研究筛选标准 纳入研究需满足以下条件：采用功能磁共振成像（fMRI）对比ASD或SZ患者与匹配的健康对照组；提供标准立体定向空间内的激活坐标；采用标准化的面部情绪识别（Facial Emotion Recognition，FER）或心理理论（Theory of Mind，TOM）实验范式。
数据提取 对符合纳入标准的33项研究的激活焦点，采用激活似然估计法开展基于体素的定量元分析，最终纳入的被试包括146名ASD患者、336名SZ患者及492名健康对照个体。
研究结果 ASD与SZ患者均表现出内侧前额叶低激活，且该异常在ASD群体中更为显著；而腹外侧前额叶功能异常则主要与SZ相关。在FER任务中，SZ患者观察到杏仁核低激活，而ASD患者的该现象则出现在更复杂的TOM任务中。两类疾病在TOM任务中均表现出颞上回（Superior Temporal Sulcus，STS）低激活，但在情绪加工任务中，ASD患者的该脑区激活反而增强。研究还发现疾病特异性的躯体感觉皮层激活差异：SZ患者该脑区激活水平升高，而ASD患者则出现激活降低。丘脑激活减弱仅在SZ患者中单独出现。
结论 前额叶-边缘系统及颞上回的激活减弱，是SZ与ASD患者社会认知缺损的共同特征。但两类疾病同时存在疾病特异性与刺激特异性的神经激活差异。本研究结果可为未来SZ与ASD的相关研究提供参考依据，并有助于提出新的病理生理学假说。