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Biagianti B, Bigoni D, Maggioni E, Brambilla P. Can neuroimaging-based biomarkers predict response to cognitive remediation in patients with psychosis? A state-of-the-art review. J Affect Disord 2022; 305:196-205. [PMID: 35283181 DOI: 10.1016/j.jad.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive Remediation (CR) is designed to halt the pathological neural systems that characterize major psychotic disorders (MPD), and its main objective is to improve cognitive functioning. The magnitude of CR-induced cognitive gains greatly varies across patients with MPD, with up to 40% of patients not showing gains in global cognitive performance. This is likely due to the high degree of heterogeneity in neural activation patterns underlying cognitive endophenotypes, and to inter-individual differences in neuroplastic potential, cortical organization and interaction between brain systems in response to learning. Here, we review studies that used neuroimaging to investigate which biomarkers could potentially serve as predictors of treatment response to CR in MPD. METHODS This systematic review followed the PRISMA guidelines. An electronic database search (Embase, Elsevier; Scopus, PsycINFO, APA; PubMed, APA) was conducted in March 2021. peer-reviewed, English-language studies were included if they reported data for adults aged 18+ with MPD, reported findings from randomized controlled trials or single-arm trials of CR; and presented neuroimaging data. RESULTS Sixteen studies were included and eight neuroimaging-based biomarkers were identified. Auditory mismatch negativity (3 studies), auditory steady-state response (1), gray matter morphology (3), white matter microstructure (1), and task-based fMRI (7) can predict response to CR. Efference copy corollary/discharge, resting state, and thalamo-cortical connectivity (1) require further research prior to being implemented. CONCLUSIONS Translational research on neuroimaging-based biomarkers can help elucidate the mechanisms by which CR influences the brain's functional architecture, better characterize psychotic subpopulations, and ultimately deliver CR that is optimized and personalized.
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Affiliation(s)
- Bruno Biagianti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Davide Bigoni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Maggioni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Scoriels L, Genaro LT, Keffer S, Guimarães AL, Barros-Dumas B, Mororó LG, Biagioni T, Lucena C, da Hora TR, Sahakian BJ, Fisher M, Vinogradov S, Panizzutti R. Changes in emotion processing and social cognition with auditory versus visual neuroscience-informed cognitive training in individuals with schizophrenia. Schizophr Res 2022; 241:267-274. [PMID: 35182906 PMCID: PMC10664860 DOI: 10.1016/j.schres.2022.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neuroscience-informed cognitive training has been used to remediate cognitive deficits in schizophrenia, but their effect on emotion processing and social cognition deficits, which may involve auditory and visual impairments, remain relatively unknown. In this study, we compared the efficacy of auditory versus visual neuroscience-informed cognitive training on emotion processing and social cognition in individuals with schizophrenia. METHODS In this randomised, double-blind clinical trial, 79 participants with chronic schizophrenia performed 40-hours auditory or visual dynamically equivalent computerised cognitive training. We assessed emotion processing and social cognition using Emotion Recognition, Affective Go-NoGo, Mayer-Salovey-Caruso Emotional-Intelligence, Theory of mind, and Hinting tests before and after 20 h and 40 h of training. RESULTS After training, participants from both groups decreased their reaction time for facial emotion recognition (p = 3 × 10-6, d = 0.9). This was more remarkable for the auditory group when analysing individual emotions. Both groups also reduced omissions in the affective go-no go (p = 0.01, d = 0.6), which was also attributed, post hoc, to the auditory group. Trends for improvement were observed in theory of mind (p = 0.06, d = 0.6) for both groups. Improvement in emotion processing was associated with improvement in reasoning and problem solving and global cognition and improvement in theory of mind was associated with improvement in attention and global cognition. CONCLUSIONS Both the auditory and the visual neuroscience-informed cognitive training were efficacious at improving emotion processing and social cognition in individuals with schizophrenia, although improvement was more remarkable for the auditory training group. These improvements were related to cognitive - but not symptom - improvement.
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Affiliation(s)
- Linda Scoriels
- Institut de Psychiatrie et Neurosciences de Paris, Inserm - Université Paris Descartes, France; Department of Psychiatry, University of Cambridge, United Kingdom; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
| | - Larissa T Genaro
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Stella Keffer
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Anna Luiza Guimarães
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Bárbara Barros-Dumas
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Luana G Mororó
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Thales Biagioni
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Camila Lucena
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Thaís R da Hora
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | | | - Melissa Fisher
- Department of Psychiatry, University of Minnesota, United States
| | | | - Rogério Panizzutti
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil.
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Cognitive and Social Rehabilitation in Schizophrenia-From Neurophysiology to Neuromodulation. Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114034. [PMID: 32517043 PMCID: PMC7312635 DOI: 10.3390/ijerph17114034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/18/2022]
Abstract
The aim of this pilot study was to analyse the influence of Galvanic Skin Response (GSR) Biofeedback training in a group of 18 men with schizophrenia at the remission stage. The results were verified according to: Positive and Negative Syndrome Scale (PANSS), Acceptance of Illness Scale (AIS), Self-efficacy Scale (GSES), Beck Cognitive Insight Scale (BCIS) scales, Colour Trial Test (CTT-1, CTT-2), d2 psychological tests, Quantitative Electroencephalogram (QEEG) Biofeedback, auditory event-related potentials (ERPs), and serum levels of brain-derived neurotrophic factor (BDNF). The results were compared in the same patients after 3 months. Statistically significant changes were noted in results for the variables on the PANSS scale. For the BDNF variable, a statistically significant increase occurred, indicating that GSR Biofeedback training may influence serum levels of the neurotrophic factor. Statistically significant changes were noted in results for the variables on the BCIS, AIS, and GSES indicating an improvement in the cognitive and social functioning. Changes were noted for results for theta/beta and theta/Sensory Motor Rhythm (SMR) ratios, which indicate an improvement in concentration and attention. Changes were noted for the N1 wave amplitude in the frontal brain region (F-z), and for the P2 wave latency in the central brain region (C-z), which indicates an improvement in the initial perceptual analysis. The use of GSR Biofeedback in a group of patients with schizophrenia gives interesting results, but requires further in-depth research.
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Balice-Gordon R, Honey GD, Chatham C, Arce E, Duvvuri S, Naylor MG, Liu W, Xie Z, DeMartinis N, Harel BT, Braley GH, Kozak R, Park L, Gray DL. A Neurofunctional Domains Approach to Evaluate D1/D5 Dopamine Receptor Partial Agonism on Cognition and Motivation in Healthy Volunteers With Low Working Memory Capacity. Int J Neuropsychopharmacol 2020; 23:287-299. [PMID: 32055822 PMCID: PMC7251631 DOI: 10.1093/ijnp/pyaa007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/02/2020] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dopamine D1 receptor signaling plays key roles in core domains of neural function, including cognition and reward processing; however, many questions remain about the functions of circuits modulated by dopamine D1 receptor, largely because clinically viable, selective agonists have yet to be tested in humans. METHODS Using a novel, exploratory neurofunctional domains study design, we assessed the safety, tolerability, pharmacodynamics, and pharmacokinetics of PF-06412562, a selective D1/D5R partial agonist, in healthy male volunteers who met prespecified criteria for low working memory capacity. Functional magnetic resonance imaging, electrophysiologic endpoints, and behavioral paradigms were used to assess working memory, executive function, and motivation/reward processing following multiple-dose administration of PF-06412562. A total of 77 patients were assigned PF-06412562 (3 mg twice daily and 15 mg twice daily) or placebo administered for 5 to 7 days. Due to the exploratory nature of the study, it was neither powered for any specific treatment effect nor corrected for multiple comparisons. RESULTS Nominally significant improvements from baseline in cognitive endpoints were observed in all 3 groups; however, improvements in PF-06412562-treated patients were less than in placebo-treated participants. Motivation/reward processing endpoints were variable. PF-06412562 was safe and well tolerated, with no serious adverse events, severe adverse events, or adverse events leading to dose reduction or temporary discontinuation except for 1 permanent discontinuation due to increased orthostatic heart rate. CONCLUSIONS PF-06412562, in the dose range and patient population explored in this study, did not improve cognitive function or motivation/reward processing more than placebo over the 5- to 7-day treatment period. CLINICALTRIALS.GOV IDENTIFIER NCT02306876.
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Affiliation(s)
| | - Garry D Honey
- Pfizer Worldwide Research and Development, Cambridge, MA
| | | | - Estibaliz Arce
- Pfizer Worldwide Research and Development, Cambridge, MA
| | | | | | - Wenlei Liu
- Pfizer Worldwide Research and Development, Cambridge, MA
| | - Zhiyong Xie
- Pfizer Worldwide Research and Development, Cambridge, MA
| | | | - Brian T Harel
- Pfizer Worldwide Research and Development, Cambridge, MA
| | | | - Rouba Kozak
- Pfizer Worldwide Research and Development, Cambridge, MA
| | - Lovingly Park
- California Clinical Trials Medical Group/PAREXEL International, Glendale, CA
| | - David L Gray
- Pfizer Worldwide Research and Development, Cambridge, MA
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Biagianti B, Merchant J, Brambilla P, Lewandowski KE. The effects of cognitive remediation in patients with affective psychosis: A systematic review: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders. J Affect Disord 2019; 255:S0165-0327(18)32460-1. [PMID: 30878159 PMCID: PMC6591034 DOI: 10.1016/j.jad.2019.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Schizophrenia, schizoaffective disorder, and related illnesses are associated with significant impairment in cognitive functioning which is among the strongest predictors of disability and poor quality of life. Cognitive remediation (CR) was developed as a set of behavioral interventions directly targeting cognitive symptoms. Studies have shown that CR produces cognitive improvements in patients with schizophrenia and bipolar disorder that may be associated with improvements in functioning. However, the relative efficacy of CR across diagnoses has not been established. Indirect evidence suggests that CR is effective in patients with affective illness as well as patients with schizophrenia (SZ); however, the one study to evaluate the effects of diagnosis on outcomes directly in patients with SZ versus schizoaffective disorder (SZA) found no differences by diagnosis. METHODS In this systematic review, we evaluated cognitive and functional outcomes after CR in studies including patients with SZA, and examined specificity of training content to outcomes. RESULTS Sixteen studies met inclusion criteria: 10 studies that compared CR to a control condition (n = 779) and 6 comparative effectiveness studies. None of the studies explicitly compared patients by diagnosis. Studies included a mixture of patients with SZA or SZ. Of the CR versus control studies, effect sizes for cognitive outcomes were moderate-large (d = .36-.94). Studies comparing CR paradigms targeting different cognitive domains showed specificity of training focus to outcomes. Five of studies reported significant functional improvement after CR as secondary outcomes. CONCLUSIONS In this review, we found support for the use of CR paradigms in patients with affective psychosis, with evidence that reported treatment effects in mixed affective and non-affective samples are at or above the levels previously reported in SZ. However, lack of availability of data directly comparing patients by diagnosis or examining moderator or mediator effects of diagnosis or diagnosis-related patient characteristics limits our understanding of the relative efficacy of CR across patient group.
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Affiliation(s)
- Bruno Biagianti
- Posit Science Inc.,160 Pine Street Suite 200, 94111 San Francisco, CA, USA.
| | - Jaisal Merchant
- Schizophrenia and Bipolar Disorder Program, McLean
Hospital, Belmont, MA, USA
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation,
University of Milan, Milan, Italy,Department of Psychiatry, IRCCS Fondazione Ca’
Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;,Department of Psychiatry and Behavioral Sciences, The
University of Texas Health Science Center at Houston, McGovern Medical School,
Houston, TX, USA
| | - Kathryn E Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean
Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston,
MA, USA
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Dondé C, Mondino M, Brunelin J, Haesebaert F. Sensory-targeted cognitive training for schizophrenia. Expert Rev Neurother 2019; 19:211-225. [PMID: 30741038 DOI: 10.1080/14737175.2019.1581609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Auditory and visual dysfunctions are key pathophysiological features of schizophrenia (Sz). Therefore, remedial interventions that directly target such impairments could potentially drive gains in higher-order cognition (e.g., memory, executive functions, emotion processing), symptoms and functional outcome, in addition to improving sensory abilities in this population. Here, we reviewed available sensory-targeted cognitive training (S-TCT) programs that were investigated so far in Sz patients. Area covered: A systematic review of the literature was conducted following PRISMA guidelines. Twenty-seven relevant records were included. The superiority of S-TCT over control conditions on higher-order cognition measures was repeatedly demonstrated, but mostly lost significance at later endpoints of evaluation. Clinical symptoms and functional outcome were improved in a minority of studies. S-TCT interventions were associated with the relative normalization of several neurobiological biomarkers of neuroplasticity and sensory mechanisms. Expert commentary: S-TCT, although time-intensive, is a cost-efficient, safe and promising technique for Sz treatment. Its efficacy on higher-order cognition opens a critical window for clinical and functional improvement. The biological impact of S-TCT may allow for the identification of therapeutic biomarkers to further precision-medicine. Additional research is required to investigate the long-term effects of S-TCT, optimal training parameters and potential confounding factors associated with the illness.
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Affiliation(s)
- Clément Dondé
- a INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team , Lyon, F-69678 , France.,b University Lyon 1 , Villeurbanne, F-69000 , France.,c Centre Hospitalier Le Vinatier, Department of Psychiatry , Bron, F-69000 , France
| | - Marine Mondino
- a INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team , Lyon, F-69678 , France.,b University Lyon 1 , Villeurbanne, F-69000 , France.,c Centre Hospitalier Le Vinatier, Department of Psychiatry , Bron, F-69000 , France
| | - Jérôme Brunelin
- a INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team , Lyon, F-69678 , France.,b University Lyon 1 , Villeurbanne, F-69000 , France.,c Centre Hospitalier Le Vinatier, Department of Psychiatry , Bron, F-69000 , France
| | - Frédéric Haesebaert
- a INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team , Lyon, F-69678 , France.,b University Lyon 1 , Villeurbanne, F-69000 , France.,c Centre Hospitalier Le Vinatier, Department of Psychiatry , Bron, F-69000 , France
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Biagianti B, Roach BJ, Fisher M, Loewy R, Ford JM, Vinogradov S, Mathalon DH. Trait aspects of auditory mismatch negativity predict response to auditory training in individuals with early illness schizophrenia. NEUROPSYCHIATRIC ELECTROPHYSIOLOGY 2017; 3:2. [PMID: 28845238 PMCID: PMC5568850 DOI: 10.1186/s40810-017-0024-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/05/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Individuals with schizophrenia have heterogeneous impairments of the auditory processing system that likely mediate differences in the cognitive gains induced by auditory training (AT). Mismatch negativity (MMN) is an event-related potential component reflecting auditory echoic memory, and its amplitude reduction in schizophrenia has been linked to cognitive deficits. Therefore, MMN may predict response to AT and identify individuals with schizophrenia who have the most to gain from AT. Furthermore, to the extent that AT strengthens auditory deviance processing, MMN may also serve as a readout of the underlying changes in the auditory system induced by AT. METHODS Fifty-six individuals early in the course of a schizophrenia-spectrum illness (ESZ) were randomly assigned to 40 h of AT or Computer Games (CG). Cognitive assessments and EEG recordings during a multi-deviant MMN paradigm were obtained before and after AT and CG. Changes in these measures were compared between the treatment groups. Baseline and trait-like MMN data were evaluated as predictors of treatment response. MMN data collected with the same paradigm from a sample of Healthy Controls (HC; n = 105) were compared to baseline MMN data from the ESZ group. RESULTS Compared to HC, ESZ individuals showed significant MMN reductions at baseline (p = .003). Reduced Double-Deviant MMN was associated with greater general cognitive impairment in ESZ individuals (p = .020). Neither ESZ intervention group showed significant change in MMN. We found high correlations in all MMN deviant types (rs = .59-.68, all ps < .001) between baseline and post-intervention amplitudes irrespective of treatment group, suggesting trait-like stability of the MMN signal. Greater deficits in trait-like Double-Deviant MMN predicted greater cognitive improvements in the AT group (p = .02), but not in the CG group. CONCLUSIONS In this sample of ESZ individuals, AT had no effect on auditory deviance processing as assessed by MMN. In ESZ individuals, baseline MMN was significantly reduced relative to HCs, and associated with global cognitive impairment. MMN did not show changes after AT and exhibited trait-like stability. Greater deficits in the trait aspects of Double-Deviant MMN predicted greater gains in global cognition in response to AT, suggesting that MMN may identify individuals who stand to gain the most from AT. TRIAL REGISTRATION NCT00694889. Registered 1 August 2007.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Brian J. Roach
- Department of Mental Health, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Melissa Fisher
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Loewy
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Judith M. Ford
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
- Department of Mental Health, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sophia Vinogradov
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Daniel H. Mathalon
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
- Department of Mental Health, San Francisco VA Medical Center, San Francisco, CA, USA
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Kärgel C, Sartory G, Kariofillis D, Wiltfang J, Müller BW. The effect of auditory and visual training on the mismatch negativity in schizophrenia. Int J Psychophysiol 2016; 102:47-54. [DOI: 10.1016/j.ijpsycho.2016.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
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Isaac C, Januel D. Neural correlates of cognitive improvements following cognitive remediation in schizophrenia: a systematic review of randomized trials. SOCIOAFFECTIVE NEUROSCIENCE & PSYCHOLOGY 2016; 6:30054. [PMID: 26993787 PMCID: PMC4799394 DOI: 10.3402/snp.v6.30054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/31/2015] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cognitive impairments are a core feature in schizophrenia and are linked to poor social functioning. Numerous studies have shown that cognitive remediation can enhance cognitive and functional abilities in patients with this pathology. The underlying mechanism of these behavioral improvements seems to be related to structural and functional changes in the brain. However, studies on neural correlates of such enhancement remain scarce. OBJECTIVES We explored the neural correlates of cognitive enhancement following cognitive remediation interventions in schizophrenia and the differential effect between cognitive training and other therapeutic interventions or patients' usual care. METHOD We searched MEDLINE, PsycInfo, and ScienceDirect databases for studies on cognitive remediation therapy in schizophrenia that used neuroimaging techniques and a randomized design. Search terms included randomized controlled trial, cognitive remediation, cognitive training, rehabilitation, magnetic resonance imaging, positron emission tomography, electroencephalography, magnetoencephalography, near infrared spectroscopy, and diffusion tensor imaging. We selected randomized controlled trials that proposed multiple sessions of cognitive training to adult patients with a schizophrenia spectrum disorder and assessed its efficacy with imaging techniques. RESULTS In total, 15 reports involving 19 studies were included in the systematic review. They involved a total of 455 adult patients, 271 of whom received cognitive remediation. Cognitive remediation therapy seems to provide a neurobiological enhancing effect in schizophrenia. After therapy, increased activations are observed in various brain regions mainly in frontal - especially prefrontal - and also in occipital and anterior cingulate regions during working memory and executive tasks. Several studies provide evidence of an improved functional connectivity after cognitive training, suggesting a neuroplastic effect of therapy through mechanisms of functional reorganization. Neurocognitive and social-cognitive training may have a cumulative effect on neural networks involved in social cognition. The variety of proposed programs, imaging tasks, and techniques may explain the heterogeneity of observed neural improvements. Future studies would need to specify the effect of cognitive training depending on those variables.
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Affiliation(s)
- Clémence Isaac
- Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-Sur-Marne, France;
| | - Dominique Januel
- Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-Sur-Marne, France
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