1
|
Li JY, Wu H, Yuan S, Wang C, Wang Q, Zhong Y, Zhang N, Heffner K, Fox PT. A meta-analysis on neural changes of cognitive training for mental disorders in executive function tasks: increase or decrease brain activation? BMC Psychiatry 2022; 22:155. [PMID: 35232404 PMCID: PMC8886766 DOI: 10.1186/s12888-022-03796-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairment is often found in patients with psychiatric disorders, and cognitive training (CT) has been shown to help these patients. To better understand the mechanisms of CT, many neuroimaging studies have investigated the neural changes associated with it. However, the results of those studies have been inconsistent, making it difficult to draw conclusions from the literature. Therefore, the objective of this meta-analysis was to identify consistent patterns in the literature of neural changes associated with CT for psychiatric disorders. METHODS We searched for cognitive training imaging studies in PubMed, Cochrane library, Scopus, and ProQuest electronic databases. We conducted an activation likelihood estimation (ALE) for coordinate-based meta-analysis of neuroimaging studies, conduct behavioral analysis of brain regions identified by ALE analysis, conduct behavioral analysis of brain regions identified by ALE analysis, and then created a functional meta-analytic connectivity model (fMACM) of the resulting regions. RESULTS Results showed that CT studies consistently reported increased activation in the left inferior frontal gyrus (IFG) and decreased activation in the left precuneus and cuneus from pre- to post- CT. CONCLUSION CT improves cognitive function by supporting language and memory function, and reducing neuronal resources associated with basic visual processing.
Collapse
Affiliation(s)
- Jin Yang Li
- grid.89957.3a0000 0000 9255 8984Nan jing Brain Hospital affiliated to Nanjing Medical University, Nanjing, 210029 Jiangsu China ,grid.89957.3a0000 0000 9255 8984Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, 210029 Jiangsu China
| | - Huiqin Wu
- grid.89957.3a0000 0000 9255 8984Nan jing Brain Hospital affiliated to Nanjing Medical University, Nanjing, 210029 Jiangsu China
| | - Shiting Yuan
- grid.89957.3a0000 0000 9255 8984Nan jing Brain Hospital affiliated to Nanjing Medical University, Nanjing, 210029 Jiangsu China
| | - Chun Wang
- Nan jing Brain Hospital affiliated to Nanjing Medical University, Nanjing, 210029, Jiangsu, China. .,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Qian Wang
- grid.24696.3f0000 0004 0369 153XBeiJing TianTan Hospital, Capital Medical University, Beijing, 100050 China
| | - Yuan Zhong
- grid.260474.30000 0001 0089 5711School of Psychology, Nanjing Normal University, Nanjing, 210029 Jiangsu China
| | - Ning Zhang
- grid.89957.3a0000 0000 9255 8984Nan jing Brain Hospital affiliated to Nanjing Medical University, Nanjing, 210029 Jiangsu China ,grid.89957.3a0000 0000 9255 8984Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, 210029 Jiangsu China
| | - Kathi Heffner
- grid.412750.50000 0004 1936 9166Department of Psychiatry, University of Rochester School of Nursing, Rochester, New York 14622 USA
| | - Peter T. Fox
- grid.89957.3a0000 0000 9255 8984Nan jing Brain Hospital affiliated to Nanjing Medical University, Nanjing, 210029 Jiangsu China ,grid.89957.3a0000 0000 9255 8984Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, 210029 Jiangsu China ,grid.267309.90000 0001 0629 5880South Texas Veterans Healthcare System, University of Texas Health San Antonio, San Antonio, USA ,grid.267309.90000 0001 0629 5880Research Imaging Institute, University of Texas Health San Antonio, San Antonio, USA
| |
Collapse
|
2
|
Wexler BE. Returning to basic principles to develop more effective treatments for central nervous system disorders. Exp Biol Med (Maywood) 2022; 247:856-867. [PMID: 35172621 PMCID: PMC9158240 DOI: 10.1177/15353702221078291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Development of new treatments for diseases of the central nervous system (CNS) is
stalled. Of candidate drugs developed through costly preclinical research, 93%
fail clinical trials. Hoped-for improvements in diagnosis or treatment from
decades of positron emission tomography (PET) and functional magnetic resonance
imaging (fMRI) imaging have yet to materialize. To understand what we are doing
wrong, I begin with recognition that all aspects of life, including the brain
and mind, are physical phenomena consistent with processes described by
physicists. Two processes, emergence and entropy, are of particular relevance in
complex arrangements of matter that constitute life in general and the brain in
particular. The human brain functions through dynamically reconfiguring and
hierarchically organized neural functional systems with emergent properties of
cognition, emotion, and conscious experience. These systems are shaped and
maintained by negentropic environmental input transformed by sensory receptors
into neural signals that trigger epigenetic neuroplastic processes. CNS diseases
produce clinical disorders by disrupting these systems. As researchers seek
appropriate levels of system organization at which to characterize and treat
illness, focus has been on medications that impact processes at lower levels or
transcranial electric or magnetic stimulation that impact broad contiguous
swaths of tissue. Neither align with the brain’s neurosystem organization and
therefore lack specificity necessary to be effective and to limit side effects.
Digital neurotherapies (DNTs), in contrast, align with neurosystem organization
and achieve the needed specificity using the same input pathways and
neuroplastic processes that created the neural systems organization to repair
it. The omission of DNTs from major systems-based initiatives represents
powerful residua of dualist thinking. Interventions based on perceptual and
cognitive processes are not thought of as being as physical as drugs or electric
or magnetic stimulation through the skull. In fact, they are examples of the
most basic processes that create and support life itself.
Collapse
|
3
|
Ma S, Li Y, Liu Y, Xu C, Li H, Yao Q, Wang Y, Yang Z, Zuo P, Yang M, Mo X. Changes in Cortical Thickness Are Associated With Cognitive Ability in Postoperative School-Aged Children With Tetralogy of Fallot. Front Neurol 2020; 11:691. [PMID: 32765405 PMCID: PMC7380078 DOI: 10.3389/fneur.2020.00691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022] Open
Abstract
In children with tetralogy of Fallot (TOF), there is a risk of brain injury even if intracardiac deformities are corrected. This population follow-up study aimed to identify the correlation between cerebral morphology changes and cognition in postoperative school-aged children with TOF. Resting-state functional magnetic resonance imaging (rs-fMRI) and the Wechsler Intelligence Scale for Children–Chinese revised edition (WISC-CR) were used to assess the difference between children with TOF and healthy children (HCs). Multiple linear regression showed that the TOF group had a lower verbal intelligence quotient (VIQ, 95.000 ± 13.433, p = 0.001) than the HC group and that VIQ had significant positive correlations with the cortical thickness of both the left precuneus (p < 0.05) and the right caudal middle frontal gyrus (p < 0.05) after adjustment for preoperative SpO2, preoperative systolic blood pressure (SBP), preoperative diastolic blood pressure (DBP) and time of aortic override (AO). Our results suggested that brain injury induced by TOF would exert lasting effects on cortical and cognitive development at least to school age. This study provides direct evidence of the relationship between cortical thickness and VIQ and of the need for strengthened verbal training in school-aged TOF patients after corrective surgery.
Collapse
Affiliation(s)
- Siyu Ma
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yaping Li
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yuting Liu
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Xu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Huijun Li
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qiong Yao
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Wang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhaocong Yang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Pengcheng Zuo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Smith SD, Vitulano LA, Katsovich L, Li S, Moore C, Li F, Grantz H, Zheng X, Eicher V, Guloksuz SA, Zheng Y, Dong J, Sukhodolsky DG, Leckman JF. A Randomized Controlled Trial of an Integrated Brain, Body, and Social Intervention for Children With ADHD. J Atten Disord 2020; 24:780-794. [PMID: 27178060 PMCID: PMC5107355 DOI: 10.1177/1087054716647490] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: This study evaluated the efficacy of an Integrated Brain, Body, and Social (IBBS) intervention for children with ADHD. Treatment consisted of computerized cognitive remediation training, physical exercises, and a behavior management strategy. Method: Ninety-two children aged 5 to 9 years with ADHD were randomly assigned to 15 weeks of IBBS or to treatment-as-usual. Primary outcome measures included blinded clinician ratings of ADHD symptoms and global clinical functioning. Secondary outcome measures consisted of parent and teacher ratings of ADHD and neurocognitive tests. Results: No significant treatment effects were found on any of our primary outcome measures. In terms of secondary outcome measures, the IBBS group showed significant improvement on a verbal working memory task; however, this result did not survive correction for multiple group comparisons. Conclusion: These results suggest that expanding cognitive training to multiple domains by means of two training modalities does not lead to generalized improvement of ADHD symptomatology.
Collapse
Affiliation(s)
- Stephanie D. Smith
- Yale School of Medicine, New Haven, CT, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | - Shuaixing Li
- Beijing Physical Education & Skill College, People’s Republic of China
| | - Christina Moore
- Yale School of Medicine, New Haven, CT, USA
- University of Delaware, Newark, DE, USA
| | - Fenghua Li
- Chinese Academy of Sciences, Beijing, People’s Republic of China
| | | | - Xixi Zheng
- Peking Union Medical College, Beijing, People’s Republic of China
| | | | | | - Yi Zheng
- Capital Medical University, Beijing, People’s Republic of China
| | - Jinxia Dong
- Peking University, Beijing, People’s Republic of China
| | | | | |
Collapse
|
5
|
Wiest DJ, Wong EH, Bacon JM, Rosales KP, Wiest GM. The effectiveness of computerized cognitive training on working memory in a school setting. APPLIED COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1002/acp.3634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Dudley J. Wiest
- Department of Special Education, Rehabilitation, and CounselingCalifornia State University San Bernardino San Bernardino CA
| | - Eugene H. Wong
- Department of PsychologyCalifornia State University San Bernardino San Bernardino CA
| | - Jennifer M. Bacon
- Department of PsychologyCalifornia State University San Bernardino San Bernardino CA
| | - Kevin P. Rosales
- Division of Behavioral and Organizational SciencesClaremont Graduate University Claremont CA
| | - Grahamm M. Wiest
- Department of PsychologyAlliant International University Los Angeles CA
| |
Collapse
|
6
|
Zhao W, Huang L, Li Y, Zhang Q, Chen X, Fu W, Du B, Deng X, Ji F, Xiang YT, Wang C, Li X, Dong Q, Chen C, Jaeggi SM, Li J. Evidence for the contribution of COMT gene Val158/108Met polymorphism (rs4680) to working memory training-related prefrontal plasticity. Brain Behav 2020; 10:e01523. [PMID: 31917897 PMCID: PMC7010579 DOI: 10.1002/brb3.1523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/28/2019] [Accepted: 12/07/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Genetic factors have been suggested to affect the efficacy of working memory training. However, few studies have attempted to identify the relevant genes. METHODS In this study, we first performed a randomized controlled trial (RCT) to identify brain regions that were specifically affected by working memory training. Sixty undergraduate students were randomly assigned to either the adaptive training group (N = 30) or the active control group (N = 30). Both groups were trained for 20 sessions during 4 weeks and received fMRI scans before and after the training. Afterward, we combined the data from the 30 participants in the RCT study who received adaptive training with data from 71 additional participants who also received the same adaptive training but were not part of the RCT study (total N = 101) to test the contribution of the COMT Val158/108Met polymorphism to the interindividual difference in the training effect within the identified brain regions. RESULTS In the RCT study, we found that the adaptive training significantly decreased brain activation in the left prefrontal cortex (TFCE-FWE corrected p = .030). In the genetic study, we found that compared with the Val allele homozygotes, the Met allele carriers' brain activation decreased more after the training at the left prefrontal cortex (TFCE-FWE corrected p = .025). CONCLUSIONS This study provided evidence for the neural effect of a visual-spatial span training and suggested that genetic factors such as the COMT Val158/108Met polymorphism may have to be considered in future studies of such training.
Collapse
Affiliation(s)
- Wan Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Ling Huang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yang Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Qiumei Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,School of Mental Health, Jining Medical University, Jining, China
| | - Xiongying Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Wenjin Fu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Boqi Du
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xiaoxiang Deng
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Feng Ji
- School of Mental Health, Jining Medical University, Jining, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Taipa, China
| | - Chuanyue Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Qi Dong
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Chuansheng Chen
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Susanne M Jaeggi
- School of Education & Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Jun Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| |
Collapse
|
7
|
Riedl L, Nagels A, Sammer G, Straube B. A Multimodal Speech-Gesture Training Intervention for Patients With Schizophrenia and Its Neural Underpinnings - the Study Protocol of a Randomized Controlled Pilot Trial. Front Psychiatry 2020; 11:110. [PMID: 32210849 PMCID: PMC7068208 DOI: 10.3389/fpsyt.2020.00110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 02/07/2020] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia that also affects quality of life. Interpreting abstract speech and integrating nonverbal modalities is particularly affected. Considering the impact of communication on social life but failure to treat communication dysfunctions with usual treatment, we will investigate the possibility to improve verbal and non-verbal communication in schizophrenia by applying a multimodal speech-gesture training (MSG training). Here we describe the newly developed MSG training program and the study design for the first clinical investigation. The intervention contains perceptive rating (match/mismatch of sentence and gesture) and memory tasks (n-back tasks), imitation and productive tasks (e.g., SG fluency-similar to verbal fluency where words are accompanied by gesture). In addition, we offer information about gesture as meta-learning element as well as homework for reasons of transfer to everyday life as part of every session. In the MSG training intervention, we offer eight sessions (60 min each) of training. The first pilot study is currently conducted as a single-center, randomized controlled trial of speech-gesture intervention versus wait-list control with a follow-up. Outcomes are measured through pre-post-fMRI and standardized psychological questionnaires comparing two subject groups (30 patients with schizophrenia and 30 healthy controls). Patients and healthy controls are randomized in two intervention groups (with 20 being in the wait-training group and 10 in the training-follow-up group). With our study design we will be able to demonstrate the beneficial effect of the MSG training intervention on behavioral and neural levels. CLINICAL TRIAL REGISTRATION DRKS.de, identifier DRKS00015118.
Collapse
Affiliation(s)
- Lydia Riedl
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Arne Nagels
- Department of English and Linguistics, Johannes-Gutenberg-University, Mainz, Germany
| | - Gebhard Sammer
- Department of Psychiatry and Psychotherapy, Justus-Liebig-University, Gießen, Germany
| | - Benjamin Straube
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| |
Collapse
|
8
|
Uscinska M, Polla Mattiot A, Bellino S. Treatment-Induced Brain Plasticity in Psychiatric Disorders. Behav Neurosci 2019. [DOI: 10.5772/intechopen.85448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
Li X, Chu MY, Lv QY, Hu HX, Li Z, Yi ZH, Wang JH, Zhang JY, Lui SSY, Cheung EFC, Shum DHK, Chan RCK. The remediation effects of working memory training in schizophrenia patients with prominent negative symptoms. Cogn Neuropsychiatry 2019; 24:434-453. [PMID: 31583951 DOI: 10.1080/13546805.2019.1674644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Negative symptoms, particularly amotivation and anhedonia, are important predictors of poor functional outcome in patients with schizophrenia. There has been interest in the efficacy and mechanism of non-pharmacological interventions to alleviate these symptoms. The present study aimed to examine the remediation effect of working memory (WM) training in patients with schizophrenia with prominent negative symptoms.Methods: Thirty-one schizophrenia patients with prominent negative symptoms were recruited and assigned to either a WM training group or a treatment-as-usual (TAU) control group. The WM training group underwent 20 sessions of training using the dual n-back task over one month. A functional neuroimaging paradigm of the Affective Incentive Delay (AID) task was administered before and after the training intervention to evaluate the remediation effect of the intervention.Results: Our results showed that the WM training group demonstrated significant improvement in the WM training task and inattention symptoms. Compared with the TAU group, increased brain activations were observed at the right insula and the right frontal sub-gyral after WM training in the training group.Conclusions: These findings support the efficacy of WM training in ameliorating hedonic dysfunction in schizophrenia patients with prominent negative symptoms.
Collapse
Affiliation(s)
- Xu Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China.,Key Laboratory of Adolescent Cyberpsychology and Behavior(CCNU), Ministry of Education, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Min-Yi Chu
- Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qin-Yu Lv
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hui-Xin Hu
- Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhi Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Zheng-Hui Yi
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jin-Hong Wang
- MRI Center, Shanghai Mental Health Centre, Shanghai, People's Republic of China
| | - Jian-Ye Zhang
- MRI Center, Shanghai Mental Health Centre, Shanghai, People's Republic of China
| | - Simon S Y Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Castle Peak Hospital, Hong Kong Special Administration Region, People's Republic of China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administration Region, People's Republic of China
| | - David H K Shum
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Gold Coast, Australia.,Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China.,Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Gold Coast, Australia
| |
Collapse
|
10
|
Mothersill D, Donohoe G. Neural Effects of Cognitive Training in Schizophrenia: A Systematic Review and Activation Likelihood Estimation Meta-analysis. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:688-696. [PMID: 31072761 DOI: 10.1016/j.bpsc.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/13/2019] [Accepted: 03/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cognitive dysfunction is a core feature of schizophrenia and a strong predictor of functional outcome. There is growing evidence for the effectiveness of behaviorally based cognitive training programs, although the neural basis of these benefits is unclear. To address this, we reviewed all published studies that have used neuroimaging to measure neural changes following cognitive training in schizophrenia to identify brain regions most consistently affected. METHODS We searched PubMed for all neuroimaging studies examining cognitive training in schizophrenia published until December 2018. An activation likelihood estimation meta-analysis was conducted on a subset of functional magnetic resonance imaging studies to examine whether any brain regions showed consistent effects across studies. RESULTS In total, 31 original neuroimaging studies of cognitive training were retrieved. Of these studies, 16 were functional neuroimaging studies, and 15 of these studies reported increased neural activation following cognitive training, with increased left prefrontal activation being the most frequently observed finding. However, activation likelihood estimation meta-analysis did not reveal any specific brain regions showing consistent effects across studies but rather suggested a broader, more distributed pattern of effects resulting from the interventions tested. CONCLUSIONS Although several studies reported increased left prefrontal cortical activation after cognitive training, the lack of statistically significant overlap of brain regions affected by training across studies suggests broad effects of training on brain activation, possibly due to the variety of training programs used.
Collapse
Affiliation(s)
- David Mothersill
- School of Psychology and Centre for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland.
| | - Gary Donohoe
- School of Psychology and Centre for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
11
|
Neuroimaging Studies of Cognitive Function in Schizophrenia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1118:117-134. [PMID: 30747420 DOI: 10.1007/978-3-030-05542-4_6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Persons suffering from schizophrenia present cognitive impairments that have a major functional impact on their lives. Particularly, executive functions and episodic memory are consistently found to be impaired. Neuroimaging allows the investigation of affected areas of the brain associated with these impairments and, moreover, the detection of brain functioning improvements after cognitive remediation interventions. For instance, executive function impairments have been associated with prefrontal cortex volume and thickness; cognitive control impairments are correlated with an increased activation in the anterior cingulate cortex, and episodic memory impairments are linked to hippocampal reduction. Some findings suggest the presence of brain compensatory mechanisms in schizophrenia, e.g. recruiting broader cortical areas to perform identical tasks. Similarly, neuroimaging studies of cognitive remediation in schizophrenia focus differentially on structural, functional and connectivity changes. Cognitive remediation improvements have been reported in two main areas: the prefrontal and thalamic regions. It has been suggested that those changes imply a functional reorganisation of neural networks, and cognitive remediation interventions might have a neuroprotective effect. Future studies should use multimodal neuroimaging procedures and more complex theoretical models to identify, confirm and clarify these and newer outcomes. This chapter highlights neuroimaging findings in anatomical and functional brain correlates of schizophrenia, as well as its application and potential use for identifying brain changes after cognitive remediation.
Collapse
|
12
|
Cho YT, Lam NH, Starc M, Santamauro N, Savic A, Diehl CK, Schleifer CH, Moujaes F, Srihari VH, Repovs G, Murray JD, Anticevic A. Effects of reward on spatial working memory in schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:695-709. [PMID: 30335439 DOI: 10.1037/abn0000369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reward processing and cognition are disrupted in schizophrenia (SCZ), yet how these processes interface is unknown. In SCZ, deficits in reward representation may affect motivated, goal-directed behaviors. To test this, we examined the effects of monetary reward on spatial working memory (WM) performance in patients with SCZ. To capture complimentary effects, we tested biophysically grounded computational models of neuropharmacologic manipulations onto a canonical fronto-parietal association cortical microcircuit capable of WM computations. Patients with SCZ (n = 33) and healthy control subjects (HCS; n = 32) performed a spatial WM task with 2 reward manipulations: reward cues presented prior to each trial, or contextually prior to a block of trials. WM performance was compared with cortical circuit models of WM subjected to feed-forward glutamatergic excitation, feed-forward GABAergic inhibition, or recurrent modulation strengthening local connections. Results demonstrated that both groups improved WM performance to reward cues presented prior to each trial (HCS d = -0.62; SCZ d = -1.0), with percent improvement correlating with baseline WM performance (r = .472, p < .001). However, rewards presented contextually before a block of trials did not improve WM performance in patients with SCZ (d = 0.01). Modeling simulations achieved improved WM precision through strengthened local connections via neuromodulation, or feed-forward inhibition. Taken together, this work demonstrates that patients with SCZ can improve WM performance to short-term, but not longer-term rewards-thus, motivated behaviors may be limited by strength of reward representation. A potential mechanism for transiently improved WM performance may be strengthening of local fronto-parietal microcircuit connections via neuromodulation or feed-forward inhibitory drive. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
- Youngsun T Cho
- Department of Psychiatry, Yale University School of Medicine
| | | | | | | | | | | | | | - Flora Moujaes
- Department of Psychiatry, Yale University School of Medicine
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine
| | - Grega Repovs
- Department of Psychology, University of Ljubljana
| | - John D Murray
- Department of Psychiatry, Yale University School of Medicine
| | - Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine
| |
Collapse
|
13
|
Covey TJ, Shucard JL, Shucard DW. Working memory training and perceptual discrimination training impact overlapping and distinct neurocognitive processes: Evidence from event-related potentials and transfer of training gains. Cognition 2018; 182:50-72. [PMID: 30218913 DOI: 10.1016/j.cognition.2018.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/06/2018] [Accepted: 08/21/2018] [Indexed: 12/01/2022]
Abstract
There is emerging evidence that working memory (WM) can potentially be enhanced via targeted training protocols. However, the differential effects of targeted training of WM vs. training of general attentional processes on distinct neurocognitive mechanisms is not well understood. In the present study, we compared adaptive n-back WM training to an adaptive visual search training task that targeted perceptual discrimination, in the absence of demands on WM. The search task was closely matched to the n-back task on difficulty and participant engagement. The training duration for both protocols was 20 sessions over approximately 4 weeks. Before and after training, young adult participants were tested on a battery of cognitive tasks to examine transfer of training gains to untrained tests of WM, processing speed, cognitive control, and fluid intelligence. Event-related brain potential (ERP) measures obtained during a Letter 3-Back task and a Search task were examined to determine the neural processes that were affected by each training protocol. Both groups improved on measures of cognitive control and fluid intelligence at post- compared to pretest. However, n-back training resulted in more pronounced transfer effects to tasks involving WM compared to search training. With respect to ERPs, both groups exhibited enhancement of P3 amplitude following training, but distinct changes in neural responses were also observed for the two training protocols. The search training group exhibited earlier ERP latencies at post- compared to pretest on the Search task, indicating generalized improvement in processing speed. The n-back group exhibited a pronounced enhancement and earlier latency of the N2 ERP component on the Letter 3-back task, following training. Given the theoretical underpinnings of the N2, this finding was interpreted as an enhancement of conflict monitoring and sequential mismatch identification. The findings provide evidence that n-back training enhances distinct neural processes underlying executive aspects of WM.
Collapse
Affiliation(s)
- Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States.
| | - Janet L Shucard
- Division of Cognitive and Behavioral Neurosciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States
| | - David W Shucard
- Division of Cognitive and Behavioral Neurosciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 114 Sherman Hall Annex, South Campus, Buffalo, NY 14214, United States
| |
Collapse
|
14
|
Donohoe G, Dillon R, Hargreaves A, Mothersill O, Castorina M, Furey E, Fagan AJ, Meaney JF, Fitzmaurice B, Hallahan B, McDonald C, Wykes T, Corvin A, Robertson IH. Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial. Psychol Med 2018; 48:751-764. [PMID: 28933314 DOI: 10.1017/s0033291717001982] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cognitive remediation (CR) training has emerged as a promising approach to improving cognitive deficits in schizophrenia and related psychosis. The limited availability of psychological services for psychosis is a major barrier to accessing this intervention however. This study investigated the effectiveness of a low support, remotely accessible, computerised working memory (WM) training programme in patients with psychosis. METHODS Ninety patients were enrolled into a single blind randomised controlled trial of CR. Effectiveness of the intervention was assessed in terms of neuropsychological performance, social and occupational function, and functional MRI 2 weeks post-intervention, with neuropsychological and social function again assessed 3-6 months post-treatment. RESULTS Patients who completed the intervention showed significant gains in both neuropsychological function (measured using both untrained WM and episodic task performance, and a measure of performance IQ), and social function at both 2-week follow-up and 3-6-month follow-up timepoints. Furthermore, patients who completed MRI scanning showed improved resting state functional connectivity relative to patients in the placebo condition. CONCLUSIONS CR training has already been shown to improve cognitive and social function in patient with psychosis. This study demonstrates that, at least for some chronic but stable outpatients, a low support treatment was associated with gains that were comparable with those reported for CR delivered entirely on a 1:1 basis. We conclude that CR has potential to be delivered even in services in which psychological supports for patients with psychosis are limited.
Collapse
Affiliation(s)
- G Donohoe
- School of Psychology& Center for Neuroimaging and Cognitive Genomics,National University of Ireland Galway,Galway,Ireland
| | - R Dillon
- Department of Psychiatry,Trinity College Dublin,Dublin,Ireland
| | - A Hargreaves
- Department of Psychiatry,Trinity College Dublin,Dublin,Ireland
| | - O Mothersill
- School of Psychology& Center for Neuroimaging and Cognitive Genomics,National University of Ireland Galway,Galway,Ireland
| | - M Castorina
- Trinity College Institute of Neuroscience,Trinity College Dublin,Ireland,Trinity College Dublin,Ireland
| | - E Furey
- School of Psychology& Center for Neuroimaging and Cognitive Genomics,National University of Ireland Galway,Galway,Ireland
| | - A J Fagan
- National Centre for Advanced Medical Imaging (CAMI),St. James's Hospital/School of Medicine,Trinity College Dublin,Dublin,Ireland
| | - J F Meaney
- National Centre for Advanced Medical Imaging (CAMI),St. James's Hospital/School of Medicine,Trinity College Dublin,Dublin,Ireland
| | - B Fitzmaurice
- Department of Psychiatry,Trinity College Dublin,Dublin,Ireland
| | - B Hallahan
- Department of Psychiatry & Center for neuroimaging and Cognitive genomics,National University of Ireland Galway,Ireland
| | - C McDonald
- Department of Psychiatry & Center for neuroimaging and Cognitive genomics,National University of Ireland Galway,Ireland
| | - T Wykes
- Institute of Psychiatry,Psychology & Neuroscience,King's College London,London,England
| | - A Corvin
- Department of Psychiatry,Trinity College Dublin,Dublin,Ireland
| | - I H Robertson
- Trinity College Institute of Neuroscience,Trinity College Dublin,Ireland,Trinity College Dublin,Ireland
| |
Collapse
|
15
|
White matter microstructure predicts cognitive training-induced improvements in attention and executive functioning in schizophrenia. Schizophr Res 2018; 193:276-283. [PMID: 28689758 PMCID: PMC5999406 DOI: 10.1016/j.schres.2017.06.062] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/11/2022]
Abstract
We examined the relationship between white matter microstructure in schizophrenia using diffusion tensor imaging (DTI) and cognitive improvements induced by 70h (~16weeks) of cognitive training. We measured anatomical connectivity in 48 patients with schizophrenia (SZ) and 28 healthy control participants (HC) at baseline, and then examined the relationship between anatomical connectivity at baseline and training-induced cognitive gains in 30 SZ who performed diffusion imaging after completing 70h of training. Compared with healthy control participants, individuals with schizophrenia showed reduced white matter integrity at baseline, as indexed by fractional anisotropy metrics, in bilateral posterior corona radiata, bilateral retrolenticular internal capsules, bilateral posterior thalamic radiation, left anterior corona radiata, left superior longitudinal fasciculus, left sagittal stratum, right cerebral peduncle and the genu and splenium of the corpus callosum. After training, schizophrenia participants showed significant gains in attention/vigilance, speed of processing, verbal learning, visual learning and executive functioning. White matter integrity within the right fronto-occipital fasciculus predicted training-induced improvements in attention/vigilance, while white matter integrity within the right corticospinal tract and bilateral medial lemnisci predicted cognitive training-induced improvements in executive functioning, areas that did not show white matter tract deficits at baseline. These findings suggest that preserved white matter integrity connecting long-range prefrontal-thalamic-sensorimotor areas may be an important determinant for training-induced neurocognitive plasticity.
Collapse
|
16
|
Aguilar EJ, Corripio I, García-Martí G, Grasa E, Martí-Bonmatí L, Gómez-Ansón B, Sanjuán J, Núñez-Marín F, Lorente-Rovira E, Escartí MJ, Brabban A, Turkington D. Emotional fMR auditory paradigm demonstrates normalization of limbic hyperactivity after cognitive behavior therapy for auditory hallucinations. Schizophr Res 2018; 193:304-312. [PMID: 28720416 DOI: 10.1016/j.schres.2017.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/08/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eduardo J Aguilar
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Psychiatry Unit, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain; Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain.
| | - Gracián García-Martí
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Radiology Department, Quirón Hospital, Avda. Blasco Ibáñez 14, 46010 Valencia, Spain.
| | - Eva Grasa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Psychiatry Unit, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain; Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain.
| | - Luis Martí-Bonmatí
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; Radiology Department, Quirón Hospital, Avda. Blasco Ibáñez 14, 46010 Valencia, Spain; Radiology Department and GIBI230 Research Group, La Fe University and Polytechnic Hospital, Bulevar Sur, s/n, 46026 Valencia, Spain.
| | - Beatriz Gómez-Ansón
- Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain; Neuroradiology Unit, Radiology Department, Neuroradiology Research Group, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain.
| | - Julio Sanjuán
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Fidel Núñez-Marín
- Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain; Neuroradiology Unit, Radiology Department, Neuroradiology Research Group, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain.
| | - Esther Lorente-Rovira
- INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - María J Escartí
- INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Alison Brabban
- Durham University, Stockton Rd, Durham, County Durham DH1, United Kingdom.
| | - Douglas Turkington
- Newcastle University, Newcastle upon Tyne, Tyne and Wear NE1 7RU, United Kingdom.
| |
Collapse
|
17
|
Fisher M, Herman A, Stephens DB, Vinogradov S. Neuroscience-informed computer-assisted cognitive training in schizophrenia. Ann N Y Acad Sci 2017; 1366:90-114. [PMID: 27111135 DOI: 10.1111/nyas.13042] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/29/2016] [Accepted: 02/16/2016] [Indexed: 01/09/2023]
Abstract
Schizophrenia is a heterogeneous psychiatric syndrome characterized by psychosis. It is also a neurodevelopmental disorder. In the earliest phases of the illness, at-risk individuals exhibit subtle, nonspecific symptoms, including cognitive dysfunction and progressive brain volumetric loss. Generally, schizophrenia is characterized by abnormal/inefficient neural system operations and neural oscillatory activity, as well as functional disconnectivity across frontal-temporo parietal and frontal-subcortical networks; it thus may best be described as a widespread neural oscillatory connectomopathy. Despite earlier views of schizophrenia as an inevitably progressive neurodegenerative disease, emerging evidence indicates that endogenous neuroplastic capacity is retained. An active area of research is directed at understanding how best to harness this learning-induced neuroplasticity to enhance neural system functioning, improve cognition, and prevent-and possibly even reverse-disease progression. In this review, we present an overview of results from the most widely used computer-assisted cognitive-training programs in schizophrenia, contrasting a broad neuropsychological rehabilitation approach with a targeted cognitive-training approach. We then review studies on the neurobiological effects of these two training methods. Finally, we discuss future directions with a focus on the "oscillatory connectome" as a key area of investigation for developing the most precise and scientifically informed treatment approaches for this illness.
Collapse
Affiliation(s)
- Melissa Fisher
- Department of Psychiatry, University of California, San Francisco, and San Francisco Department of Veterans Affairs Medical Center, San Francisco, California
| | - Alexander Herman
- School of Medicine, University of California, San Francisco, California
| | | | - Sophia Vinogradov
- Department of Psychiatry, University of California, San Francisco, and San Francisco Department of Veterans Affairs Medical Center, San Francisco, California
| |
Collapse
|
18
|
Computerized cognitive remediation therapy effects on resting state brain activity and cognition in schizophrenia. Sci Rep 2017; 7:4758. [PMID: 28684776 PMCID: PMC5500543 DOI: 10.1038/s41598-017-04829-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/22/2017] [Indexed: 01/09/2023] Open
Abstract
This study aimed to test how an 8-week training using computerized cognitive remediation therapy (CCRT) would modify resting brain functional activity and improve cognitive function in patients with schizophrenia. Twenty-seven patients with schizophrenia were recruited and randomized into two groups: CCRT or treatment-as-usual (TAU). The CCRT group received 40 sessions of computerized cognitive training over an eight-week period. There was a significant treatment group × time interaction on the processing speed (trail making test: F = 8.14, P = 0.01) and a trend in problem solving (mazes test: P = 0.06). Post-hoc tests showed that CCRT but not TAU significantly improved scores from baseline to end-of-treatment on these two cognitive assessments. For the resting brain functional activity, significant group × time interaction effect was found in the medial prefrontal cortex (mPFC)/anterior cingulate cortex (ACC) and brainstem pons region. Post-hoc tests showed that there was significant increased activity in the mPFC/ACC in CCRT but not TAU group. In this small sample study, computerized cognitive remediation therapy is shown to enhance mPFC/ACC activity even at resting state and improve cognitive function in patients with schizophrenia. If replicated, this community and clinic accessible therapy may assist cognitive remediation effort for people with schizophrenia.
Collapse
|
19
|
Takeda K, Matsumoto M, Ogata Y, Maida K, Murakami H, Murayama K, Shimoji K, Hanakawa T, Matsumoto K, Nakagome K. Impaired prefrontal activity to regulate the intrinsic motivation-action link in schizophrenia. NEUROIMAGE-CLINICAL 2017; 16:32-42. [PMID: 29071207 PMCID: PMC5650579 DOI: 10.1016/j.nicl.2017.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 12/04/2022]
Abstract
A core feature of schizophrenia (SCZ) is impairment in intrinsic motivation. Although intrinsic motivation plays an important role in enhancing improvement of the social functioning, its neural mechanisms of impairment have yet to be clarified. We hypothesized that abnormal function of the frontostriatal loop consisting of the striatum and lateral prefrontal cortex (LPFC) may be related to impaired intrinsic motivation in SCZ. We tested this by comparing the brain activity measured by functional magnetic resonance imaging and behavioral parameters associated with movement, motivation, and cognitive control between 18 stable SCZ patients and 17 healthy control (HC) participants during a task that elicits intrinsic motivation. We also compared the functional connectivity during resting-state and the fractional anisotropy using diffusion tensor imaging analysis between the two groups. We adopted an enjoyable timing task to stop a stopwatch at an exact time, which in our previous study has demonstrated to elicit intrinsic motivation. Although the performance level in general was not different between groups, the SCZ group performed worse than the HC group in trials following “overshoot” errors (i.e., the response was too late). SCZ participants showed lower intrinsic motivation to the task than the HC group in an inventory report. The striatal activity during the prediction at the task cue period was consistently lower in SCZ participants than in HC. The LPFC activity at the task cue period positively correlated with intrinsic motivation and also with the rate of success following overshoot errors in the HC group, but not in the SCZ group. The LPFC activity at the task cue period was also positively correlated with the striatal activity in both groups. The striatal activity during the feedback period was not significantly different between groups. These results suggest that, unlike HC, the neural activity in the LPFC fails to mediate between prediction of hedonic events and cognitive control of action plans in SCZ, whereas the hedonic response is retained. The neural basis of impaired motivation in schizophrenia is examined using fMRI. The hedonic response to a feedback in the striatum is retained in schizophrenia. Translating hedonic events to action plans is impeded by poor cognitive control. The cognitive control impairment is associated with altered prefrontal function.
Collapse
Affiliation(s)
- Kazuyoshi Takeda
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Madoka Matsumoto
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yousuke Ogata
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan.,Institute of Innovative Research, Tokyo Institute of Technology, Nagatsuta-cho, Yokohama 226-8503, Japan
| | - Keiko Maida
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Hiroki Murakami
- Department of Psychology, Oita University, Oita City 870-1192, Japan.,Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Kou Murayama
- Faculty of Life Sciences, University of Reading, Reading, Berkshire RG6 6AH, UK.,Research Unit of Psychology, Education & Technology, Kochi University of Technology, Tosayamada-machi, Kochi 782-8502, Japan
| | - Keigo Shimoji
- Department of Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo 173-0015, Japan
| | - Takashi Hanakawa
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Kenji Matsumoto
- Brain Science Institute, Tamagawa University, Machida, Tokyo 194-8610, Japan
| | - Kazuyuki Nakagome
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| |
Collapse
|
20
|
Hayashi Y, Rivera EA, Modico JG, Foreman AM, Wirth O. Texting while driving, executive function, and impulsivity in college students. ACCIDENT; ANALYSIS AND PREVENTION 2017; 102:72-80. [PMID: 28267655 PMCID: PMC6481653 DOI: 10.1016/j.aap.2017.02.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 05/26/2023]
Abstract
The purpose of the present study was to investigate the cognitive processes underlying texting while driving. A sample of 120 college students completed a survey to assess how frequently they send and read a text message while driving. Based on this information, students were assigned to one of two groups: 20 students who frequently text while driving and 20 matched-control students who infrequently text while driving but were similar in gender, age, years of education, and years driving. The groups were compared on the extent to which they differed in self-reported measures of executive function and impulsivity. The groups were also compared on a behavioral measure of impulsivity: the extent to which they discounted hypothetical monetary rewards as a function of the delay. For this measure, the students made repeated choices between smaller monetary rewards available immediately and larger rewards available after delays ranging from 1 week to 6 months. The results show that the group of students who frequently text while driving showed (a) significantly lower levels of executive function and (b) higher levels of self-reported impulsivity, although the groups did not differ significantly on the behavioral measure of impulsivity. These results support a general conclusion that drivers with lower levels of executive function and higher levels of impulsivity are more likely to text while driving.
Collapse
Affiliation(s)
- Yusuke Hayashi
- Pennsylvania State University, Hazleton, 76 University Drive, Hazleton, PA 18202, USA.
| | - Esteban A Rivera
- Pennsylvania State University, Hazleton, 76 University Drive, Hazleton, PA 18202, USA
| | - James G Modico
- Pennsylvania State University, Hazleton, 76 University Drive, Hazleton, PA 18202, USA
| | - Anne M Foreman
- National Institute for Occupational Safety and Health, 1095 Willowdale Rd, Morgantown, WV 26505, USA
| | - Oliver Wirth
- National Institute for Occupational Safety and Health, 1095 Willowdale Rd, Morgantown, WV 26505, USA
| |
Collapse
|
21
|
Keshavan MS, Eack SM, Prasad KM, Haller CS, Cho RY. Longitudinal functional brain imaging study in early course schizophrenia before and after cognitive enhancement therapy. Neuroimage 2017; 151:55-64. [DOI: 10.1016/j.neuroimage.2016.11.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022] Open
|
22
|
Gruber SA, Dahlgren MK, Sagar KA, Gonenc A, Norris L, Cohen BM, Ongur D, Lewandowski KE. Decreased Cingulate Cortex activation during cognitive control processing in bipolar disorder. J Affect Disord 2017; 213:86-95. [PMID: 28199893 DOI: 10.1016/j.jad.2017.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/05/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive deficits are well-documented in patients with bipolar disorder (BPD) and may impact the efficacy of psychotherapy. Cognitive control, a form of executive functioning, is often used therapeutically to shift patients' thoughts and behaviors from automatic, maladaptive responses to adaptive coping strategies. This study examined cognitive control processing in patients with BPD using the Multi-Source Interference Task (MSIT). METHOD Twenty-nine patients diagnosed with BPD and 21 healthy control (HC) subjects completed the MSIT with concurrent functional magnetic resonance imaging (fMRI). RESULTS Patients with BPD generally performed worse on the MSIT relative to HC participants; the BPD group had significantly lower performance accuracy and made more omission errors. Further, fMRI analyses revealed differential patterns of activation between the groups during the MSIT. Region of interest (ROI) analyses revealed that relative to HC participants, patients with BPD activated significantly fewer voxels within the cingulate cortex (CC) and more voxels within prefrontal cortex (PFC), although the PFC findings did not survive more stringent significance thresholds. LIMITATIONS Patients and HCs were not matched for age, sex, and premorbid verbal IQ, however, these variables were controlled for statistically. Medication usage in the BPD group may have possibly impacted the results. Given a priori hypotheses, ROI analyses were utilized. CONCLUSIONS Decreased CC activation and increased PFC activation may be associated with impaired cognitive control, demonstrated by BPD patients when completing the MSIT. Identifying the neural mechanisms which underlie key cognitive abnormalities in BPD may aid in clarifying the pathophysiology of this disorder and inform selection of potential targets for cognition remediation in BPD.
Collapse
Affiliation(s)
- Staci A Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States.
| | - M Kathryn Dahlgren
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychology, Tufts University, Medford, MA 02155, United States
| | - Kelly A Sagar
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States
| | - Atilla Gonenc
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States
| | - Lesley Norris
- Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Bruce M Cohen
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Program for Neuropsychiatric Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Dost Ongur
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Program for Neuropsychiatric Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Kathryn E Lewandowski
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| |
Collapse
|
23
|
Penadés R, González-Rodríguez A, Catalán R, Segura B, Bernardo M, Junqué C. Neuroimaging studies of cognitive remediation in schizophrenia: A systematic and critical review. World J Psychiatry 2017; 7:34-43. [PMID: 28401047 PMCID: PMC5371171 DOI: 10.5498/wjp.v7.i1.34] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/14/2016] [Accepted: 12/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To examine the effects of cognitive remediation therapies on brain functioning through neuroimaging procedures in patients with schizophrenia.
METHODS A systematic, computerised literature search was conducted in the PubMed/Medline and PsychInfo databases. The search was performed through February 2016 without any restrictions on language or publication date. The search was performed using the following search terms: [(“cogniti*” and “remediation” or “training” or “enhancement”) and (“fMRI” or “MRI” or “PET” or “SPECT”) and (schizophrenia or schiz*)]. The search was accompanied by a manual online search and a review of the references from each of the papers selected, and those papers fulfilling our inclusion criteria were also included.
RESULTS A total of 101 studies were found, but only 18 of them fulfilled the inclusion criteria. These studies indicated that cognitive remediation improves brain activation in neuroimaging studies. The most commonly reported changes were those that involved the prefrontal and thalamic regions. Those findings are in agreement with the hypofrontality hypothesis, which proposes that frontal hypoactivation is the underlying mechanism of cognitive impairments in schizophrenia. Nonetheless, great heterogeneity among the studies was found. They presented different hypotheses, different results and different findings. The results of more recent studies interpreted cognitive recovery within broader frameworks, namely, as amelioration of the efficiency of different networks. Furthermore, advances in neuroimaging methodologies, such as the use of whole-brain analysis, tractography, graph analysis, and other sophisticated methodologies of data processing, might be conditioning the interpretation of results and generating new theoretical frameworks. Additionally, structural changes were described in both the grey and white matter, suggesting a neuroprotective effect of cognitive remediation. Cognitive, functional and structural improvements tended to be positively correlated.
CONCLUSION Neuroimaging studies of cognitive remediation in patients with schizophrenia suggest a positive effect on brain functioning in terms of the functional reorganisation of neural networks.
Collapse
|
24
|
Wei YY, Wang JJ, Yan C, Li ZQ, Pan X, Cui Y, Su T, Liu TS, Tang YX. Correlation Between Brain Activation Changes and Cognitive Improvement Following Cognitive Remediation Therapy in Schizophrenia: An Activation Likelihood Estimation Meta-analysis. Chin Med J (Engl) 2017; 129:578-85. [PMID: 26904993 PMCID: PMC4804440 DOI: 10.4103/0366-6999.176983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Several studies using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have indicated that cognitive remediation therapy (CRT) might improve cognitive function by changing brain activations in patients with schizophrenia. However, the results were not consistent in these changed brain areas in different studies. The present activation likelihood estimation (ALE) meta-analysis was conducted to investigate whether cognitive function change was accompanied by the brain activation changes, and where the main areas most related to these changes were in schizophrenia patients after CRT. Analyses of whole-brain studies and whole-brain + region of interest (ROI) studies were compared to explore the effect of the different methodologies on the results. Methods: A computerized systematic search was conducted to collect fMRI and PET studies on brain activation changes in schizophrenia patients from pre- to post-CRT. Nine studies using fMRI techniques were included in the meta-analysis. Ginger ALE 2.3.1 was used to perform meta-analysis across these imaging studies. Results: The main areas with increased brain activation were in frontal and parietal lobe, including left medial frontal gyrus, left inferior frontal gyrus, right middle frontal gyrus, right postcentral gyrus, and inferior parietal lobule in patients after CRT, yet no decreased brain activation was found. Although similar increased activation brain areas were identified in ALE with or without ROI studies, analysis including ROI studies had a higher ALE value. Conclusions: The current findings suggest that CRT might improve the cognition of schizophrenia patients by increasing activations of the frontal and parietal lobe. In addition, it might provide more evidence to confirm results by including ROI studies in ALE meta-analysis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Yun-Xiang Tang
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai 200433, China
| |
Collapse
|
25
|
Cantarella A, Borella E, Carretti B, Kliegel M, de Beni R. Benefits in tasks related to everyday life competences after a working memory training in older adults. Int J Geriatr Psychiatry 2017; 32:86-93. [PMID: 26968329 DOI: 10.1002/gps.4448] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/21/2015] [Accepted: 01/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The impact of working memory (WM) training on everyday life functioning has rarely been examined, and it is not clear whether WM training gains are transferred to reasoning abilities. The aim of this study was to assess the efficacy of a verbal WM training in older adults, in terms of specific gains and transfer effects to everyday life and reasoning abilities. METHOD Thirty-six community dwelling older adults (from 65 to 75 years of age) were randomly assigned to a training or an active control group. The specific gains in a WM task similar to the one trained were assessed. Transfer effects to everyday life and reasoning abilities were also examined using (i) objective performance-based tasks (the Everyday Problem Test and the Timed Instrumental Activities of Daily Living Scale) and (ii) the Cattell test and Raven's Standard Progressive Matrices, respectively. RESULTS Only the trained group showed specific benefits and transfer effects to one of the everyday abilities measures (the Everyday Problem Test) and in the two reasoning tasks. CONCLUSION These results suggest that WM training can positively impact cognitive functioning and, more importantly, older adults' abilities in everyday living. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | - Erika Borella
- Department of General Psychology, University of Padova, Padova, Italy
| | - Barbara Carretti
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Rossana de Beni
- Department of General Psychology, University of Padova, Padova, Italy
| |
Collapse
|
26
|
Kani AS, Shinn AK, Lewandowski KE, Öngür D. Converging effects of diverse treatment modalities on frontal cortex in schizophrenia: A review of longitudinal functional magnetic resonance imaging studies. J Psychiatr Res 2017; 84:256-276. [PMID: 27776293 PMCID: PMC5135290 DOI: 10.1016/j.jpsychires.2016.10.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES A variety of treatment options exist for schizophrenia, but the effects of these treatments on brain function are not clearly understood. To facilitate the development of more effective treatment strategies, it is important to identify how brain function in schizophrenia patients is affected by the diverse therapeutic approaches that are currently available. The aim of the present article is to systematically review the evidence for functional brain changes associated with different treatment modalities for schizophrenia. METHODS We searched PubMed for longitudinal functional MRI (fMRI) studies reporting on the effects of antipsychotic medications (APM), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), cognitive remediation therapy (CRT) and cognitive behavioral therapy for psychosis (CBTp) on brain function in schizophrenia. RESULTS Thirty six studies fulfilled the inclusion criteria. Functional alterations were observed in diverse brain regions. Across intervention modalities, changes in fMRI parameters were reported most commonly in frontal brain regions including prefrontal cortex, anterior cingulate and inferior frontal cortex. CONCLUSIONS We conclude that current treatments for schizophrenia commonly induce functional brain alterations in frontal brain regions. However, interpretability is limited by inconsistency in task and region of interest selection, and failures to replicate. Further task independent fMRI studies examining treatment effects with whole brain analysis are needed to deepen our insights.
Collapse
Affiliation(s)
- Ayse Sakalli Kani
- Sivas Numune State Hospital, Department of Psychiatry, Sivas, Turkey.
| | - Ann K. Shinn
- Psychotic Disorders Division, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Harvard Medical School, Department of Psychiatry, Boston, MA 02114, USA.
| | - Kathryn E. Lewandowski
- Psychotic Disorders Division, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Harvard Medical School, Department of Psychiatry, Boston, MA 02114, USA.
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, 115 Mill St., Belmont, MA, 02478, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, 02114, USA.
| |
Collapse
|
27
|
Wexler BE, Iseli M, Leon S, Zaggle W, Rush C, Goodman A, Esat Imal A, Bo E. Cognitive Priming and Cognitive Training: Immediate and Far Transfer to Academic Skills in Children. Sci Rep 2016; 6:32859. [PMID: 27615029 PMCID: PMC5018694 DOI: 10.1038/srep32859] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/11/2016] [Indexed: 11/20/2022] Open
Abstract
Cognitive operations are supported by dynamically reconfiguring neural systems that integrate processing components widely distributed throughout the brain. The inter-neuronal connections that constitute these systems are powerfully shaped by environmental input. We evaluated the ability of computer-presented brain training games done in school to harness this neuroplastic potential and improve learning in an overall study sample of 583 second-grade children. Doing a 5-minute brain-training game immediately before math or reading curricular content games increased performance on the curricular content games. Doing three 20-minute brain training sessions per week for four months increased gains on school-administered math and reading achievement tests compared to control classes tested at the same times without intervening brain training. These results provide evidence of cognitive priming with immediate effects on learning, and longer-term brain training with far-transfer or generalized effects on academic achievement.
Collapse
Affiliation(s)
- Bruce E Wexler
- Department of Psychiatry Yale University School of Medicine, 34 Park St, New Haven, CT 05619, USA
| | - Markus Iseli
- National Center for Research on Evaluation, Standards, and Student Testing, CRESST/UCLA, 300 Charles E. Young Drive North, Los Angeles, CA, 90095USA
| | - Seth Leon
- National Center for Research on Evaluation, Standards, and Student Testing, CRESST/UCLA, 300 Charles E. Young Drive North, Los Angeles, CA, 90095USA
| | - William Zaggle
- C8 Sciences, 5 Science Park, New Haven, CT 06511, 970-371-1795, USA
| | - Cynthia Rush
- Department of Statistics, Yale University, 24 Hilhouse Ave, New Haven CT, 06511, USA
| | - Annette Goodman
- New Initiatives, 6 Cedar Lane, Cedarhurst, NY 11516, 917-584-0137, USA
| | - A Esat Imal
- Department of Psychiatry Yale University School of Medicine, 34 Park St, New Haven, CT 05619, USA
| | - Emily Bo
- National Center for Research on Evaluation, Standards, and Student Testing, CRESST/UCLA, 300 Charles E. Young Drive North, Los Angeles, CA, 90095USA
| |
Collapse
|
28
|
Abstract
The development of cognitive remediation programs has been a key step toward the creation of a treatment approach to address the cognitive-symptom domain in psychosis. Studies support the efficacy of cognitive remediation in producing moderate effects on cognition at the group level in patients with schizophrenia. Cognitive remediation may harness neuroplasticity in relevant systems that underpin the cognitive functions being addressed. Since neuroplasticity may be greater in people who (1) are younger and (2) have not yet experienced the consequences of long-term psychosis, cognitive remediation may be particularly effective in people in the early course of illness or in the prodrome, prior to the onset of frank symptoms. The present article reviews the evidence for implementing cognitive remediation in patients with recent-onset psychosis and people identified as being at high risk for developing schizophrenia, and also the evidence for cognitive remediation to modify neural targets. Promising findings suggest that cognitive remediation may be useful in addressing cognitive deficits in early-course and prodromal participants. Additionally, a growing literature using neuroimaging techniques demonstrates the ability of cognitive remediation paradigms to engage neural targets.
Collapse
|
29
|
Cassetta BD, Goghari VM. Working memory and processing speed training in schizophrenia: study protocol for a randomized controlled trial. Trials 2016; 17:49. [PMID: 26812902 PMCID: PMC4728776 DOI: 10.1186/s13063-016-1188-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 01/20/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In most domains of cognition, individuals with schizophrenia are generally found to be one standard deviation below the mean of the controls. As a result, examining the impact of cognitive remediation in individuals with schizophrenia has been a burgeoning area of research. However, the state of the literature remains unclear as to which domains of cognition should be targeted to produce the most widespread and durable benefits for individuals with schizophrenia. One suggestion is that targeting lower-level cognitive processes that are important for higher-level and more complex aspects of cognition may produce the most widespread benefits in cognition and everyday functioning. Relatively few studies have examined the effects of working memory or processing speed training in schizophrenia, as most studies examine broad-based remediation programs. Thus, a need exists for targeted working memory and processing speed training studies to better understand the mechanisms of cognitive enhancement in patients. This study aims to 1) investigate near-transfer gains (that is, the transfer of learning to related contexts) associated with working memory and processing speed training in schizophrenia patients; 2) investigate far-transfer gains (that is, the transfer of learning to new contexts) associated with working memory and processing speed training (that is, gains in other neurocognitive domains and social cognition); and 3) investigate real-world gains associated with training (that is, gains in daily functioning). METHODS/DESIGN A double-blind randomized controlled trial with a three parallel group design will be conducted. A random sample of 81 patients with schizophrenia or schizoaffective disorder will be recruited through outpatient clinics at Foothills Hospital and community support programs in Calgary, Alberta. Participants will be randomly assigned using a computer-generated program in a 1:1:1 ratio to a working memory-training group, a processing speed-training group, or a no-training control group. Training will be completed at home for 30 minutes per day, 5 days per week, for a total of 10 weeks. Neurocognitive, social cognitive, and daily functioning measures will be administered both pre- and post-training to detect training-related gains. The primary outcome measures will include working memory and processing speed (near-transfer measures), as well as fluid intelligence (far-transfer measure). TRIAL REGISTRATION Current controlled trials NCT02478827 (ClinicalTrials.gov, registered on 15 June 2015).
Collapse
Affiliation(s)
- Briana D Cassetta
- Clinical Neuroscience of Schizophrenia Laboratory, Administration Building, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Vina M Goghari
- Clinical Neuroscience of Schizophrenia Laboratory, Administration Building, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| |
Collapse
|
30
|
Eack SM, Newhill CE, Keshavan MS. Cognitive Enhancement Therapy Improves Resting-State Functional Connectivity in Early Course Schizophrenia. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2016; 7:211-230. [PMID: 27713804 PMCID: PMC5047289 DOI: 10.1086/686538] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Cognitive remediation is emerging as an effective psychosocial intervention for addressing untreated cognitive and functional impairments in persons with schizophrenia, and might achieve its benefits through neuroplastic changes in brain connectivity. This study seeks to examine the effects of cognitive enhancement therapy (CET) on fronto-temporal brain connectivity in a randomized controlled trial with individuals in the early course of schizophrenia. METHOD Stabilized, early course outpatients with schizophrenia or schizoaffective disorder (N = 41) were randomly assigned to CET (n = 25) or an active enriched supportive therapy (EST) control (n = 16) and treated for 2 years. Functional MRI data were collected annually, and pseudo resting-state functional connectivity analysis was used to examine differential changes in fronto-temporal connectivity between those treated with CET compared with EST. RESULTS Individuals receiving CET evidenced significantly less functional connectivity loss between the resting-state network and the left dorsolateral prefrontal cortex as well as significantly increased connectivity with the right insular cortex compared to EST (all corrected p < .01). These neural networks are involved in emotion processing and problem-solving. Increased connectivity with the right insula significantly mediated CET effects on improved emotion perception (z' = -1.96, p = .021), and increased connectivity with the left dorsolateral prefrontal cortex mediated CET-related improvements in emotion regulation (z' = -1.71, p = .052). CONCLUSIONS These findings provide preliminary evidence that CET, a psychosocial cognitive remediation intervention, may enhance connectivity between frontal and temporal brain regions implicated in problem-solving and emotion processing in service of cognitive enhancement in schizophrenia.
Collapse
Affiliation(s)
- Shaun M Eack
- David E. Epperson Associate Professor of Social Work and an associate professor of psychiatry at the University of Pittsburgh
| | - Christina E Newhill
- professor of social work with a joint appointment to the Clinical and Translational Science Institute at the University of Pittsburgh
| | - Matcheri S Keshavan
- Stanley Cobb Professor of Psychiatry at Harvard Medical School in Boston, MA
| |
Collapse
|
31
|
Hargreaves A, Dillon R, Anderson-Schmidt H, Corvin A, Fitzmaurice B, Castorina M, Robertson IH, Donohoe G. Computerised working-memory focused cognitive remediation therapy for psychosis--A preliminary study. Schizophr Res 2015; 169:135-140. [PMID: 26421692 DOI: 10.1016/j.schres.2015.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cognitive deficits are a core feature of schizophrenia and related psychotic disorders and are associated with decreased levels of functioning. Behavioural interventions have shown success in remediating these deficits; determining how best to maximise this benefit while minimising the cost is an important next step in optimising this intervention for clinical use. AIMS To examine the effects of a novel working-memory focused cognitive remediation (CR) training on cognitive difficulties based on internet delivery of training and weekly telephone support. METHOD Participants with a diagnosis of psychosis (n=56) underwent either 8 weeks of CR (approximately 20 h) or 8 weeks of treatment as usual (TAU). General cognitive ability, working memory and episodic memory were measured both pre and post intervention for all participants. RESULTS In addition to improvements on trained working memory tasks, CR training was associated with significant improvements in two tests of verbal episodic memory. No association between CR and changes in general cognitive ability was observed. Effect sizes for statistically significant changes in memory were comparable to those reported in the literature based primarily on 1:1 training. CONCLUSIONS The cognitive benefits observed in this non-randomised preliminary study indicate that internet-based working memory training can be an effective cognitive remediation therapy. The successes and challenges of an internet-based treatment are discussed.
Collapse
Affiliation(s)
- A Hargreaves
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - R Dillon
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | | | - A Corvin
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - B Fitzmaurice
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - M Castorina
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland; School of Psychology, Trinity College Dublin, Ireland
| | - I H Robertson
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland; School of Psychology, Trinity College Dublin, Ireland
| | - G Donohoe
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; CogGene group, School of Psychology & Center for Neuroimaging, Cognition & Genomics, National University of Ireland, Galway, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| |
Collapse
|
32
|
Li W, Guo Z, Jones JA, Huang X, Chen X, Liu P, Chen S, Liu H. Training of Working Memory Impacts Neural Processing of Vocal Pitch Regulation. Sci Rep 2015; 5:16562. [PMID: 26553373 PMCID: PMC4639724 DOI: 10.1038/srep16562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 10/15/2015] [Indexed: 11/26/2022] Open
Abstract
Working memory training can improve the performance of tasks that were not trained. Whether auditory-motor integration for voice control can benefit from working memory training, however, remains unclear. The present event-related potential (ERP) study examined the impact of working memory training on the auditory-motor processing of vocal pitch. Trained participants underwent adaptive working memory training using a digit span backwards paradigm, while control participants did not receive any training. Before and after training, both trained and control participants were exposed to frequency-altered auditory feedback while producing vocalizations. After training, trained participants exhibited significantly decreased N1 amplitudes and increased P2 amplitudes in response to pitch errors in voice auditory feedback. In addition, there was a significant positive correlation between the degree of improvement in working memory capacity and the post-pre difference in P2 amplitudes. Training-related changes in the vocal compensation, however, were not observed. There was no systematic change in either vocal or cortical responses for control participants. These findings provide evidence that working memory training impacts the cortical processing of feedback errors in vocal pitch regulation. This enhanced cortical processing may be the result of increased neural efficiency in the detection of pitch errors between the intended and actual feedback.
Collapse
Affiliation(s)
- Weifeng Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Zhiqiang Guo
- Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University, Guangzhou, China, 510006
| | - Jeffery A Jones
- Psychology Department and Laurier Centre for Cognitive Neuroscience, Wilfrid Laurier University, Waterloo, Ontario, N2L 3C5, Canada
| | - Xiyan Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Xi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Peng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Shaozhen Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Hanjun Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, P. R. China.,Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University, Guangzhou, China, 510006
| |
Collapse
|
33
|
Tallus J, Soveri A, Hämäläinen H, Tuomainen J, Laine M. Effects of Auditory Attention Training with the Dichotic Listening Task: Behavioural and Neurophysiological Evidence. PLoS One 2015; 10:e0139318. [PMID: 26439112 PMCID: PMC4595478 DOI: 10.1371/journal.pone.0139318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 09/11/2015] [Indexed: 11/18/2022] Open
Abstract
Facilitation of general cognitive capacities such as executive functions through training has stirred considerable research interest during the last decade. Recently we demonstrated that training of auditory attention with forced attention dichotic listening not only facilitated that performance but also generalized to an untrained attentional task. In the present study, 13 participants underwent a 4-week dichotic listening training programme with instructions to report syllables presented to the left ear (FL training group). Another group (n = 13) was trained using the non-forced instruction, asked to report whichever syllable they heard the best (NF training group). The study aimed to replicate our previous behavioural results, and to explore the neurophysiological correlates of training through event-related brain potentials (ERPs). We partially replicated our previous behavioural training effects, as the FL training group tended to show more allocation of auditory spatial attention to the left ear in a standard dichotic listening task. ERP measures showed diminished N1 and enhanced P2 responses to dichotic stimuli after training in both groups, interpreted as improvement in early perceptual processing of the stimuli. Additionally, enhanced anterior N2 amplitudes were found after training, with relatively larger changes in the FL training group in the forced-left condition, suggesting improved top-down control on the trained task. These results show that top-down cognitive training can modulate the left-right allocation of auditory spatial attention, accompanied by a change in an evoked brain potential related to cognitive control.
Collapse
Affiliation(s)
- Jussi Tallus
- Department of Psychology, Centre for Cognitive Neuroscience, and Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Anna Soveri
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Heikki Hämäläinen
- Department of Psychology, Centre for Cognitive Neuroscience, and Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Jyrki Tuomainen
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
- * E-mail:
| | - Matti Laine
- Department of Psychology, Åbo Akademi University, Turku, Finland
| |
Collapse
|
34
|
Fredrick MM, Mintz J, Roberts DL, Maples NJ, Sarkar S, Li X, Velligan DI. Is cognitive adaptation training (CAT) compensatory, restorative, or both? Schizophr Res 2015; 166:290-6. [PMID: 26126419 DOI: 10.1016/j.schres.2015.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/02/2015] [Accepted: 06/05/2015] [Indexed: 02/02/2023]
Abstract
Cognitive adaptation training (CAT) is a psychosocial treatment incorporating environmental supports including signs, checklists to bypass the cognitive deficits of schizophrenia. Our objective was to examine the association between CAT, functional outcomes, and cognitive test performance (cognition). The two research questions were as follows: 1) Does cognition mediate the effect of CAT intervention on functional outcome? 2) Does CAT impact cognitive test performance? A total of 120 participants with schizophrenia were randomized to one of three treatments: 1) CAT (weekly for 9months; monthly thereafter), 2) generic environmental supports (given to participants on clinic visits to promote adaptive behavior), or 3) treatment as usual (TAU). Assessments of cognition and functional outcome were conducted at baseline, 9 and 24months. Mediation analyses and mixed effects regression were conducted. Mediation analyses revealed that during the initial 9months, the direct path from treatment group to functional outcome on the primary measure was positive and highly significant. CAT significantly improved functional outcome compared to the other treatments. However, paths involving cognition were negligible. There was no evidence that cognition mediated improvement in functional outcomes. At 24months, cognition improved more in CAT compared to other treatment groups. The test for cognition mediating improvement in functional outcomes was not significant at this time point. However, improvement in functional outcome led to better performance on cognitive testing. We concluded that improvement in cognition is not a necessary condition for improvement in functional outcome and that greater engagement in functional behavior has a positive impact on cognition.
Collapse
Affiliation(s)
- Megan M Fredrick
- Department of Psychiatry, UPL, University of Texas Health Science Center, San Antonio, TX 78229, United States.
| | - Jim Mintz
- Department of Psychiatry, NWC 13.132, University of Texas Health Science Center, San Antonio, TX 78229, United States.
| | - David L Roberts
- Department of Psychiatry, UPL, University of Texas Health Science Center, San Antonio, TX 78229, United States.
| | - Natalie J Maples
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, United States.
| | - Sonali Sarkar
- Department of Psychiatry, School of Medicine, University of Texas Health Science Center, San Antonio, TX 78229, United States.
| | - Xueying Li
- Department of Psychiatry, NWC 13.132, University of Texas Health Science Center, San Antonio, TX 78229, United States.
| | - Dawn I Velligan
- Department of Psychiatry, UPL, University of Texas Health Science Center, San Antonio, TX 78229, United States.
| |
Collapse
|
35
|
The neuroplastic effect of working memory training in healthy volunteers and patients with schizophrenia: Implications for cognitive rehabilitation. Neuropsychologia 2015; 75:149-62. [PMID: 26032579 DOI: 10.1016/j.neuropsychologia.2015.05.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 01/19/2023]
Abstract
We conducted an activation likelihood estimation (ALE) meta-analysis to quantitatively review the existing working memory (WM) training studies that investigated neural activation changes both in healthy individuals and patients with schizophrenia. ALE analysis of studies in healthy individuals indicates a widespread distribution of activation changes with WM training in the frontal and parietal regions, especially the dorsolateral prefrontal cortex, the medial frontal cortex and the precuneus, as well as subcortical regions such as the insula and the striatum. WM training is also accompanied by activation changes in patients with schizophrenia, mainly in the dorsolateral prefrontal cortex, the precuneus and the fusiform gyrus. Our results demonstrate that WM training is accompanied by changes in neural activation patterns in healthy individuals, which may provide the basis for understanding neuroplastic changes in patients with schizophrenia.
Collapse
|
36
|
Hubacher M, Kappos L, Weier K, Stöcklin M, Opwis K, Penner IK. Case-Based fMRI Analysis after Cognitive Rehabilitation in MS: A Novel Approach. Front Neurol 2015; 6:78. [PMID: 25904893 PMCID: PMC4389546 DOI: 10.3389/fneur.2015.00078] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/23/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive decline in multiple sclerosis (MS) negatively impacts patients' everyday functioning and quality of life. Since symptomatic pharmacological treatment is not yet available alternative treatment strategies such as cognitive rehabilitation are of particular interest. OBJECTIVES To analyse the ways in which MS patients respond to cognitive training, by combining behavioral and fMRI data in a case-based triangulation approach. METHODS Ten relapsing-remitting (RR) MS patients aged between 39 and 58 years and between 1 and 8 years post MS diagnosis were included. EDSS ranged from 1 to 3.5. Participants had normal to high intelligence levels. Six patients were assigned to the training group (TG) and four to the control group (CG) without intervention. The TG received a 4-week computerized working memory (WM) training, consisting of 16 training sessions of 45 min duration each. Before and after the training a neuropsychological examination and fMRI investigation by using an N-back task of different complexity was applied. RESULTS Patients in the TG responded differently to cognitive training. Four participants did not meet the triangulation criteria for being treatment responders. The two responders showed two distinct changes regarding activation patterns after training: (I) decreased brain activation associated with increased processing speed and (II) increased brain activation associated with higher processing speed and WM performance. CONCLUSION The occurrence of different and opposed response patterns after the same training indicates a risk in applying classical group statistics. Different and especially opposed patterns within the same sample may distort results of classical statistical comparisons. Thus, underlying processes may not be discovered and lead to misinterpretation of results.
Collapse
Affiliation(s)
- Martina Hubacher
- Department of Cognitive Psychology and Methodology, University of Basel , Basel , Switzerland
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel , Basel , Switzerland
| | - Katrin Weier
- Department of Neurology, University Hospital Basel , Basel , Switzerland
| | - Markus Stöcklin
- Department of Cognitive Psychology and Methodology, University of Basel , Basel , Switzerland
| | - Klaus Opwis
- Department of Cognitive Psychology and Methodology, University of Basel , Basel , Switzerland
| | - Iris-Katharina Penner
- Department of Cognitive Psychology and Methodology, University of Basel , Basel , Switzerland
| |
Collapse
|
37
|
Wanmaker S, Geraerts E, Franken IHA. A working memory training to decrease rumination in depressed and anxious individuals: a double-blind randomized controlled trial. J Affect Disord 2015; 175:310-9. [PMID: 25661397 DOI: 10.1016/j.jad.2014.12.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/06/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Rumination is one of the hallmark characteristics of both anxiety disorders and depression, and has been linked to deficient executive functioning, particularly working memory (WM). Previous findings show that working memory capacity can be increased through training. METHODS The current study explored whether an adaptive stand-alone WM training could increase WMC and consequently reduce rumination, anxiety and depression by means of a double-blind randomized controlled trial in a sample of 98 patients with symptoms of anxiety and/or depression. RESULTS No positive effect of training on WMC was found. In addition, the results show that a WM training was not associated with a reduction of rumination, depression, nor anxiety. LIMITATIONS The high drop-out rate in both groups (20.11% from pre- to post-training) and the overrepresentation of men and use of anti-depressants in the placebo group might have influenced the results. Furthermore, expectations and perceptions about the training might have interacted with performance on WM tasks. CONCLUSIONS Overall, results show that a stand-alone WM training in patients with symptoms of anxiety and/or depression does not result in reduced rumination nor in reduced symptoms of depression and anxiety. We discuss potential explanations for these findings.
Collapse
Affiliation(s)
- Sabine Wanmaker
- Institute of Psychology, Erasmus University Rotterdam, The Netherlands.
| | - Elke Geraerts
- Institute of Psychology, Erasmus University Rotterdam, The Netherlands
| | | |
Collapse
|
38
|
Kurtz MM, Mueser KT, Thime WR, Corbera S, Wexler BE. Social skills training and computer-assisted cognitive remediation in schizophrenia. Schizophr Res 2015; 162:35-41. [PMID: 25640526 PMCID: PMC5146951 DOI: 10.1016/j.schres.2015.01.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/08/2015] [Accepted: 01/11/2015] [Indexed: 11/17/2022]
Abstract
A growing body of research shows that cognitive remediation (COG REM), consisting of drill-and-practice and/or strategy training in neurocognitive functions, produces moderate improvements in neurocognition. These improvements generalize to functioning when COG REM is provided with other rehabilitation interventions (Wykes et al., 2011). The number of studies using COG REM as an adjunct to other behavioral-based rehabilitation interventions however remains small and consists of widely varying interventions with few active control conditions. This study compared the effects of an extended (6-month), standardized, computer-assisted cognitive remediation intervention, administered along with a standardized program of social skills-training (SST), with those of an active control condition that included participation in the same SST program and a computer skills training program (Computer Skills). Sixty-four individuals with schizophrenia recruited from two treatment sites were randomly assigned to one of two conditions and were assessed by blinded raters on neurocognitive measures, performance-based measures of social skill, and ratings of psychosocial function before and after treatment. Results revealed that the COG REM group improved significantly more in attention, working memory, and empathy than the Computer Skills group, but there were no differences between groups on other measures of psychosocial functioning or skills. Taken together, these findings suggest that COG REM used in the context of other evidence-based psychosocial interventions (SST) improves working memory in schizophrenia and suggests that this effect may generalize to improved empathy.
Collapse
Affiliation(s)
- Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT, United States; Schizophrenia Rehabilitation Program, Institute of Living, Hartford, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, United States
| | - Warren R Thime
- Schizophrenia Rehabilitation Program, Institute of Living, Hartford, CT, United States
| | - Silvia Corbera
- Schizophrenia Rehabilitation Program, Institute of Living, Hartford, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Bruce E Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
39
|
Gruner P, Anticevic A, Lee D, Pittenger C. Arbitration between Action Strategies in Obsessive-Compulsive Disorder. Neuroscientist 2015; 22:188-98. [PMID: 25605642 DOI: 10.1177/1073858414568317] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decision making in a complex world, characterized both by predictable regularities and by frequent departures from the norm, requires dynamic switching between rapid habit-like, automatic processes and slower, more flexible evaluative processes. These strategies, formalized as "model-free" and "model-based" reinforcement learning algorithms, respectively, can lead to divergent behavioral outcomes, requiring a mechanism to arbitrate between them in a context-appropriate manner. Recent data suggest that individuals with obsessive-compulsive disorder (OCD) rely excessively on inflexible habit-like decision making during reinforcement-driven learning. We propose that inflexible reliance on habit in OCD may reflect a functional weakness in the mechanism for context-appropriate dynamic arbitration between model-free and model-based decision making. Support for this hypothesis derives from emerging functional imaging findings. A deficit in arbitration in OCD may help reconcile evidence for excessive reliance on habit in rewarded learning tasks with an older literature suggesting inappropriate recruitment of circuitry associated with model-based decision making in unreinforced procedural learning. The hypothesized deficit and corresponding circuitry may be a particularly fruitful target for interventions, including cognitive remediation.
Collapse
Affiliation(s)
- Patricia Gruner
- Department of Psychiatry, Yale University, New Haven, CT, USA Learning Based Recovery Center, VA Connecticut Health System, West Haven, CT, USA
| | - Alan Anticevic
- Department of Psychiatry, Yale University, New Haven, CT, USA Department of Psychology, Yale University, New Haven, CT, USA Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA
| | - Daeyeol Lee
- Department of Psychology, Yale University, New Haven, CT, USA Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA Department of Neurobiology, Yale University, New Haven, CT, USA
| | - Christopher Pittenger
- Department of Psychiatry, Yale University, New Haven, CT, USA Department of Psychology, Yale University, New Haven, CT, USA Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA Child Study Center, Yale University, New Haven, CT, USA
| |
Collapse
|
40
|
Abstract
Abnormal hippocampal function likely contributes to relational learning deficits observed in schizophrenia. It is unknown whether these deficits can be attenuated with a training intervention. The purpose of this project was to determine if training could facilitate relational learning of the transverse patterning task in schizophrenia. Healthy and schizophrenia subjects completed a version of transverse patterning that incorporated training. The majority of subjects with schizophrenia successfully learned transverse patterning when provided with training. A subgroup (approximately 25%) of schizophrenia subjects showed no tendency to learn with training. These results were replicated in a second study with a separate cohort and different stimuli. This study illustrates that relational learning of the transverse patterning can be facilitated in schizophrenia with training.
Collapse
|
41
|
Lawlor-Savage L, Goghari VM. Working memory training in schizophrenia and healthy populations. Behav Sci (Basel) 2014; 4:301-319. [PMID: 25379283 PMCID: PMC4219266 DOI: 10.3390/bs4030301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/17/2014] [Accepted: 08/13/2014] [Indexed: 12/25/2022] Open
Abstract
Cognitive deficits are consistently demonstrated in individuals with schizophrenia. Cognitive training involves structured exercises prescribed and undertaken with the intention of enhancing cognitive abilities such as attention, memory, and problem solving. Thus, cognitive training represents a potentially promising intervention for enhancing cognitive abilities in schizophrenia. However, cognitive training programs are numerous and heterogeneous, hence, the generalizability of training related outcomes can be challenging to assess. This article will provide a brief overview of current literature on cognitive training and explore how knowledge of working memory training in healthy populations can potentially be applied to enhance cognitive functioning of individuals with schizophrenia.
Collapse
Affiliation(s)
| | - Vina M. Goghari
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-403-210-7344; Fax: +1-403-282-8249
| |
Collapse
|
42
|
Pillet B, Morvan Y, Todd A, Franck N, Duboc C, Grosz A, Launay C, Demily C, Gaillard R, Krebs MO, Amado I. Cognitive remediation therapy (CRT) benefits more to patients with schizophrenia with low initial memory performances. Disabil Rehabil 2014; 37:846-53. [PMID: 25109501 DOI: 10.3109/09638288.2014.946153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Cognitive deficits in schizophrenia mainly affect memory, attention and executive functions. Cognitive remediation is a technique derived from neuropsychology, which aims to improve or compensate for these deficits. Working memory, verbal learning, and executive functions are crucial factors for functional outcome. Our purpose was to assess the impact of the cognitive remediation therapy (CRT) program on cognitive difficulties in patients with schizophrenia, especially on working memory, verbal memory, and cognitive flexibility. METHODS We collected data from clinical and neuropsychological assessments in 24 patients suffering from schizophrenia (Diagnostic and Statistical Manual of mental Disorders-Fourth Edition, DSM-IV) who followed a 3-month (CRT) program. Verbal and visuo-spatial working memory, verbal memory, and cognitive flexibility were assessed before and after CRT. RESULTS The Wilcoxon test showed significant improvements on the backward digit span, on the visual working memory span, on verbal memory and on flexibility. Cognitive improvement was substantial when baseline performance was low, independently from clinical benefit. CONCLUSIONS CRT is effective on crucial cognitive domains and provides a huge benefit for patients having low baseline performance. Such cognitive amelioration appears highly promising for improving the outcome in cognitively impaired patients.
Collapse
Affiliation(s)
- Benoit Pillet
- Centre Référent en Remédiation et Réhabilitation Psychosociale (C3R-P) (SHU, Secteur 17), Inserm U894, Hôpital Sainte-Anne , Paris , France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Subramaniam K, Luks TL, Garrett C, Chung C, Fisher M, Nagarajan S, Vinogradov S. Intensive cognitive training in schizophrenia enhances working memory and associated prefrontal cortical efficiency in a manner that drives long-term functional gains. Neuroimage 2014; 99:281-92. [PMID: 24867353 DOI: 10.1016/j.neuroimage.2014.05.057] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 05/15/2014] [Accepted: 05/17/2014] [Indexed: 12/14/2022] Open
Abstract
We investigated whether intensive computerized cognitive training in schizophrenia could improve working memory performance and increase signal efficiency of associated middle frontal gyri (MFG) circuits in a functionally meaningful manner. Thirty schizophrenia participants and 13 healthy comparison participants underwent fMRI scanning during a letter N-back working memory task. Schizophrenia participants were then randomly assigned to either 80 h (16 weeks) of cognitive training or a computer games control condition. After this intervention, participants completed a second fMRI N-back scanning session. At baseline, during 2-back working memory trials, healthy participants showed the largest and most significant activation in bilateral MFG, which correlated with task performance. Schizophrenia participants showed impaired working memory, hypoactivation in left MFG, and no correlation between bilateral MFG signal and task performance. After training, schizophrenia participants improved their 2-back working memory performance and showed increased activation in left MFG. They also demonstrated a significant association between enhanced task performance and right MFG signal, similar to healthy participants. Both task performance and brain activity in right MFG after training predicted better generalized working memory at 6-month follow-up. Furthermore, task performance and brain activity within bilateral MFG predicted better occupational functioning at 6-month follow-up. No such findings were observed in the computer games control participants. Working memory impairments in schizophrenia and its underlying neural correlates in MFG can be improved by intensive computerized cognitive training; these improvements generalize beyond the trained task and are associated with enduring effects on cognition and functioning 6 months after the intervention.
Collapse
Affiliation(s)
- Karuna Subramaniam
- Department of Psychiatry, University of California, San Francisco, CA-94121, USA.
| | - Tracy L Luks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA-94123, USA
| | - Coleman Garrett
- Department of Psychiatry, University of California, San Francisco, CA-94121, USA
| | | | - Melissa Fisher
- Department of Psychiatry, University of California, San Francisco, CA-94121, USA
| | - Srikantan Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA-94123, USA
| | - Sophia Vinogradov
- Department of Psychiatry, University of California, San Francisco, CA-94121, USA
| |
Collapse
|
44
|
Vianin P, Urben S, Magistretti P, Marquet P, Fornari E, Jaugey L. Increased activation in Broca's area after cognitive remediation in schizophrenia. Psychiatry Res 2014; 221:204-9. [PMID: 24507118 DOI: 10.1016/j.pscychresns.2014.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 12/21/2013] [Accepted: 01/10/2014] [Indexed: 12/21/2022]
Abstract
Functional magnetic resonance imaging (fMRI) was used to measure changes in cerebral activity in patients with schizophrenia after participation in the Cognitive Remediation Program for Schizophrenia and other related disorders (RECOS). As RECOS therapists make use of problem-solving and verbal mediation techniques, known to be beneficial in the rehabilitation of dysexecutive syndromes, we expected an increased activation of frontal areas after remediation. Executive functioning and cerebral activation during a covert verbal fluency task were measured in eight patients with schizophrenia before (T1) and after (T2) 14 weeks of RECOS therapy. The same measures were recorded in eight patients with schizophrenia who did not participate in RECOS at the same intervals of time (TAU group). Increased activation in Broca's area, as well as improvements in performance of executive/frontal tasks, was observed after cognitive training. Metacognitive techniques of verbalization are hypothesized to be the main factor underlying the brain changes observed in the present study.
Collapse
Affiliation(s)
- Pascal Vianin
- Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois (DP-CHUV), Lausanne, Switzerland.
| | - Sébastien Urben
- Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois (DP-CHUV), Lausanne, Switzerland
| | - Pierre Magistretti
- Centre des Neurosciences Psychiatriques (DP-CHUV), Lausanne, Switzerland; Brain Mind Institute, EPFL, Lausanne, Switzerland
| | - Pierre Marquet
- Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois (DP-CHUV), Lausanne, Switzerland; Centre des Neurosciences Psychiatriques (DP-CHUV), Lausanne, Switzerland
| | - Eleonora Fornari
- Centre d'Imagerie Biomédicale (CIBM), CHUV Unit, Department of Radiology, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, Switzerland
| | - Laure Jaugey
- Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois (DP-CHUV), Lausanne, Switzerland
| |
Collapse
|
45
|
A pilot study on the effects of cognitive remediation on hemodynamic responses in the prefrontal cortices of patients with schizophrenia: a multi-channel near-infrared spectroscopy study. Schizophr Res 2014; 153:87-95. [PMID: 24556471 DOI: 10.1016/j.schres.2014.01.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 01/17/2014] [Accepted: 01/19/2014] [Indexed: 02/04/2023]
Abstract
The regional neuronal changes taking place between before and after cognitive rehabilitation are still not characterized in schizophrenia patients. In addition, it is not known whether these regional changes are predictive or correlated with treatment response. We conducted a preliminary quasi-experimental study to investigate the effects of a Neuropsychological Educational Approach to Cognitive Remediation (NEAR), one of the cognitive remediation therapies, on neurocognitive functioning assessed by the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J), and on prefrontal and temporal hemodynamic responses during working memory (WM) task (2-back, letter version) using 52-channel near-infrared spectroscopy (NIRS). We assessed 19 patients with schizophrenia or schizoaffective disorder twice with an interval of 6months. Moreover, taking into consideration the possible practice effect, we assessed 12 control patients twice with an interval of 6months. The NEAR group, in comparison with the control group, showed significant improvement in two subcomponents of BACS-J, that is, motor speed and executive function along with the composite scores. The NEAR group also showed a significant increase in brain activation in the bilateral cortical regions associated with WM, and in comparison with the control group the between-group differences were restricted to the right frontopolar area. In addition, the amount of enhancement in some cognitive subcomponents was positively correlated with the magnitude of an increase in hemodynamic response during WM task predominantly in the right hemispheres. These findings suggest that neurocognitive deficits in schizophrenia and their neural dysfunction may be improved by NEAR, and NIRS may be a useful tool to assess the changes of the neural activity underlying the improvement of neurocognitive functioning elicited by neurocognitive rehabilitation.
Collapse
|
46
|
Lett TA, Voineskos AN, Kennedy JL, Levine B, Daskalakis ZJ. Treating working memory deficits in schizophrenia: a review of the neurobiology. Biol Psychiatry 2014; 75:361-70. [PMID: 24011822 DOI: 10.1016/j.biopsych.2013.07.026] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 01/06/2023]
Abstract
Cognitive deficits are a core feature of schizophrenia. Among these deficits, working memory impairment is considered a central cognitive impairment in schizophrenia. The prefrontal cortex, a region critical for working memory performance, has been demonstrated as a critical liability region in schizophrenia. As yet, there are no standardized treatment options for working memory deficits in schizophrenia. In this review, we summarize the neuronal basis for working memory impairment in schizophrenia, including dysfunction in prefrontal signaling pathways (e.g., γ-aminobutyric acid transmission) and neural network synchrony (e.g., gamma/theta oscillations). We discuss therapeutic strategies for working memory dysfunction such as pharmacological agents, cognitive remediation therapy, and repetitive transcranial magnetic stimulation. Despite the drawbacks of current approaches, the advances in neurobiological and translational treatment strategies suggest that clinical application of these methods will occur in the near future.
Collapse
Affiliation(s)
- Tristram A Lett
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Toronto, Ontario, Canada; Department of Psychiatry, Toronto, Ontario, Canada
| | - James L Kennedy
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Toronto, Ontario, Canada; Department of Psychiatry, Toronto, Ontario, Canada
| | - Brian Levine
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest Centre Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Toronto, Ontario, Canada; Department of Psychiatry, Toronto, Ontario, Canada.
| |
Collapse
|
47
|
Vallat-Azouvi C, Pradat-Diehl P, Azouvi P. Modularity in rehabilitation of working memory: A single-case study. Neuropsychol Rehabil 2014; 24:220-37. [DOI: 10.1080/09602011.2014.881294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
48
|
Thorsen AL, Johansson K, Løberg EM. Neurobiology of cognitive remediation therapy for schizophrenia: a systematic review. Front Psychiatry 2014; 5:103. [PMID: 25177300 PMCID: PMC4133649 DOI: 10.3389/fpsyt.2014.00103] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/01/2014] [Indexed: 12/13/2022] Open
Abstract
Cognitive impairment is an important aspect of schizophrenia, where cognitive remediation therapy (CRT) is a promising treatment for improving cognitive functioning. While neurobiological dysfunction in schizophrenia has been the target of much research, the neural substrate of cognitive remediation and recovery has not been thoroughly examined. The aim of the present article is to systematically review the evidence for neural changes after CRT for schizophrenia. The reviewed studies indicate that CRT affects several brain regions and circuits, including prefrontal, parietal, and limbic areas, both in terms of activity and structure. Changes in prefrontal areas are the most reported finding, fitting to previous evidence of dysfunction in this region. Two limitations of the current research are the few studies and the lack of knowledge on the mechanisms underlying neural and cognitive changes after treatment. Despite these limitations, the current evidence suggests that CRT is associated with both neurobiological and cognitive improvement. The evidence from these findings may shed light on both the neural substrate of cognitive impairment in schizophrenia, and how better treatment can be developed and applied.
Collapse
Affiliation(s)
| | - Kyrre Johansson
- Department of Psychosocial Science, University of Bergen , Bergen , Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital , Bergen , Norway ; Department of Biological and Medical Psychology, University of Bergen , Bergen , Norway
| |
Collapse
|
49
|
Neural correlates of cognitive remediation in patients with mood disorders. Psychiatry Res 2013; 214:142-52. [PMID: 23993991 DOI: 10.1016/j.pscychresns.2013.06.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 06/02/2013] [Accepted: 06/14/2013] [Indexed: 11/23/2022]
Abstract
Little is known about the brain changes that mediate improvement following cognitive remediation. We used neuropsychological tests and functional magnetic resonance imaging to study working memory and recollection memory in patients with mood disorders, before (PRE) and after (POST) 10 weeks of cognitive remediation. Thirty-eight patients completed a recollection memory task at PRE (28 had complete PRE and POST scans) and 35 patients completed an n-back working memory task at PRE (23 had complete PRE and POST scans). We also compared patients at PRE with two groups of healthy controls subjects (n=18 for the recollection memory task and n=15 for the working memory task). At PRE, compared to controls, patients had (i) poorer backward digit span scores, (ii) lower accuracy scores and weaker frontopolar activation during the 2-back condition, and (iii) poorer recollection scores and altered medial temporal activation on the recollection memory task. Following remediation, patients (i) improved on the backward digit span, (ii) activation increased in lateral and medial prefrontal, superior temporal, and lateral parietal regions in the 2-back condition, and (iii) recollection-related activation increased in the bilateral hippocampus. Improvements in 2-back accuracy correlated with activation increases in lateral and medial prefrontal and lateral parietal regions, and improved recollection scores correlated with activation increases in the left hippocampus. PRE-POST improvements on the backward digit span correlated with PRE-POST improvements in 2-back task accuracy; however, there was no direct association between improvement on the backward digit span following training and change in functional activation. These findings suggest that cognitive remediation may lead to behavioural improvements on tests of working memory. The relation between behavioural change and changes in functional activation following remediation requires further study.
Collapse
|
50
|
Hooker CI, Bruce L, Fisher M, Verosky SC, Miyakawa A, D'Esposito M, Vinogradov S. The influence of combined cognitive plus social-cognitive training on amygdala response during face emotion recognition in schizophrenia. Psychiatry Res 2013; 213:99-107. [PMID: 23746615 PMCID: PMC6999046 DOI: 10.1016/j.pscychresns.2013.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 12/12/2012] [Accepted: 04/05/2013] [Indexed: 12/18/2022]
Abstract
Both cognitive and social-cognitive deficits impact functional outcome in schizophrenia. Cognitive remediation studies indicate that targeted cognitive and/or social-cognitive training improves behavioral performance on trained skills. However, the neural effects of training in schizophrenia and their relation to behavioral gains are largely unknown. This study tested whether a 50-h intervention which included both cognitive and social-cognitive training would influence neural mechanisms that support social ccognition. Schizophrenia participants completed a computer-based intervention of either auditory-based cognitive training (AT) plus social-cognition training (SCT) (N=11) or non-specific computer games (CG) (N=11). Assessments included a functional magnetic resonance imaging (fMRI) task of facial emotion recognition, and behavioral measures of cognition, social cognition, and functional outcome. The fMRI results showed the predicted group-by-time interaction. Results were strongest for emotion recognition of happy, surprise and fear: relative to CG participants, AT+SCT participants showed a neural activity increase in bilateral amygdala, right putamen and right medial prefrontal cortex. Across all participants, pre-to-post intervention neural activity increase in these regions predicted behavioral improvement on an independent emotion perception measure (MSCEIT: Perceiving Emotions). Among AT+SCT participants alone, neural activity increase in right amygdala predicted behavioral improvement in emotion perception. The findings indicate that combined cognition and social-cognition training improves neural systems that support social-cognition skills.
Collapse
Affiliation(s)
- Christine I Hooker
- Department of Psychology, Harvard University, 33 Kirkland St., Cambridge, MA 02138, United States.
| | | | | | | | | | | | | |
Collapse
|