Association Between Frontotemporal Atrophy and Cognitive Impairment in Patients with Schizophrenia Based on Computed Tomography Imaging

Yueling Wang,1,* Juntao Yang,2,* Ying Ye,1 Lihua Lu,1 Haolei Wang,1 Peipei Guo,1 Na Hou,1 Xiaohan Huang,3 Cairui Li4 1Department of Medical Imaging, Mental Hospital of Yunnan Province, Kunming, 650000, People’s Republic of China; 2Department of Radiology, People’s Hospital of Dali Bai Autonomous Prefecture, Dali Bai Autonomous Prefecture, Yunnan, 671000, People’s Republic of China; 3School of Stomatology, Kunming Medical University, Kunming, Yunnan, 650500, People’s Republic of China; 4Department of Ophthalmology, People’s Hospital of Dali Bai Autonomous Prefecture, Dali Bai Autonomous Prefecture, Yunnan, 671000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cairui Li, Department of Ophthalmology, People’s Hospital of Dali Bai Autonomous Prefecture, No. 35, Renmin South Road, Dali, Dali Bai Autonomous Prefecture, Yunnan, 671000, People’s Republic of China, Email lcrbrett@163.com Xiaohan Huang, School of Stomatology, Kunming Medical University, No. 1088, Haiyuan Middle Road, Wuhua District, Kunming, Yunnan, 650500, People’s Republic of China, Email Huangxh12319780@163.comBackground: Patients with schizophrenia (SZ) exhibit frontotemporal atrophy accompanied by cognitive impairment. However, the relationship between CT-derived structural changes and cognitive deficits remains underexplored. This study aimed to evaluate the association between frontotemporal atrophy and cognitive performance using routine cranial CT.Methods: This retrospective cross-sectional case–control study included 120 patients with SZ and 100 healthy controls. Bifrontal ratio (BFR), frontal horn width (FHW), mean temporal horn width (THW_mean), sylvian fissure width (SFW), and frontotemporal atrophy index (FTAI) were measured. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the Trail Making Test (TMT). Group comparisons, Spearman correlation, and multivariable regression analyses were performed.Results: Patients with SZ showed significantly increased atrophy indices and reduced cognitive performance. FTAI was negatively associated with global cognition, executive function, and attention. In multivariable models, FTAI remained significantly associated with cognitive outcomes and contributed to improved model fit (ΔR2 = 0.319).Conclusion: CT-derived frontotemporal atrophy was significantly associated with cognitive impairment in SZ. These findings suggest that CT-based structural measures may provide a clinically accessible approach for characterizing brain changes related to cognitive dysfunction.Keywords: schizophrenia, cognitive impairment, frontotemporal atrophy, computed tomography imaging, montreal cognitive assessment, trail making test, multivariable regression