1
|
Chen CS, Vinogradov S. Personalized Cognitive Health in Psychiatry: Current State and the Promise of Computational Methods. Schizophr Bull 2024; 50:1028-1038. [PMID: 38934792 PMCID: PMC11349010 DOI: 10.1093/schbul/sbae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND Decades of research have firmly established that cognitive health and cognitive treatment services are a key need for people living with psychosis. However, many current clinical programs do not address this need, despite the essential role that an individual's cognitive and social cognitive capacities play in determining their real-world functioning. Preliminary practice-based research in the Early Psychosis Intervention Network early psychosis intervention network shows that it is possible to develop and implement tools that delineate an individuals' cognitive health profile and that help engage the client and the clinician in shared decision-making and treatment planning that includes cognitive treatments. These findings signify a promising shift toward personalized cognitive health. STUDY DESIGN Extending upon this early progress, we review the concept of interindividual variability in cognitive domains/processes in psychosis as the basis for offering personalized treatment plans. We present evidence from studies that have used traditional neuropsychological measures as well as findings from emerging computational studies that leverage trial-by-trial behavior data to illuminate the different latent strategies that individuals employ. STUDY RESULT We posit that these computational techniques, when combined with traditional cognitive assessments, can enrich our understanding of individual differences in treatment needs, which in turn can guide evermore personalized interventions. CONCLUSION As we find clinically relevant ways to decompose maladaptive behaviors into separate latent cognitive elements captured by model parameters, the ultimate goal is to develop and implement approaches that empower clients and their clinical providers to leverage individual's existing learning capacities to improve their cognitive health and well-being.
Collapse
Affiliation(s)
- Cathy S Chen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sophia Vinogradov
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
2
|
Markiewicz R, Markiewicz-Gospodarek A, Trubalski M, Łoza B. Neurocognitive, Clinical and Reelin Activity in Rehabilitation Using Neurofeedback Therapy in Patients with Schizophrenia. J Clin Med 2024; 13:4035. [PMID: 39064075 PMCID: PMC11277514 DOI: 10.3390/jcm13144035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction: Reelin is a neuropeptide responsible for the migration and positioning of pyramidal neurons, interneurons, and Purkinje cells. In adulthood, it still supports neuroplasticity, especially dendritic spines formation and glutamatergic neurotransmission. Genetic studies have confirmed the involvement of reelin system failure in the etiopathogenesis of mental diseases, including schizophrenia. Given the role of reelin in brain cytoarchitectonics and the regularly observed reduction in its activity in prefrontal areas in cases of schizophrenia, dysfunction of the reelin pathway fits the neurodevelopmental hypothesis of schizophrenia, both as a biochemical predisposition and/or the ultimate trigger of psychosis and as a biosocial factor determining the clinical course, and finally, as a potential target for disease monitoring and treatment. Aim: The purpose of this study was to examine associations of the reelin blood level with clinical and neurocognitive parameters during an intensive, structured neurofeedback therapy of patients with schizophrenia. Methods: Thirty-seven male patients with paranoid schizophrenia were randomly divided into two groups: a group with 3-month neurofeedback as an add-on to ongoing antipsychotic treatment (NF, N18), and a control group with standard social support and antipsychotic treatment (CON, N19). The reelin serum concentration, clinical and neurocognitive tests were compared between the groups. Results: After 3-month trial (T2), the reelin serum level increased in the NF group vs. the CON group. The negative and general symptoms of PANSS (Positive and Negative Syndrome Scale) were reduced significantly more in the NF group at T2, and the d2 (d2 Sustained Attention Test) and BCIS (Beck Cognitive Insight Scale) scores improved only in the NF group. The AIS scores improved more dynamically in the NF group, but not enough to differentiate them from the CON group at T2. Conclusions: The clinical and neurocognitive improvement within the 3-month NF add-on therapy trial was associated with a significant increase of reelin serum level in schizophrenia patients.
Collapse
Affiliation(s)
- Renata Markiewicz
- Occupational Therapy Laboratory, Medical University of Lublin, 7 Chodźki St., 20-093 Lublin, Poland;
| | | | - Mateusz Trubalski
- Student Scientific Association at the Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Bartosz Łoza
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland;
| |
Collapse
|
3
|
Macoveanu J, Petersen JZ, Mariegaard J, Jespersen AE, Cramer K, Bruun CF, Madsen HØ, Jørgensen MB, Vinberg M, Fisher PM, Knudsen GM, Hageman I, Ehrenreich H, Kessing LV, Miskowiak KW. Effects of erythropoietin on cognitive impairment and prefrontal cortex activity across affective disorders: A randomized, double-blinded, placebo-controlled trial. J Psychopharmacol 2024; 38:362-374. [PMID: 38519416 DOI: 10.1177/02698811241237869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Persistent cognitive impairment is frequent across bipolar disorder (BD) and major depressive disorder (MDD), highlighting an urgent need for pro-cognitive treatments. AIM This study investigated effects of erythropoietin (EPO) on cognitive impairment and dorsal prefrontal cortex (dPFC) activity in affective disorders. METHODS In this randomized, double-blinded, placebo-controlled trial, cognitively impaired patients with remitted BD or MDD received 1 weekly recombinant human EPO (40,000 IU/mL) or saline infusion for a 12-week period. Assessments were conducted at baseline, after 2 weeks of treatment (week 3), immediately after treatment (week 13) and at 6-months follow-up. Participants underwent functional MRI during performance on a n-back working memory (WM) task at baseline and week 3, and for a subgroup 6 weeks post-treatment (week 18). The primary outcome was a cognitive composite score at week 13, whereas secondary outcomes comprised sustained attention and functioning. WM-related dPFC activity was a tertiary outcome. RESULTS Data were analysed for 101 of the 103 included patients (EPO, n = 58; saline, n = 43). There were no effects of EPO over saline on any cognitive or functional outcomes or on WM-related dPFC activity. CONCLUSIONS The absence of treatment-related changes in cognition and neural activity was unexpected and contrasts with multiple previous preclinical and clinical studies. It is possible that the lack of effects resulted from a recent change in the manufacturing process for EPO. Nevertheless, the findings support the validity of dPFC target engagement as a biomarker model for pro-cognitive effects, according to which treatments that do not improve cognition should not modulate dPFC activity. TRIAL REGISTRATIONS EudraCT no.: 2016-004023-24; ClinicalTrials.gov identifier: NCT03315897.
Collapse
Affiliation(s)
- Julian Macoveanu
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Jeff Zarp Petersen
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Johanna Mariegaard
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Elleby Jespersen
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Cramer
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Caroline Fussing Bruun
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Helle Østergaard Madsen
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Early Multimodular Prevention and Intervention Research Institution, Mental Health Centre, Northern Zealand, Mental Health Services CPH, Copenhagen, Denmark
| | - Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Services, Copenhagen University Hospital, Capital Region of Denmark, Copenhagen, Denmark
| | - Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute for Multidisciplinary Sciences (City Campus), Göttingen, Germany
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Jespersen AE, Lumbye A, Vinberg M, Glenthøj L, Nordentoft M, Wæhrens EE, Knudsen GM, Makransky G, Miskowiak KW. Effect of immersive virtual reality-based cognitive remediation in patients with mood or psychosis spectrum disorders: study protocol for a randomized, controlled, double-blinded trial. Trials 2024; 25:82. [PMID: 38268043 PMCID: PMC10809611 DOI: 10.1186/s13063-024-07910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Cognitive impairments are prevalent across mood disorders and psychosis spectrum disorders, but there is a lack of real-life-like cognitive training programmes. Fully immersive virtual reality has the potential to ensure motivating and engaging cognitive training directly relevant to patients' daily lives. We will examine the effect of a 4-week, intensive virtual reality-based cognitive remediation programme involving daily life challenges on cognition and daily life functioning in patients with mood disorders or psychosis spectrum disorders and explore the neuronal underpinnings of potential treatment efficacy. METHODS The trial has a randomized, controlled, double-blinded, parallel-group design. We will include 66 symptomatically stable outpatients with mood disorders or psychosis spectrum disorders aged 18-55 years with objective and subjective cognitive impairment. Assessments encompassing a virtual reality test of daily life cognitive skills, neuropsychological testing, measures of daily life functioning, symptom ratings, questionnaires on subjective cognitive complaints, and quality of life are carried out at baseline, after the end of 4 weeks of treatment and at a 3-month follow-up after treatment completion. Functional magnetic resonance imaging scans are performed at baseline and at the end of treatment. The primary outcome is a broad cognitive composite score comprising five subtasks on a novel ecologically valid virtual reality test of daily life cognitive functions. Two complete data sets for 54 patients will provide a power of 80% to detect a clinically relevant between-group difference in the primary outcome. Behavioural data will be analysed using linear mixed models in SPSS, while MRI data will be analysed with the FMRIB Expert Analysis Tool (FEAT). Treatment-related changes in neural activity from baseline to end of treatment will be investigated for the dorsal prefrontal cortex and hippocampus as the regions of interest. DISCUSSION The results will provide insight into whether virtual reality-based cognitive remediation has beneficial effects on cognition and functioning in symptomatically stable patients with mood disorders or psychosis spectrum disorders, which can aid future treatment development. TRIAL REGISTRATION ClinicalTrials.gov NCT06038955. Registered on September 15, 2023.
Collapse
Affiliation(s)
- Andreas E Jespersen
- Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, DK-2000, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services, The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen, Denmark
| | - Louise Glenthøj
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Guido Makransky
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Virtual Learning Lab, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, DK-2000, Copenhagen, Denmark.
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
5
|
Kuo SS, Ventura J, Forsyth JK, Subotnik KL, Turner LR, Nuechterlein KH. Developmental trajectories of premorbid functioning predict cognitive remediation treatment response in first-episode schizophrenia. Psychol Med 2023; 53:6132-6141. [PMID: 36349373 PMCID: PMC10166766 DOI: 10.1017/s0033291722003312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cognitive development after schizophrenia onset can be shaped by interventions such as cognitive remediation, yet no study to date has investigated whether patterns of early behavioral development may predict later cognitive changes following intervention. We therefore investigated the extent to which premorbid adjustment trajectories predict cognitive remediation gains in schizophrenia. METHODS In a total sample of 215 participants (170 first-episode schizophrenia participants and 45 controls), we classified premorbid functioning trajectories from childhood through late adolescence using the Cannon-Spoor Premorbid Adjustment Scale. For the 62 schizophrenia participants who underwent 6 months of computer-assisted, bottom-up cognitive remediation interventions, we identified MATRICS Consensus Cognitive Battery scores for which participants demonstrated mean changes after intervention, then evaluated whether developmental trajectories predicted these changes. RESULTS Growth mixture models supported three premorbid functioning trajectories: stable-good, deteriorating, and stable-poor adjustment. Schizophrenia participants demonstrated significant cognitive remediation gains in processing speed, verbal learning, and overall cognition. Notably, participants with stable-poor trajectories demonstrated significantly greater improvements in processing speed compared to participants with deteriorating trajectories. CONCLUSIONS This is the first study to our knowledge to characterize the associations between premorbid functioning trajectories and cognitive remediation gains after schizophrenia onset, indicating that 6 months of bottom-up cognitive remediation appears to be sufficient to yield a full standard deviation gain in processing speed for individuals with early, enduring functioning difficulties. Our findings highlight the connection between trajectories of premorbid and postmorbid functioning in schizophrenia and emphasize the utility of considering the lifespan developmental course in personalizing therapeutic interventions.
Collapse
Affiliation(s)
- Susan S. Kuo
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
| | | | | | - Luana R. Turner
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
- Department of Psychology, UCLA, Los Angeles, USA
| |
Collapse
|
6
|
Sampedro A, Ibarretxe-Bilbao N, Peña J, Cabrera-Zubizarreta A, Sánchez P, Gómez-Gastiasoro A, Iriarte-Yoller N, Pavón C, Tous-Espelosin M, Ojeda N. Analyzing structural and functional brain changes related to an integrative cognitive remediation program for schizophrenia: A randomized controlled trial. Schizophr Res 2023; 255:82-92. [PMID: 36965364 DOI: 10.1016/j.schres.2023.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/07/2023] [Accepted: 03/11/2023] [Indexed: 03/27/2023]
Abstract
Cognitive remediation has been shown to improve cognition in schizophrenia, but little is known about the specific functional and structural brain changes related to the implementation of an integrative cognitive remediation program. This study analyzed the functional and structural brain changes identified after implementing an integrative cognitive remediation program, REHACOP, in schizophrenia. The program combined cognitive remediation, social cognitive training, and functional and social skills training. The sample included 59 patients that were assigned to either the REHACOP group or an active control group for 20 weeks. In addition to a clinical and neuropsychological assessment, T1-weighted, diffusion-weighted and functional magnetic resonance images were acquired during a resting-state and during a memory paradigm, both at baseline and follow-up. Voxel-based morphometry, tract-based spatial statistics, resting-state functional connectivity, and brain activation analyses during the memory paradigm were performed. Brain changes were assessed with a 2 × 2 repeated-measure analysis of covariance for group x time interaction. Intragroup paired t-tests were also carried out. Repeated-measure analyses revealed improvements in cognition and functional outcome, but no significant brain changes associated with the integrative cognitive remediation program. Intragroup analyses showed greater gray matter volume and cortical thickness in right temporal regions at post-treatment in the REHACOP group. The absence of significant brain-level results associated with cognitive remediation may be partly due to the small sample size, which limited the statistical power of the study. Therefore, further research is needed to clarify whether the temporal lobe may be a key area involved in cognitive improvements following cognitive remediation.
Collapse
Affiliation(s)
- Agurne Sampedro
- University of Deusto, Faculty of Health Sciences, Department of Psychology, Bilbao, Spain
| | - Naroa Ibarretxe-Bilbao
- University of Deusto, Faculty of Health Sciences, Department of Psychology, Bilbao, Spain
| | - Javier Peña
- University of Deusto, Faculty of Health Sciences, Department of Psychology, Bilbao, Spain.
| | | | - Pedro Sánchez
- Bioaraba, New Therapies in Mental Health, Osakidetza Basque Health Service, Araba Mental Health Service, Alava Psychiatric Hospital, Vitoria-Gasteiz, Spain; University of Deusto, Faculty of Health Sciences, Department of Medicine, Bilbao, Spain
| | - Ainara Gómez-Gastiasoro
- University of the Basque Country (UPV/EHU), Faculty of Psychology, Department of Basic Psychological Processes and Development, Donostia, Spain
| | - Nagore Iriarte-Yoller
- Bioaraba, New Therapies in Mental Health, Osakidetza Basque Health Service, Araba Mental Health Service, Alava Psychiatric Hospital, Vitoria-Gasteiz, Spain
| | - Cristóbal Pavón
- Bioaraba, New Therapies in Mental Health, Osakidetza Basque Health Service, Araba Mental Health Service, Alava Psychiatric Hospital, Vitoria-Gasteiz, Spain
| | - Mikel Tous-Espelosin
- University of the Basque Country (UPV/EHU), Faculty of Education and Sport, Department of Physical Education and Sport, Vitoria-Gasteiz, Spain
| | - Natalia Ojeda
- University of Deusto, Faculty of Health Sciences, Department of Psychology, Bilbao, Spain
| |
Collapse
|
7
|
Mayeli A, Clancy KJ, Sonnenschein S, Sarpal DK, Ferrarelli F. A narrative review of treatment interventions to improve cognitive performance in schizophrenia, with an emphasis on at-risk and early course stages. Psychiatry Res 2022; 317:114926. [PMID: 36932470 PMCID: PMC10729941 DOI: 10.1016/j.psychres.2022.114926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 10/31/2022]
Abstract
Cognitive dysfunction is a core feature of schizophrenia (SCZ), which unfavorably affects SCZ patients' daily functioning and overall clinical outcome. An increasing body of evidence has shown that cognitive deficits are present not only at the beginning of the illness but also several years before the onset of psychosis. Nonetheless, the majority of treatment interventions targeting cognitive dysfunction in SCZ, using both pharmacological and nonpharmacological approaches, have focused on chronic patients rather than individuals at high risk or in the early stages of the disease. In this article, we provide a narrative review of cognitive interventions in SCZ patients, with a particular focus on pre-emptive interventions in at-risk/early course individuals when available. Furthermore, we discuss current challenges for these pre-emptive treatment interventions and provide some suggestions on how future work may ameliorate cognitive dysfunction in these individuals.
Collapse
Affiliation(s)
- Ahmad Mayeli
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA
| | - Kevin J Clancy
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA
| | - Susan Sonnenschein
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA.
| |
Collapse
|
8
|
Miskowiak KW, Yalin N, Seeberg I, Burdick KE, Balanzá‐Martínez V, Bonnin CDM, Bowie CR, Carvalho AF, Dols A, Douglas K, Gallagher P, Hasler G, Kessing LV, Lafer B, Lewandowski KE, López‐Jaramillo C, Martinez‐Aran A, McIntyre RS, Porter RJ, Purdon SE, Schaffer A, Sumiyoshi T, Torres IJ, Van Rheenen TE, Yatham LN, Young AH, Vieta E, Stokes PRA. Can magnetic resonance imaging enhance the assessment of potential new treatments for cognitive impairment in mood disorders? A systematic review and position paper by the International Society for Bipolar Disorders Targeting Cognition Task Force. Bipolar Disord 2022; 24:615-636. [PMID: 35950925 PMCID: PMC9826389 DOI: 10.1111/bdi.13247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Developing treatments for cognitive impairment is key to improving the functioning of people with mood disorders. Neuroimaging may assist in identifying brain-based efficacy markers. This systematic review and position paper by the International Society for Bipolar Disorders Targeting Cognition Task Force examines the evidence from neuroimaging studies of pro-cognitive interventions. METHODS We included magnetic resonance imaging (MRI) studies of candidate interventions in people with mood disorders or healthy individuals, following the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 statement. Searches were conducted on PubMed/MEDLINE, PsycInfo, EMBASE, Cochrane Library, and Clinicaltrials.gov from inception to 30th April 2021. Two independent authors reviewed the studies using the National Heart, Lung, Blood Institutes of Health Quality Assessment Tool for Controlled Intervention Studies and the quality of neuroimaging methodology assessment checklist. RESULTS We identified 26 studies (N = 702). Six investigated cognitive remediation or pharmacological treatments in mood disorders (N = 190). In healthy individuals, 14 studies investigated pharmacological interventions (N = 319), 2 cognitive training (N = 73) and 4 neuromodulatory treatments (N = 120). Methodologies were mostly rated as 'fair'. 77% of studies investigated effects with task-based fMRI. Findings varied but most consistently involved treatment-associated cognitive control network (CCN) activity increases with cognitive improvements, or CCN activity decreases with no cognitive change, and increased functional connectivity. In mood disorders, treatment-related default mode network suppression occurred. CONCLUSIONS Modulation of CCN and DMN activity is a putative efficacy biomarker. Methodological recommendations are to pre-declare intended analyses and use task-based fMRI, paradigms probing the CCN, longitudinal assessments, mock scanning, and out-of-scanner tests.
Collapse
Affiliation(s)
- Kamilla W. Miskowiak
- Copenhagen Affective disorder Research Centre (CADIC), Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Nefize Yalin
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Ida Seeberg
- Copenhagen Affective disorder Research Centre (CADIC), Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - Katherine E. Burdick
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA,Department of PsychiatryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Vicent Balanzá‐Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of MedicineUniversity of Valencia, CIBERSAMValenciaSpain
| | - Caterina del Mar Bonnin
- Clinical Institute of Neuroscience, Hospital ClinicUniversity of Barcelona, IDIBAPS, CIBERSAMBarcelonaSpain
| | | | - Andre F. Carvalho
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment)Deakin UniversityGeelongVictoriaAustralia
| | - Annemieke Dols
- Department of Old Age Psychiatry, GGZ in Geest, Amsterdam UMC, location VUmc, Amsterdam NeuroscienceAmsterdam Public Health research instituteAmsterdamThe Netherlands
| | - Katie Douglas
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Peter Gallagher
- Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle‐upon‐TyneUK
| | - Gregor Hasler
- Psychiatry Research UnitUniversity of FribourgFribourgSwitzerland
| | - Lars V. Kessing
- Copenhagen Affective disorder Research Centre (CADIC), Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Beny Lafer
- Bipolar Disorder Research Program, Institute of Psychiatry, Hospital das Clinicas, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Kathryn E. Lewandowski
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA,McLean HospitalSchizophrenia and Bipolar Disorder ProgramBelmontMassachusettsUSA
| | - Carlos López‐Jaramillo
- Research Group in Psychiatry, Department of PsychiatryUniversidad de AntioquiaMedellínColombia
| | - Anabel Martinez‐Aran
- Clinical Institute of Neuroscience, Hospital ClinicUniversity of Barcelona, IDIBAPS, CIBERSAMBarcelonaSpain
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery FoundationUniversity of TorontoTorontoCanada
| | - Richard J. Porter
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Scot E. Purdon
- Department of PsychiatryUniversity of AlbertaEdmontonCanada
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoCanada
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Ivan J. Torres
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Tamsyn E. Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of PsychiatryUniversity of MelbourneCarltonAustralia,Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne UniversityHawthornAustralia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Allan H. Young
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital ClinicUniversity of Barcelona, IDIBAPS, CIBERSAMBarcelonaSpain
| | - Paul R. A. Stokes
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| |
Collapse
|
9
|
Guimond S, Ling G, Drodge J, Matheson H, Wojtalik JA, Lopez B, Collin G, Brady R, Mesholam-Gately RI, Thermenos H, Eack SM, Keshavan MS. Functional connectivity associated with improvement in emotion management after cognitive enhancement therapy in early-course schizophrenia. Psychol Med 2022; 52:2245-2254. [PMID: 33183362 PMCID: PMC10763577 DOI: 10.1017/s0033291720004110] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The ability to manage emotions is an important social-cognitive domain impaired in schizophrenia and linked to functional outcome. The goal of our study was to examine the impact of cognitive enhancement therapy (CET) on the ability to manage emotions and brain functional connectivity in early-course schizophrenia. METHODS Participants were randomly assigned to CET (n = 55) or an enriched supportive therapy (EST) control group (n = 45). The resting-state functional magnetic resonance imaging scans and measures of emotion management performances were collected at baseline, 9, and 18 months follow-up. The final sample consisted of 37 CET and 25 EST participants, including 19 CET and 12 EST participants with imaging data. Linear mixed-effects models investigated the impact of treatment on emotion management and functional connectivity from the amygdala to ventrolateral and dorsolateral prefrontal cortex (dlPFC). RESULTS The CET group showed significant improvement over time in emotion management compared to EST. Neither functional connectivity changes nor main group differences were observed following treatment. However, a significant between-group interaction showed that improved emotion management ability was associated with increased functional connectivity between the left amygdala and the left dlPFC in the CET group exclusively. CONCLUSION Our results replicate the previous work demonstrating that CET is effective at improving some aspects of social cognition in schizophrenia. We found evidence that improvement in emotion management may be associated with a change in amygdala-dlPFC connectivity. This fronto-limbic circuit may provide a mechanistic link between the biology of emotion management processes that can be enhanced in individuals with schizophrenia.
Collapse
Affiliation(s)
- Synthia Guimond
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
- Department of Psychoeducation and Psychology, University of Québec in Outaouais, Gatineau, QC, J8X 3X7, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1H 8L1, Canada
| | - George Ling
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Jessica Drodge
- Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1H 8L1, Canada
| | - Hannah Matheson
- Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
| | - Jessica A. Wojtalik
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Betzamel Lopez
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
| | - Guusje Collin
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- University Medical Center Utrecht Brain Center, 3584 XC Utrecht, The Netherlands
| | - Roscoe Brady
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Raquelle I. Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Heidi Thermenos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Shaun M. Eack
- School of Social Work and Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|
10
|
Zarp Petersen J, Varo C, Skovsen CF, Ott CV, Kjaerstad HL, Vieta E, Harmer CJ, Knudsen GM, Kessing LV, Macoveanu J, Miskowiak KW. Neuronal underpinnings of cognitive impairment in bipolar disorder: A large data-driven functional magnetic resonance imaging study. Bipolar Disord 2022; 24:69-81. [PMID: 33955648 DOI: 10.1111/bdi.13100] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/22/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Cognitive impairment occurs in approximately 50% of remitted patients with bipolar disorder (BD). However, there exists no treatment with replicated and robust efficacy on cognition in BD. This is partially due to limited insight into the neuronal underpinnings of cognitive impairment in these patients. This is the first study to investigate neuronal underpinnings of cognitive impairment in a large functional magnetic resonance imaging (fMRI) dataset comparing neural activity patterns between distinct neurocognitive subgroups of partially or fully remitted patients with BD. METHODS Patients (n = 153) and healthy controls (HC) (n = 52) underwent neuropsychological assessment and fMRI, during which they performed a verbal N-back working memory (WM) task. Based on hierarchical cluster analysis of neuropsychological test performance, patients were grouped into one of two neurocognitive subgroups (cognitively impaired, n = 91; cognitively normal compared to HC, n = 62) that were compared on WM-related neural activity. RESULTS Cognitively impaired patients displayed WM-related hypo-activity in left dorsolateral prefrontal cortex and frontal and parietal regions within a cognitive control network (CCN) as well as hyper-activity in the default mode network (DMN) compared to cognitively normal patients. In contrast, cognitively normal patients only exhibited hypo-activity within a small cluster in the superior frontal gyrus relative to HC. CONCLUSIONS Cognitive impairment in BD seems to originate from a failure to recruit key regions in the CCN and to suppress task-irrelevant DMN activity during cognitive performance. These results highlight modulation of aberrant dorsal prefrontal and DMN activity as a putative target for pro-cognitive treatment in BD.
Collapse
Affiliation(s)
- Jeff Zarp Petersen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Varo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Cecilie F Skovsen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Caroline V Ott
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Hanne L Kjaerstad
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Gitte M Knudsen
- Neurobiology Research Unit and The Center for Experimental Medicine Neuropharmacology, Neurobiology Research Unit and Center for Integrated Molecular Imaging, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Macoveanu J, Kjærstad HL, Vinberg M, Harmer C, Fisher PM, Knudsen GM, Kessing LV, Miskowiak KW. Affective episodes in recently diagnosed patients with bipolar disorder associated with altered working memory-related prefrontal cortex activity: A longitudinal fMRI study. J Affect Disord 2021; 295:647-656. [PMID: 34509780 DOI: 10.1016/j.jad.2021.08.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/09/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is often accompanied by trait-related cognitive impairments, but it is unclear which neurocircuitry abnormalities give rise to these impairments and whether neurocircuitry differences are exacerbated with illness progression. This longitudinal fMRI study of recently diagnosed BD patients investigates whether aberrant working memory (WM) related activity in the cognitive control network is accentuated by new affective episodes. METHODS Forty-seven recently diagnosed BD patients in full or partial remission and 38 healthy controls were assessed with neurocognitive tests and fMRI during the performance of a verbal n-back WM task at baseline and follow-up (15.4 months in average). RESULTS Patients showed WM-related hypo-activity in dorsal prefrontal cortex (dPFC) and impaired cognitive function within attention and psychomotor speed, WM and executive function, and verbal learning and memory compared to controls at baseline. During the follow-up period, 26 patients experienced at least one affective episode (BD+), while 21 remained in remission (BD-). There was no deterioration in cognitive performance in BD+ compared to BD- patients. Nevertheless, BD+ displayed increased WM-related dPFC activity at follow-up compared with BD- patients. This change in dPFC response was independent of mood symptoms and medication. LIMITATIONS The study did not account for type or frequency of affective episodes. CONCLUSION The study identifies cognitive impairment and WM-related hypo-activity in dPFC early during the course of BD. Increased high-load WM related dPFC activity over the follow-up period in BD+ versus BD- patients in the absence of changes in cognitive performance may reflect an episode-related reduction in PFC efficiency.
Collapse
Affiliation(s)
- Julian Macoveanu
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Department O, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Department O, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Department O, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine University of Copenhagen, Copenhagen, Denmark; Mental Health Services, Capital Region of Denmark, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Catherine Harmer
- University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | | | - Gitte Moos Knudsen
- Department of Clinical Medicine University of Copenhagen, Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Department O, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Department O, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Smucny J, Carter CS, Maddock RJ. Medial Prefrontal Cortex Glutamate Is Reduced in Schizophrenia and Moderated by Measurement Quality: A Meta-analysis of Proton Magnetic Resonance Spectroscopy Studies. Biol Psychiatry 2021; 90:643-651. [PMID: 34344534 PMCID: PMC9303057 DOI: 10.1016/j.biopsych.2021.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Magnetic resonance spectroscopy studies measuring brain glutamate separately from glutamine are helping elucidate schizophrenia pathophysiology. An expanded literature and improved methodologies motivate an updated meta-analysis examining effects of measurement quality and other moderating factors in characterizing abnormal glutamate levels in schizophrenia. METHODS Searching previous meta-analyses and the MEDLINE database identified 83 proton magnetic resonance spectroscopy datasets published through March 25, 2020. Three quality metrics were extracted-Cramér-Rao lower bound (CRLB), line width, and coefficient of variation. Pooled effect sizes (Hedges' g) were calculated with random-effects, inverse variance-weighted models. Moderator analyses were conducted using quality metrics, field strength, echo time, medication, age, and stage of illness. RESULTS Across 36 datasets (2086 participants), medial prefrontal cortex glutamate was significantly reduced in patients (g = -0.19, confidence interval [CI] = -0.07 to -0.32). CRLB and coefficient of variation quality subgroups significantly moderated this effect. Glutamate was significantly more reduced in studies with lower CRLB or coefficient of variation (g = -0.44, CI = -0.29 to -0.60, and g = -0.43, CI = -0.29 to -0.57, respectively). Studies using echo time ≤20 ms also showed significantly greater reduction in glutamate (g = -0.41, CI = -0.26 to -0.55). Across 11 hippocampal datasets, group differences and moderator effects were nonsignificant. Group effects in thalamus and dorsolateral prefrontal cortex were also nonsignificant. CONCLUSIONS High-quality measurements reveal consistently reduced medial prefrontal cortex glutamate in schizophrenia. Stricter CRLB criteria and reduced nuisance variance may increase the sensitivity of future studies examining additional regions and the pathophysiological significance of abnormal glutamate levels in schizophrenia.
Collapse
Affiliation(s)
- Jason Smucny
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Richard J Maddock
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California.
| |
Collapse
|
13
|
Karantonis JA, Carruthers SP, Rossell SL, Pantelis C, Hughes M, Wannan C, Cropley V, Van Rheenen TE. A Systematic Review of Cognition-Brain Morphology Relationships on the Schizophrenia-Bipolar Disorder Spectrum. Schizophr Bull 2021; 47:1557-1600. [PMID: 34097043 PMCID: PMC8530395 DOI: 10.1093/schbul/sbab054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The nature of the relationship between cognition and brain morphology in schizophrenia-spectrum disorders (SSD) and bipolar disorder (BD) is uncertain. This review aimed to address this, by providing a comprehensive systematic investigation of links between several cognitive domains and brain volume, cortical thickness, and cortical surface area in SSD and BD patients across early and established illness stages. An initial search of PubMed and Scopus databases resulted in 1486 articles, of which 124 met inclusion criteria and were reviewed in detail. The majority of studies focused on SSD, while those of BD were scarce. Replicated evidence for specific regions associated with indices of cognition was minimal, however for several cognitive domains, the frontal and temporal regions were broadly implicated across both recent-onset and established SSD, and to a lesser extent BD. Collectively, the findings of this review emphasize the significance of both frontal and temporal regions for some domains of cognition in SSD, while highlighting the need for future BD-related studies on this topic.
Collapse
Affiliation(s)
- James A Karantonis
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Sean P Carruthers
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Susan L Rossell
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- St Vincent’s Mental Health, St Vincent’s Hospital, Melbourne, Australia
| | - Christos Pantelis
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Australia
- Department of Electrical and Electronic Engineering, University of Melbourne, Melbourne, Australia
| | - Matthew Hughes
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Cassandra Wannan
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Vanessa Cropley
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Tamsyn E Van Rheenen
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| |
Collapse
|
14
|
Toward a transdiagnostic neurocircuitry-based biomarker model for pro-cognitive effects: challenges, opportunities, and next steps. CNS Spectr 2021; 26:333-337. [PMID: 32122432 DOI: 10.1017/s1092852920000061] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive impairment has emerged as a key treatment priority in neuropsychiatric disorders. However, there is a lack of treatments with solid and lasting efficacy on cognition. A neurocircuitry-based biomarker model of pro-cognitive effects is critically needed to select among new candidate treatments. In a recent review of functional magnetic resonance imaging (fMRI) studies in mood disorders, we found that cognitive impairments are consistently accompanied by aberrant (hypo- and hyper-) activity in the dorsal prefrontal cortex (PFC) and the default mode network (DMN), and that activity change in these regions commonly occurs with cognitive improvements. Here, we (i) review the putative model from our recent review article, which explains the discrepant findings regarding the direction of aberrant dorsal PFC activity and treatment-related activity change in mood disorders. Inspired by the Research Domain Criteria project, we do this in order to (ii) examine whether a similar pattern of activity change occurs across distinct neuropsychiatric disorders and thereby provides a common biomarker for pro-cognitive effects. Lastly, we (iii) discuss whether dorsal PFC and DMN target engagement is a putative transdiagnostic neurocircuitry-based biomarker model for pro-cognitive effects, and (iv) outline the necessary next steps to address this question.
Collapse
|
15
|
Mohammadi-Nejad AR, Hossein-Zadeh GA, Shahsavand Ananloo E, Soltanian-Zadeh H. The effect of groupness constraint on the sensitivity and specificity of canonical correlation analysis, a multi-modal anatomical and functional MRI study. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Ramsay IS, Fryer S, Roach BJ, Boos A, Fisher M, Loewy R, Ford JM, Vinogradov S, Mathalon DH. Response to targeted cognitive training may be neuroprotective in patients with early schizophrenia. Psychiatry Res Neuroimaging 2021; 312:111285. [PMID: 33865147 PMCID: PMC8137670 DOI: 10.1016/j.pscychresns.2021.111285] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 01/07/2023]
Abstract
Individuals with schizophrenia exhibit widespread cortical thinning associated with illness severity and deficits in cognition. However, intact cortical thickness (CTh) may serve as a protective factor. The current study sought to examine changes in CTh in response to auditory targeted cognitive training (TCT) in individuals with recent onset schizophrenia. Participants underwent MRI scanning and a cognitive assessment before and after being randomly assigned to 40 h of either TCT (N = 21) or a computer games control condition (CG; N = 22) over 16 weeks. Groups did not differ at baseline on demographic variables or measures of CTh. At the level of group averages, neither group showed significant pre-post changes in CTh in any brain region. However, changes in CTh related to individual differences in treatment outcome, as improved global cognition in the TCT group corresponded to reduced cortical thinning in frontal, temporal, parietal, and occipital lobes. These relationships were not observed in the CG group. The current findings suggest that TCT may be neuroprotective in early schizophrenia, such that individuals who improved in response to training also showed a reduction in cortical thinning that may be otherwise hastened due to age and illness.
Collapse
Affiliation(s)
- Ian S Ramsay
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, USA.
| | - Susanna Fryer
- University of California, San Francisco, Department of Psychiatry and Behavioral Science, USA; San Francisco Veterans Affairs Medical Center, USA
| | - Brian J Roach
- University of California, San Francisco, Department of Psychiatry and Behavioral Science, USA; San Francisco Veterans Affairs Medical Center, USA
| | - Alison Boos
- University of California, San Francisco, Department of Psychiatry and Behavioral Science, USA; San Francisco Veterans Affairs Medical Center, USA
| | - Melissa Fisher
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, USA
| | - Rachel Loewy
- University of California, San Francisco, Department of Psychiatry and Behavioral Science, USA; San Francisco Veterans Affairs Medical Center, USA
| | - Judith M Ford
- University of California, San Francisco, Department of Psychiatry and Behavioral Science, USA; San Francisco Veterans Affairs Medical Center, USA
| | - Sophia Vinogradov
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, USA
| | - Daniel H Mathalon
- University of California, San Francisco, Department of Psychiatry and Behavioral Science, USA; San Francisco Veterans Affairs Medical Center, USA
| |
Collapse
|
17
|
Ott CV, Macoveanu J, Bowie CR, Fisher PM, Knudsen GM, Kessing LV, Miskowiak KW. Change in prefrontal activity and executive functions after action-based cognitive remediation in bipolar disorder: a randomized controlled trial. Neuropsychopharmacology 2021; 46:1113-1121. [PMID: 33168945 PMCID: PMC8115100 DOI: 10.1038/s41386-020-00901-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022]
Abstract
Cognitive impairment is prevalent in bipolar disorder (BD) but treatments with pro-cognitive effects are lacking. Insight concerning the neurocircuitry of cognitive improvement could provide a biomarker for pro-cognitive effects to advance treatment development. The dorsal prefrontal cortex (dPFC) is a promising region for such treatment target engagement. The aim of this functional magnetic resonance imaging (fMRI) study was to examine the effects of action-based cognitive remediation (ABCR) on early change in the dPFC blood-oxygen-level-dependent response in patients with BD in remission, and whether the observed neural change predicted improved executive functions following 10 weeks of treatment. Forty-five participants with remitted BD (ABCR: n = 26, control treatment: n = 19) completed a spatial n-back working memory task during fMRI and executive function tasks outside the scanner before and after two weeks of ABCR/control treatment, and an additional assessment of executive function at treatment completion. Thirty-four healthy controls underwent a single fMRI and executive function assessment for baseline comparisons. We found an early reversal of pretreatment hypo-activity in the dorsolateral prefrontal cortex (dlPFC) following ABCR vs. control during both high-load (2-back > 1-back) working memory (WM) (F(1,43) = 5.69, p = 0.02, η2 = 0.12) and general WM (2-back > 0-back) (F(1,43) = 5.61, p = 0.02, η2 = 0.12). This dlPFC activity increase predicted improved executive functions at treatment completion (high-load WM: B = -0.45, p = 0.01, general WM: B = -0.41, p < 0.01), independent of changes in subsyndromal symptoms. In conclusion, early dPFC increase may provide a neurocircuitry-based biomarker for pro-cognitive effects. Future cognition trials should include fMRI assessments to confirm the validity of this putative biomarker model across disorders with cognitive impairment.
Collapse
Affiliation(s)
- Caroline V Ott
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Julian Macoveanu
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Patrick M Fisher
- Neurobiology Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
18
|
Haas SS, Antonucci LA, Wenzel J, Ruef A, Biagianti B, Paolini M, Rauchmann BS, Weiske J, Kambeitz J, Borgwardt S, Brambilla P, Meisenzahl E, Salokangas RKR, Upthegrove R, Wood SJ, Koutsouleris N, Kambeitz-Ilankovic L. A multivariate neuromonitoring approach to neuroplasticity-based computerized cognitive training in recent onset psychosis. Neuropsychopharmacology 2021; 46:828-835. [PMID: 33027802 PMCID: PMC8027389 DOI: 10.1038/s41386-020-00877-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
Two decades of studies suggest that computerized cognitive training (CCT) has an effect on cognitive improvement and the restoration of brain activity. Nevertheless, individual response to CCT remains heterogenous, and the predictive potential of neuroimaging in gauging response to CCT remains unknown. We employed multivariate pattern analysis (MVPA) on whole-brain resting-state functional connectivity (rsFC) to (neuro)monitor clinical outcome defined as psychosis-likeness change after 10-hours of CCT in recent onset psychosis (ROP) patients. Additionally, we investigated if sensory processing (SP) change during CCT is associated with individual psychosis-likeness change and cognitive gains after CCT. 26 ROP patients were divided into maintainers and improvers based on their SP change during CCT. A support vector machine (SVM) classifier separating 56 healthy controls (HC) from 35 ROP patients using rsFC (balanced accuracy of 65.5%, P < 0.01) was built in an independent sample to create a naturalistic model representing the HC-ROP hyperplane. This model was out-of-sample cross-validated in the ROP patients from the CCT trial to assess associations between rsFC pattern change, cognitive gains and SP during CCT. Patients with intact SP threshold at baseline showed improved attention despite psychosis status on the SVM hyperplane at follow-up (p < 0.05). Contrarily, the attentional gains occurred in the ROP patients who showed impaired SP at baseline only if rsfMRI diagnosis status shifted to the healthy-like side of the SVM continuum. Our results reveal the utility of MVPA for elucidating treatment response neuromarkers based on rsFC-SP change and pave the road to more personalized interventions.
Collapse
Affiliation(s)
- Shalaila S. Haas
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Linda A. Antonucci
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany ,grid.7644.10000 0001 0120 3326Department of Education, Psychology, Communication – University of Bari “Aldo Moro”, Bari, Italy
| | - Julian Wenzel
- grid.6190.e0000 0000 8580 3777University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anne Ruef
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Bruno Biagianti
- grid.438587.50000 0004 0450 1574Department of R&D, Posit Science Corporation, San Francisco, CA USA ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Transplantation, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Marco Paolini
- Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Boris-Stephan Rauchmann
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany ,Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Johanna Weiske
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Joseph Kambeitz
- grid.6190.e0000 0000 8580 3777University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Stefan Borgwardt
- grid.4562.50000 0001 0057 2672Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Paolo Brambilla
- grid.414818.00000 0004 1757 8749Department of Neuroscience and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Eva Meisenzahl
- grid.411327.20000 0001 2176 9917Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Raimo K. R. Salokangas
- grid.1374.10000 0001 2097 1371Department of Psychiatry, University of Turku, Turku, Finland
| | - Rachel Upthegrove
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Birmingham, United Kingdom ,grid.6572.60000 0004 1936 7486Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stephen J. Wood
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Birmingham, United Kingdom ,grid.488501.0Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, VIC Australia
| | - Nikolaos Koutsouleris
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany. .,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
| |
Collapse
|
19
|
Kolskår KK, Richard G, Alnæs D, Dørum ES, Sanders A, Ulrichsen KM, Sánchez JM, Ihle‐Hansen H, Nordvik JE, Westlye LT. Reliability, sensitivity, and predictive value of fMRI during multiple object tracking as a marker of cognitive training gain in combination with tDCS in stroke survivors. Hum Brain Mapp 2021; 42:1167-1181. [PMID: 33216408 PMCID: PMC7856645 DOI: 10.1002/hbm.25284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
Computerized cognitive training (CCT) combined with transcranial direct current stimulation (tDCS) has showed some promise in alleviating cognitive impairments in patients with brain disorders, but the robustness and possible mechanisms are unclear. In this prospective double-blind randomized clinical trial, we investigated the feasibility and effectiveness of combining CCT and tDCS, and tested the predictive value of and training-related changes in fMRI-based brain activation during attentive performance (multiple object tracking) obtained at inclusion, before initiating training, and after the three-weeks intervention in chronic stroke patients (>6 months since hospital admission). Patients were randomized to one of two groups, receiving CCT and either (a) tDCS targeting left dorsolateral prefrontal cortex (1 mA), or (b) sham tDCS, with 40s active stimulation (1 mA) before fade out of the current. Of note, 77 patients were enrolled in the study, 54 completed the cognitive training, and 48 completed all training and MRI sessions. We found significant improvement in performance across all trained tasks, but no additional gain of tDCS. fMRI-based brain activation showed high reliability, and higher cognitive performance was associated with increased tracking-related activation in the dorsal attention network and default mode network as well as anterior cingulate after compared to before the intervention. We found no significant associations between cognitive gain and brain activation measured before training or in the difference in activation after intervention. Combined, these results show significant training effects on trained cognitive tasks in stroke survivors, with no clear evidence of additional gain of concurrent tDCS.
Collapse
Affiliation(s)
- Knut K. Kolskår
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Geneviève Richard
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Dag Alnæs
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Bjørknes collegeOsloNorway
| | - Erlend S. Dørum
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Anne‐Marthe Sanders
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Kristine M. Ulrichsen
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Jennifer Monereo Sánchez
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
| | - Hege Ihle‐Hansen
- Department of Geriatric MedicineOslo University HospitalOsloNorway
| | | | - Lars T. Westlye
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of OsloOsloNorway
| |
Collapse
|
20
|
Penadés R, Segura B, Inguanzo A, García-Rizo C, Catalán R, Masana G, Bernardo M, Junqué C. Cognitive remediation and brain connectivity: A resting-state fMRI study in patients with schizophrenia. Psychiatry Res Neuroimaging 2020; 303:111140. [PMID: 32693320 DOI: 10.1016/j.pscychresns.2020.111140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
Cognitive remediation is able to improve activation patterns in the frontal lobe but only few data on neuroconnectivity has been reported yet. Resting-state approach is a neuroimaging methodology with potentiality for testing neuroconnectivity in the context of cognitive remediation in schizophrenia. A resting-state fMRI data was acquired in part of the sample (n = 26 patients, n = 10 healthy controls) of a partner study (NCT02341131) testing the effects of cognitive remediation. A data-driven approach using independent component analysis (ICA) was used to identify functional brain networks, which were compared between groups and group per time using a dual-regression approach. ICA results revealed reduced functional connectivity between patients and controls in sensorimotor, basal ganglia, default mode and visual networks at baseline (p<0.05 FWE-corrected). After treatment, time per group analyses evidenced increased connectivity in sensorimotor network. Furthermore, group comparison at follow-up showed similar connectivity patterns between patients and healthy controls in sensorimotor network, but also in default mode and basal ganglia networks. No differences between treatment groups were found. Our results add some evidence to the hypothesis of altered connectivity in schizophrenia, and the possibility to modify some aspects of brain connectivity networks after psychological interventions.
Collapse
Affiliation(s)
- Rafael Penadés
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
| | - Bàrbara Segura
- Medical Psychology Unit, Department of Medicine. Institute of Neuroscience, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Inguanzo
- Medical Psychology Unit, Department of Medicine. Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Clemente García-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Rosa Catalán
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Guillem Masana
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Carme Junqué
- Medical Psychology Unit, Department of Medicine. Institute of Neuroscience, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona, Barcelona, Spain; Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
21
|
Webler RD, Hamady C, Molnar C, Johnson K, Bonilha L, Anderson BS, Bruin C, Bohning DE, George MS, Nahas Z. Decreased interhemispheric connectivity and increased cortical excitability in unmedicated schizophrenia: A prefrontal interleaved TMS fMRI study. Brain Stimul 2020; 13:1467-1475. [PMID: 32585355 DOI: 10.1016/j.brs.2020.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/08/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prefrontal abnormalities in schizophrenia have consistently emerged from resting state and cognitive neuroimaging studies. However, these correlative findings require causal verification via combined imaging/stimulation approaches. To date, no interleaved transcranial magnetic stimulation and functional magnetic resonance imaging study (TMS fMRI) has probed putative prefrontal cortex abnormalities in schizophrenia. OBJECTIVE /Hypothesis: We hypothesized that subjects with schizophrenia would show significant hyperexcitability at the site of stimulation (BA9) and decreased interhemispheric functional connectivity. METHODS We enrolled 19 unmedicated subjects with schizophrenia and 22 controls. All subjects underwent brain imaging using a 3T MRI scanner with a SENSE coil. They also underwent a single TMS fMRI session involving motor threshold (rMT) determination, structural imaging, and a parametric TMS fMRI protocol with 10 Hz triplet pulses at 0, 80, 100 and 120% rMT. Scanning involved a surface MR coil optimized for bilateral prefrontal cortex image acquisition. RESULTS Of the original 41 enrolled subjects, 8 subjects with schizophrenia and 11 controls met full criteria for final data analyses. At equal TMS intensity, subjects with schizophrenia showed hyperexcitability in left BA9 (p = 0.0157; max z-score = 4.7) and neighboring BA46 (p = 0.019; max z-score = 4.47). Controls showed more contralateral functional connectivity between left BA9 and right BA9 through increased activation in right BA9 (p = 0.02; max z-score = 3.4). GM density in subjects with schizophrenia positively correlated with normalized prefrontal to motor cortex ratio of the corresponding distance from skull to cortex ratio (S-BA9/S-MC) (r = 0.83, p = 0.004). CONCLUSIONS Subjects with schizophrenia showed hyperexcitability in left BA9 and impaired interhemispheric functional connectivity compared to controls. Interleaved TMS fMRI is a promising tool to investigate prefrontal dysfunction in schizophrenia.
Collapse
Affiliation(s)
- Ryan D Webler
- University of Minnesota, Department of Psychology, USA
| | - Carmen Hamady
- American University of Beirut, Department of Psychiatry, USA
| | - Chris Molnar
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, USA
| | | | | | | | - Claartje Bruin
- American University of Beirut, Department of Psychiatry, USA
| | - Daryl E Bohning
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, USA
| | - Mark S George
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Ziad Nahas
- American University of Beirut, Department of Psychiatry, USA; University of Minnesota, Department of Psychiatry, USA.
| |
Collapse
|
22
|
Tsapekos D, Seccomandi B, Mantingh T, Cella M, Wykes T, Young AH. Cognitive enhancement interventions for people with bipolar disorder: A systematic review of methodological quality, treatment approaches, and outcomes. Bipolar Disord 2020; 22:216-230. [PMID: 31610086 DOI: 10.1111/bdi.12848] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with bipolar disorder (BD) suffer from cognitive deficits across several domains. The association between cognitive performance and psychosocial functioning has led to the emergence of cognition as a treatment target. OBJECTIVE This study reviews the existing literature on cognitive enhancement interventions for people with BD, focusing on different treatment approaches and methodological quality. METHODS We conducted a systematic search following the PRISMA guidelines. Sample characteristics and main outcomes for each study and treatment characteristics for each approach were extracted. Study quality was assessed using the Clinical Trials Assessment Measure (CTAM) and Cochrane Collaboration's Risk of Bias tool by independent raters. RESULTS Eleven articles reporting data from seven original studies were identified encompassing 471 participants. Two treatment approaches were identified, cognitive and functional remediation. For controlled studies, methodological quality was modest (average CTAM score = 60.3), while the overall risk of bias was considered moderate. Beneficial effects on cognitive or functional outcomes were reported in the majority of studies (91%), but these findings were isolated and not replicated across studies. Key methodological limitations included small sample sizes, poor description of randomization process, high attrition rates, and participant exclusion from the analysis. CONCLUSIONS Findings are promising but preliminary. Quality studies were few and mostly underpowered. Heterogeneity in sample characteristics, outcome measures, and treatment approaches further limit the ability to generalize findings. Adequately powered trials are required to replicate initial findings, while moderators of treatment response and mechanisms of transfer need to be explored.
Collapse
Affiliation(s)
- Dimosthenis Tsapekos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Benedetta Seccomandi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tim Mantingh
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| |
Collapse
|
23
|
Ramsay IS, Roach BJ, Fryer S, Fisher M, Loewy R, Ford J, Vinogradov S, Mathalon D. Increased global cognition correlates with increased thalamo-temporal connectivity in response to targeted cognitive training for recent onset schizophrenia. Schizophr Res 2020; 218:131-137. [PMID: 32007346 PMCID: PMC7299776 DOI: 10.1016/j.schres.2020.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/10/2020] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Abstract
Patients with schizophrenia exhibit disrupted thalamocortical connections that relate to aspects of symptoms and deficits in cognition. Targeted cognitive training (TCT) of the auditory system in schizophrenia has been shown to improve cognition, but its impact on thalamocortical connectivity is not known. Here we examined thalamocortical connections that may be neuroplastic in response to TCT using a region of interest (ROI) approach. Participants were randomly assigned to either 40 h of TCT (N = 24) or an active control condition (CG; N = 20). Participants underwent resting state fMRI and cognitive testing both before and after training. Changes in thalamocortical connectivity were measured in 15 ROIs derived from a previous study comparing a large sample of schizophrenia subjects with healthy controls. A significant group by time interaction was observed in a left superior temporal ROI which was previously found to exhibit thalamocortical hyper-connectivity in patients with schizophrenia. Changes in this ROI reflected thalamic connectivity increases in the TCT group, while the CG group showed decreases. Additionally, the relationship between connectivity change and change in global cognition showed a slope difference between groups, with increases in thalamo-temporal connectivity correlating with improvements in global cognition in TCT. No significant relationships were observed with changes in clinical symptoms or functioning. These findings demonstrate that TCT may influence intrinsic functional connections in young individuals with schizophrenia, such that improvements in cognition correspond to compensatory increases in connectivity in a temporal region previously shown to exhibit thalamic hyper-connectivity.
Collapse
Affiliation(s)
| | | | - Susanna Fryer
- University of California, San Francisco Department of Psychiatry,Veterans Affairs Medical Center San Francisco
| | | | - Rachel Loewy
- University of California, San Francisco Department of Psychiatry
| | - Judith Ford
- University of California, San Francisco Department of Psychiatry,Veterans Affairs Medical Center San Francisco
| | | | - Daniel Mathalon
- University of California, San Francisco Department of Psychiatry,Veterans Affairs Medical Center San Francisco
| |
Collapse
|
24
|
Biagianti B, Fisher M, Loewy R, Brandrett B, Ordorica C, LaCross K, Schermitzler B, McDonald M, Ramsay I, Vinogradov S. Specificity and Durability of Changes in Auditory Processing Efficiency After Targeted Cognitive Training in Individuals With Recent-Onset Psychosis. Front Psychiatry 2020; 11:857. [PMID: 33005156 PMCID: PMC7484996 DOI: 10.3389/fpsyt.2020.00857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We previously demonstrated that the high heterogeneity of response to computerized Auditory Training (AT) in psychosis can be ascribed to individual differences in sensory processing efficiency and neural plasticity. In particular, we showed that Auditory Processing Speed (APS) serves as a behavioral measure of target engagement, with faster speed predicting greater transfer effects to untrained cognitive domains. Here, we investigate whether the ability of APS to function as a proxy for target engagement is unique to AT, or if it applies to other training interventions, such as Executive Functioning Training (EFT). Additionally, we examine whether changes in APS are durable after these two forms of training. METHODS One hundred and twenty-five participants with Recent Onset Psychosis (ROP) were randomized to AT (n = 66) and EFT (n = 59), respectively. APS was captured at baseline, after treatment, and at 6-month follow-up. Mixed models repeated measures analysis with restricted maximum likelihood was used to examine whether training condition differentiated APS trajectories. Within-group correlational analyses were used to study the relationship between APS and performance improvements in each of the training exercises. RESULTS The two groups were matched for age, gender, education, and baseline APS. Participants showed high inter-individual variability in APS at each time point. The mixed model showed a significant effect of time (F = 5.99, p = .003) but not a significant group-by-time effect (F = .73, p = .48). This was driven by significant APS improvements AT patients after treatment (d = .75) that were maintained after 6 months (d = .63). Conversely, in EFT patients, APS improvements did not reach statistical significance after treatment (p = .33) or after 6 months (p = .24). In AT patients, baseline APS (but not APS change) highly predicted peak performance for each training exercise (all r's >.42). CONCLUSIONS Participant-specific speed in processing basic auditory stimuli greatly varies in ROP, and strongly influences the magnitude of response to auditory but not executive functioning training. Importantly, enhanced auditory processing efficiency persists 6 months after AT, suggesting the durability of neuroplasticity processes induced by this form of training. Future studies should aim to identify markers of target engagement and durability for cognitive training interventions that target sensory modalities beyond the auditory domain.
Collapse
Affiliation(s)
- Bruno Biagianti
- Department of R&D, Posit Science Corporation, San Francisco, CA, United States.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Melissa Fisher
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Rachel Loewy
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | | | - Catalina Ordorica
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Kristin LaCross
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Brandon Schermitzler
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Michelle McDonald
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Ian Ramsay
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
25
|
Guerin AA, Bonomo Y, Lawrence AJ, Baune BT, Nestler EJ, Rossell SL, Kim JH. Cognition and Related Neural Findings on Methamphetamine Use Disorder: Insights and Treatment Implications From Schizophrenia Research. Front Psychiatry 2019; 10:880. [PMID: 31920743 PMCID: PMC6928591 DOI: 10.3389/fpsyt.2019.00880] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022] Open
Abstract
Despite the prevalence of methamphetamine (meth) use disorder, research on meth is disproportionately scarce compared to research on other illicit drugs. Existing evidence highlights cognitive deficits as an impediment against daily function and treatment of chronic meth use. Similar deficits are also observed in schizophrenia, and this review therefore draws on schizophrenia research by examining similarities and differences between the two disorders on cognition and related neural findings. While meth use disorder and schizophrenia are two distinct disorders, they are highly co-morbid and share impairments in similar cognitive domains and altered brain structure/function. This narrative review specifically identifies overlapping features such as deficits in learning and memory, social cognition, working memory and inhibitory/impulse control. We report that while working memory deficits are a core feature of schizophrenia, such deficits are inconsistently observed following chronic meth use. Similar structural and functional abnormalities are also observed in cortical and limbic regions between the two disorders, except for cingulate activity where differences are observed. There is growing evidence that targeting cognitive symptoms may improve functional outcome in schizophrenia, with evidence of normalized abnormal brain activity in regions associated with cognition. Considering the overlap between meth use disorder and schizophrenia, targeting cognitive symptoms in people with meth use disorder may also improve treatment outcome and daily function.
Collapse
Affiliation(s)
- Alexandre A. Guerin
- Mental Health Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Women’s Alcohol and Drug Service, Royal Women’s Hospital, Melbourne, VIC, Australia
| | - Andrew John Lawrence
- Mental Health Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Eric J. Nestler
- Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia
| | - Jee Hyun Kim
- Mental Health Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
26
|
Matsuda Y, Makinodan M, Morimoto T, Kishimoto T. Neural changes following cognitive remediation therapy for schizophrenia. Psychiatry Clin Neurosci 2019; 73:676-684. [PMID: 31278805 DOI: 10.1111/pcn.12912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/13/2019] [Accepted: 07/01/2019] [Indexed: 01/15/2023]
Abstract
Patients with schizophrenia experience cognitive impairments that relate to poorer social functioning even after amelioration of positive symptoms. Pharmacological treatment and cognitive remediation are the two important therapeutic approaches for cognitive impairment in schizophrenia. Cognitive remediation therapy (CRT) for schizophrenia improves cognitive functioning and induces neuroplasticity, but different approaches and durations of CRT and different neuroimaging devices have led to varying results in meta-analyses. The objective of this review was to explore the impact of CRT on neurobiology. Several studies have provided evidence of increased activation in the frontal brain regions, such as the prefrontal cortex, anterior cingulate cortex, and parietal and occipital regions during working memory or executive function tasks after CRT. Two studies have shown alterations in resting-state connectivity between the prefrontal cortex and temporal regions. Two studies have reported that CRT induces changes in gray matter volume in the hippocampus. Further, one study observed that patients who had received CRT had elevated fractional anisotropy in the basal ganglia. We conclude that neuroimaging studies assessing CRT in patients with schizophrenia showed functional, structural, and connectivity changes that were positively correlated with cognitive improvements despite heterogeneous CRT approaches. Future studies that combine multiple modalities are required to address the differences, effects of intrinsic motivation, and pharmacological augmentation of CRT. Further understanding of the biological basis might lead to predictions of the CRT response in patients with schizophrenia and contribute to identification of schizophrenia patients for future interventions.
Collapse
Affiliation(s)
- Yasuhiro Matsuda
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Tsubasa Morimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| |
Collapse
|
27
|
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
|
28
|
Baker-Ericzén MJ, Brookman-Frazee L, Brodkin ES. Accelerating research on treatment and services for transition age youth and adults on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 22:2-5. [PMID: 29369717 DOI: 10.1177/1362361317738646] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
29
|
Neuroplasticity and Cognitive Training in Schizophrenia. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
30
|
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
|
31
|
Ott CV, Johnson CB, Macoveanu J, Miskowiak K. Structural changes in the hippocampus as a biomarker for cognitive improvements in neuropsychiatric disorders: A systematic review. Eur Neuropsychopharmacol 2019; 29:319-329. [PMID: 30654916 DOI: 10.1016/j.euroneuro.2019.01.105] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/19/2018] [Accepted: 01/06/2019] [Indexed: 02/07/2023]
Abstract
Cognitive impairments are a core feature of several neuropsychiatric disorders. A common biomarker for pro-cognitive effects may provide a much-needed tool to select amongst candidate treatments targeting cognition. The hippocampus is a promising biomarker for target-engagement due to the illness-associated morphological hippocampal changes across unipolar disorder (UD), bipolar disorder (BD) and schizophrenia (SCZ). Following the PRISMA guidelines, we searched PubMed and Embase, for clinical trials targeting cognition across neuropsychiatric disorders, with longitudinal structural magnetic resonance imaging (MRI) measures of the hippocampus. Five randomized and three open-label trials were included. Hippocampal volume increases were associated with treatment-related cognitive improvement following treatment with erythropoietin across UD, BD and SCZ, lithium treatment in BD and aerobic exercise in SCZ. Conversely, an exercise intervention in UD showed no effect on hippocampal volume or cognition. Together, these observations point to hippocampal volume change as a putative biomarker-model for cognitive improvement. Future cognition trials are encouraged to include MRI assessments pre- and post-treatment to assess the validity of hippocampal changes as a biomarker for pro-cognitive effects.
Collapse
Affiliation(s)
- Caroline Vintergaard Ott
- Neurocognition and Emotion in Affective Disorders (NEAD) Group, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, 2100 Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark
| | - Claire Bergstrom Johnson
- Neurocognition and Emotion in Affective Disorders (NEAD) Group, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, 2100 Copenhagen, Denmark
| | - Julian Macoveanu
- Neurocognition and Emotion in Affective Disorders (NEAD) Group, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, 2100 Copenhagen, Denmark
| | - Kamilla Miskowiak
- Neurocognition and Emotion in Affective Disorders (NEAD) Group, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, 2100 Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark.
| |
Collapse
|
32
|
Best MW, Milanovic M, Shamblaw AL, Muere A, Lambe LJ, Hong IK, Haque MK, Bowie CR. An examination of the moderating effects of neurophysiology on treatment outcomes from cognitive training in schizophrenia-spectrum disorders. Int J Psychophysiol 2019; 154:59-66. [PMID: 30776393 DOI: 10.1016/j.ijpsycho.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Impairments in neurocognition and community functioning are core features of schizophrenia and cognitive training techniques have been developed with the aim of improving these impairments. While cognitive training has produced reliable improvements in neurocognition and functioning, little is known about factors that moderate treatment response. Electroencephalographic (EEG) measures provide a neurophysiological indicator of cognitive functions that may moderate treatment outcomes from cognitive training. METHODS Data from a clinical trial comparing two cognitive training approaches in schizophrenia-spectrum disorders were utilized in the current report. Cluster analysis was conducted to identify participant clusters based on baseline P300, mismatch negativity (MMN), and theta power during an n-back task, and the EEG measures were also examined as continuous predictors of treatment response. RESULTS Three clusters were identified based on the baseline EEG variables; however, there were no significant differences in treatment response across the three clusters. Higher P300 amplitude and theta power during the n-back at baseline were significantly associated with greater improvements in a cognitive composite score post-treatment. None of the EEG measures were significantly associated with treatment outcomes in specific cognitive domains or community functioning. Change in EEG measures from baseline to post-treatment was not significantly associated with durability of cognitive or functional change at 12-week follow-up. CONCLUSIONS Clusters derived from the EEG measures were not significantly associated with either neurocognitive or functional outcomes. P300 and n-back theta power may be associated with learning-related processes, which are important for acquisition and retention of skills during cognitive training programs. Future research should aim to identify at an individual level who is likely to respond to specific forms of cognitive enhancement.
Collapse
Affiliation(s)
- Michael W Best
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Melissa Milanovic
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Amanda L Shamblaw
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Abi Muere
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Laura J Lambe
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Irene K Hong
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Mashal K Haque
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Kingston, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| |
Collapse
|
33
|
Abstract
Neuropsychiatric illnesses including mood disorders are accompanied by cognitive impairment, which impairs work capacity and quality of life. However, there is a lack of treatment options that would lead to solid and lasting improvement of cognition. This is partially due to the absence of valid and reliable neurocircuitry-based biomarkers for pro-cognitive effects. This systematic review therefore examined the most consistent neural underpinnings of cognitive impairment and cognitive improvement in unipolar and bipolar disorders. We identified 100 studies of the neuronal underpinnings of working memory and executive skills, learning and memory, attention, and implicit learning and 9 studies of the neuronal basis for cognitive improvements. Impairments across several cognitive domains were consistently accompanied by abnormal activity in dorsal prefrontal (PFC) cognitive control regions-with the direction of this activity depending on patients' performance levels-and failure to suppress default mode network (DMN) activity. Candidate cognition treatments seemed to enhance task-related dorsal PFC and temporo-parietal activity when performance increases were observed, and to reduce their activity when performance levels were unchanged. These treatments also attenuated DMN hyper-activity. In contrast, nonspecific cognitive improvement following symptom reduction was typically accompanied by decreased limbic reactivity and reversal of pre-treatment fronto-parietal hyper-activity. Together, the findings highlight some common neural correlates of cognitive impairments and cognitive improvements. Based on this evidence, studies are warranted to examine the reliability and predictive validity of target engagement in the identified neurocircuitries as a biomarker model of pro-cognitive effects.
Collapse
|
34
|
Kelly S, Guimond S, Lyall A, Stone WS, Shenton ME, Keshavan M, Seidman LJ. Neural correlates of cognitive deficits across developmental phases of schizophrenia. Neurobiol Dis 2018; 131:104353. [PMID: 30582983 DOI: 10.1016/j.nbd.2018.12.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 11/21/2018] [Accepted: 12/20/2018] [Indexed: 12/28/2022] Open
Abstract
Schizophrenia is associated with cognitive deficits across all stages of the illness (i.e., high risk, first episode, early and chronic phases). Identifying the underlying neurobiological mechanisms of these deficits is an important area of scientific inquiry. Here, we selectively review evidence regarding the pattern of deficits across the developmental trajectory of schizophrenia using the five cognitive domains identified by the Research Domain Criteria (RDoC) initiative. We also report associated findings from neuroimaging studies. We suggest that most cognitive domains are affected across the developmental trajectory, with corresponding brain structural and/or functional differences. The idea of a common mechanism driving these deficits is discussed, along with implications for cognitive treatment in schizophrenia.
Collapse
Affiliation(s)
- Sinead Kelly
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Synthia Guimond
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Amanda Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William S Stone
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Matcheri Keshavan
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Larry J Seidman
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
35
|
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: 7] [Impact Index Per Article: 1.2] [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
|
36
|
Macoveanu J, Demant KM, Vinberg M, Siebner HR, Kessing LV, Miskowiak KW. Towards a biomarker model for cognitive improvement: No change in memory-related prefrontal engagement following a negative cognitive remediation trial in bipolar disorder. J Psychopharmacol 2018; 32:1075-1085. [PMID: 29969938 DOI: 10.1177/0269881118783334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive deficits are prevalent in bipolar disorder during remission but effective cognition treatments are lacking due to insufficient insight into the neurobiological targets of cognitive improvement. Emerging data suggest that dorsal prefrontal cortex target engagement is a key neurocircuitry biomarker of pro-cognitive treatment effects. AIMS In this randomized controlled functional magnetic resonance imaging study, we test this hypothesis by investigating the effects of an ineffective cognitive remediation intervention on dorsal prefrontal response during strategic memory encoding and working memory engagement. METHODS Bipolar disorder patients in partial remission with subjective cognitive difficulties were randomized to receive 12-week group-based cognitive remediation ( n = 13) or to continue their standard treatment ( n = 14). The patients performed a strategic episodic picture encoding task and a spatial n-back working memory task under functional magnetic resonance imaging at baseline and following cognitive remediation or standard treatment. RESULTS The right dorsolateral prefrontal cortex was commonly activated by both strategic memory tasks across all patients. The task-related prefrontal engagement was not altered by cognitive remediation relative to standard treatment. The dorsolateral prefrontal cortex response was not significantly associated with recall accuracy or working memory performance. CONCLUSIONS As hypothesized, no task-related change in prefrontal activity was observed in a negative cognitive remediation trial in remitted bipolar disorder patients. By complementing previous findings linking cognitive improvement with increased dorsolateral prefrontal cortex engagement, our negative findings provide additional validity evidence to the dorsal prefrontal target engagement biomarker model of cognitive improvement by strengthening the proposed causality between modulation of dorsolateral prefrontal cortex engagement and pro-cognitive effects.
Collapse
Affiliation(s)
- Julian Macoveanu
- 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Denmark.,2 Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark
| | - Kirsa M Demant
- 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Maj Vinberg
- 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Hartwig R Siebner
- 2 Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark.,3 Department of Neurology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Lars V Kessing
- 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Kamilla W Miskowiak
- 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Denmark.,2 Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark.,4 Department of Psychology, University of Copenhagen, Denmark
| |
Collapse
|
37
|
Ott CV, Vinberg M, Bowie CR, Christensen EM, Knudsen GM, Kessing LV, Miskowiak KW. Effect of action-based cognitive remediation on cognition and neural activity in bipolar disorder: study protocol for a randomized controlled trial. Trials 2018; 19:487. [PMID: 30208971 PMCID: PMC6134776 DOI: 10.1186/s13063-018-2860-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 08/13/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cognitive impairment is present in bipolar disorder (BD) during the acute and remitted phases and hampers functional recovery. However, there is currently no clinically available treatment with direct and lasting effects on cognitive impairment in BD. We will examine the effect of a novel form of cognitive remediation, action-based cognitive remediation (ABCR), on cognitive impairment in patients with BD, and explore the neural substrates of potential treatment efficacy on cognition. METHODS/DESIGN The trial has a randomized, controlled, parallel-group design. In total, 58 patients with BD in full or partial remission aged 18-55 years with objective cognitive impairment will be recruited. Participants are randomized to 10 weeks of ABCR or a control group. Assessments encompassing neuropsychological testing and mood ratings, and questionnaires on subjective cognitive complaints, psychosocial functioning, and quality of life are carried out at baseline, after 2 weeks of treatment, after the end of treatment, and at a six-month-follow-up after treatment completion. Functional magnetic resonance imaging scans are performed at baseline and 2 weeks into treatment. The primary outcome is a cognitive composite score spanning verbal memory, attention, and executive function. Two complete data sets for 52 patients will provide a power of 80% to detect a clinically relevant between-group difference on the primary outcome. Behavioral data will be analyzed using mixed models in SPSS while MRI data will be analyzed with the FMRIB Expert Analysis Tool (FEAT). Early treatment-related changes in neural activity from baseline to week 2 will be investigated for the dorsal prefrontal cortex and hippocampus as the regions of interest and with an exploratory whole-brain analysis. DISCUSSION The results will provide insight into whether ABCR has beneficial effects on cognition and functioning in remitted patients with BD. The results will also provide insight into early changes in neural activity associated with improvement of cognition, which can aid future treatment development. TRIAL REGISTRATION Clinicaltrials.gov , NCT03295305 . Registered on 26 September 2017.
Collapse
Affiliation(s)
- Caroline V. Ott
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Ellen Margrethe Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gitte M. Knudsen
- Neurobiology Research Unit and Center for Experimental Medicine Neuropharmacology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars V. Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla W. Miskowiak
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
38
|
Qiu L, Yan H, Zhu R, Yan J, Yuan H, Han Y, Yue W, Tian L, Zhang D. Correlations between exploratory eye movement, hallucination, and cortical gray matter volume in people with schizophrenia. BMC Psychiatry 2018; 18:226. [PMID: 30005610 PMCID: PMC6045825 DOI: 10.1186/s12888-018-1806-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Widespread cortical gray matter alternations in people with schizophrenia are correlated with both psychotic symptoms and cognitive/behavioral abnormalities, including the impairments of exploratory eye movement (EEM). Particularly, the loss of gray matter density is specifically related to deficits of the responsive search score (RSS) of EEM in schizophrenia. It is unknown, however, whether the schizophrenia-related RSS deficits are associated with certain psychotic symptoms, such as hallucinations. METHODS In 33 participants with schizophrenia, the measurement of EEM, assessment of the hallucination severity using Positive and Negative Syndrome Scale (PANSS) and a voxel-based morphometric analysis of cortical gray matter volume (GMV) were conducted to investigate the relationships between the RSS of EEM, symptom severity, and GMV. In 29 matched healthy controls, the measurement of EEM and a voxel-based morphometric analysis of cortical GMV were also conducted to investigate the relationship between the RSS of EEM and GMV. RESULTS In participants with schizophrenia, the hallucination severity was significantly negatively correlated with both the RSS and the GMV of a large number of brain regions in the frontal, temporal, parietal, orbitofrontal, calcarine, cingulate, and insular cortices, and rolandic operculum, hippocampus, parahippocampal gyrus, and thalamus. Also in participants with schizophrenia, the RSS was significantly positively correlated with the GMV in the left supplementary motor area (SMA), left superior frontal cortex (SFG), bilateral precentral gyri, bilateral postcentral gyri, and bilateral middle frontal cortices. More importantly, the GMV of the SMA, SFG, and precentral gyrus in the left hemisphere was not only significantly negatively correlated with the hallucination severity but also significantly positively correlated with the RSS. No significant correlation could be revealed between the RSS and the GMV of any brain regions in healthy controls. CONCLUSIONS There was a significantly negative association between the hallucination severity and the RSS of EEM, suggesting that the RSS may be a potential biomarker for predicting the hallucination severity of schizophrenia. Also, the GMV of the left SMA, SFG, and precentral gyrus may be the common substrates underlying both hallucination induction and the RSS in people with schizophrenia.
Collapse
Affiliation(s)
- Linlin Qiu
- 0000 0000 9490 772Xgrid.186775.aDepartment of Medical Psychology, Chaohu Hospital, Anhui Medical University, Hefei, Anhui China ,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders & Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui China ,0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Hao Yan
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Risheng Zhu
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Jun Yan
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Huishu Yuan
- 0000 0004 0605 3760grid.411642.4The Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yonghua Han
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Weihua Yue
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Lin Tian
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China. .,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China. .,Department of Psychiatry, the Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, Jiangsu, China.
| | - Dai Zhang
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China. .,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
| |
Collapse
|
39
|
Kaneko K. Negative Symptoms and Cognitive Impairments in Schizophrenia: Two Key Symptoms Negatively Influencing Social Functioning. Yonago Acta Med 2018. [PMID: 29946215 DOI: 10.33160/yam.2018.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Schizophrenia is a chronic, disabling disorder, which commonly emerges in adolescence and young adulthood. While pharmacological treatment with currently available second-generation antipsychotics exerts beneficial effects on the positive symptoms of schizophrenia, they have little effect on negative symptoms or cognitive deficits. Because these two types of symptoms are enduring, and negatively impact social functioning throughout the course of the illness, there is an urgent requirement to develop new effective therapeutic approaches to manage them. Negative symptoms have proven difficult to assess accurately because of their complexity, even with commonly used clinical rating scales such as the Scales for Assessment of Negative Symptoms (SANS). In this context, new "next-generation" assessment tools have recently been developed, which include items representing the five domains encompassed by the two established clusters of negative symptoms (diminished expression and avolition), and enable the detection of changes in severity. Despite various therapeutic approaches to alleviating negative symptoms, there are currently no established methods available for clinical practice. Cognitive deficits are also a core feature in the majority of people with schizophrenia, with impaired performance observed across many cognitive domains, including verbal memory, working memory, attention, and executive functions. Such cognitive deficits are likely associated with either reduced or inefficient function of related distributed neural networks. Psychosocial treatments for cognitive impairments in schizophrenia seem promising given the beneficial effects of cognitive remediation therapy on such impairments, as well as on social functioning, as substantiated in several meta-analytic studies with modest effect sizes. Furthermore, using functional neuroimaging techniques, the size of these therapy-induced beneficial changes in neurocognitive performance has been demonstrated to be correlated with the degree of the changes in brain activation during performing some cognitive tasks in the prefrontal and temporal cortices. This suggests neurobiological effects are exerted by psychosocial cognitive remediation treatments.
Collapse
Affiliation(s)
- Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neurosciences, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| |
Collapse
|
40
|
Kaneko K. Negative Symptoms and Cognitive Impairments in Schizophrenia: Two Key Symptoms Negatively Influencing Social Functioning. Yonago Acta Med 2018; 61:91-102. [PMID: 29946215 PMCID: PMC6015796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/23/2018] [Indexed: 09/27/2023]
Abstract
Schizophrenia is a chronic, disabling disorder, which commonly emerges in adolescence and young adulthood. While pharmacological treatment with currently available second-generation antipsychotics exerts beneficial effects on the positive symptoms of schizophrenia, they have little effect on negative symptoms or cognitive deficits. Because these two types of symptoms are enduring, and negatively impact social functioning throughout the course of the illness, there is an urgent requirement to develop new effective therapeutic approaches to manage them. Negative symptoms have proven difficult to assess accurately because of their complexity, even with commonly used clinical rating scales such as the Scales for Assessment of Negative Symptoms (SANS). In this context, new "next-generation" assessment tools have recently been developed, which include items representing the five domains encompassed by the two established clusters of negative symptoms (diminished expression and avolition), and enable the detection of changes in severity. Despite various therapeutic approaches to alleviating negative symptoms, there are currently no established methods available for clinical practice. Cognitive deficits are also a core feature in the majority of people with schizophrenia, with impaired performance observed across many cognitive domains, including verbal memory, working memory, attention, and executive functions. Such cognitive deficits are likely associated with either reduced or inefficient function of related distributed neural networks. Psychosocial treatments for cognitive impairments in schizophrenia seem promising given the beneficial effects of cognitive remediation therapy on such impairments, as well as on social functioning, as substantiated in several meta-analytic studies with modest effect sizes. Furthermore, using functional neuroimaging techniques, the size of these therapy-induced beneficial changes in neurocognitive performance has been demonstrated to be correlated with the degree of the changes in brain activation during performing some cognitive tasks in the prefrontal and temporal cortices. This suggests neurobiological effects are exerted by psychosocial cognitive remediation treatments.
Collapse
Affiliation(s)
- Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neurosciences, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| |
Collapse
|
41
|
Rossetti I, Brambilla P, Papagno C. Metaphor Comprehension in Schizophrenic Patients. Front Psychol 2018; 9:670. [PMID: 29867648 PMCID: PMC5954116 DOI: 10.3389/fpsyg.2018.00670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/18/2018] [Indexed: 11/17/2022] Open
Abstract
People with schizophrenia often exhibit difficulties to comprehend figurative expressions, such as irony, proverbs, metaphors and idioms, with a general proneness to neglect the figurative meaning and to accept the more literal one. This inability is usually referred to as concretism and it constitutes a clinical manifestation of the broader language dysfunction called Formal Thought Disorder. The current review focuses on the neuropsychological and neuroanatomical underpinnings of schizophrenics’ misinterpretation of a subgroup of figurative expressions, i.e., metaphors. Metaphors are heterogeneous in nature, classifiable according to various criteria; for instance, metaphors can be conventional and familiar, or conversely, novel and unusual. These linguistic distinctions are substantial because the comprehension of the different types of metaphor entails partially different cognitive strategies and neural substrates. This review gathers studies that have directly investigated which neurocognitive deficits explain the inefficient comprehension of metaphor in schizophrenia. Several impairments have been put forward, such as general intelligence, executive functions and theory of mind deficits. Moreover, the neural correlates of metaphor comprehension in schizophrenia, like the left inferior/medial frontal gyrus and the temporal lobe, match those cortices affected by the neuropathology of schizophrenia. Even though the causal defective mechanism is still a matter of investigation, we provide an attempt to integrate existing findings.
Collapse
Affiliation(s)
- Ileana Rossetti
- Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy
| | - Paolo Brambilla
- Scientific Institute IRCCS "E. Medea", Bosisio Parini, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Costanza Papagno
- Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy.,Center for Mind/Brain Sciences and Centro di Riabilitazione Neurocognitiva, University of Trento, Trento, Italy
| |
Collapse
|
42
|
Kelly SM, Eack SM. White matter microstructure and cognitive remediation outcomes in schizophrenia. Schizophr Res 2018; 195:76-77. [PMID: 28965777 DOI: 10.1016/j.schres.2017.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Sinead M Kelly
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, United States; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, United States
| |
Collapse
|
43
|
Wojtalik JA, Eack SM, Smith MJ, Keshavan MS. Using Cognitive Neuroscience to Improve Mental Health Treatment: A Comprehensive Review. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2018; 9:223-260. [PMID: 30505392 PMCID: PMC6258037 DOI: 10.1086/697566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mental health interventions do not yet offer complete, client-defined functional recovery, and novel directions in treatment research are needed to improve the efficacy of available interventions. One promising direction is the integration of social work and cognitive neuroscience methods, which provides new opportunities for clinical intervention research that will guide development of more effective mental health treatments that holistically attend to the biological, social, and environmental contributors to disability and recovery. This article reviews emerging trends in cognitive neuroscience and provides examples of how these advances can be used by social workers and allied professions to improve mental health treatment. We discuss neuroplasticity, which is the dynamic and malleable nature of the brain. We also review the use of risk and resiliency biomarkers and novel treatment targets based on neuroimaging findings to prevent disability, personalize treatment, and make interventions more targeted and effective. The potential of treatment research to contribute to neuroscience discoveries regarding brain change is considered from the experimental-medicine approach adopted by the National Institute of Mental Health. Finally, we provide resources and recommendations to facilitate the integration of cognitive neuroscience into mental health research in social work.
Collapse
Affiliation(s)
- Jessica A Wojtalik
- Doctoral candidate at the University of Pittsburgh School of Social Work
| | - Shaun M Eack
- Professor at the University of Pittsburgh School of Social Work and Department of Psychiatry
| | - Matthew J Smith
- Associate professor at the University of Michigan School of Social Work
| | | |
Collapse
|
44
|
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
|
45
|
Ramsay IS, MacDonald AW. The Ups and Downs of Thalamocortical Connectivity in Schizophrenia. Biol Psychiatry 2018; 83:473-474. [PMID: 29429501 DOI: 10.1016/j.biopsych.2018.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Ian S Ramsay
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Angus W MacDonald
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota; Department of Psychology, University of Minnesota, Minneapolis, Minnesota.
| |
Collapse
|
46
|
Giraldo-Chica M, Rogers BP, Damon SM, Landman BA, Woodward ND. Prefrontal-Thalamic Anatomical Connectivity and Executive Cognitive Function in Schizophrenia. Biol Psychiatry 2018; 83:509-517. [PMID: 29113642 PMCID: PMC5809301 DOI: 10.1016/j.biopsych.2017.09.022] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/30/2017] [Accepted: 09/11/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Executive cognitive functions, including working memory, cognitive flexibility, and inhibition, are impaired in schizophrenia. Executive functions rely on coordinated information processing between the prefrontal cortex (PFC) and thalamus, particularly the mediodorsal nucleus. This raises the possibility that anatomical connectivity between the PFC and mediodorsal thalamus may be 1) reduced in schizophrenia and 2) related to deficits in executive function. The current investigation tested these hypotheses. METHODS Forty-five healthy subjects and 62 patients with a schizophrenia spectrum disorder completed a battery of tests of executive function and underwent diffusion-weighted imaging. Probabilistic tractography was used to quantify anatomical connectivity between six cortical regions, including PFC, and the thalamus. Thalamocortical anatomical connectivity was compared between healthy subjects and patients with schizophrenia using region-of-interest and voxelwise approaches, and the association between PFC-thalamic anatomical connectivity and severity of executive function impairment was examined in patients. RESULTS Anatomical connectivity between the thalamus and PFC was reduced in schizophrenia. Voxelwise analysis localized the reduction to areas of the mediodorsal thalamus connected to lateral PFC. Reduced PFC-thalamic connectivity in schizophrenia correlated with impaired working memory but not cognitive flexibility and inhibition. In contrast to reduced PFC-thalamic connectivity, thalamic connectivity with somatosensory and occipital cortices was increased in schizophrenia. CONCLUSIONS The results are consistent with models implicating disrupted PFC-thalamic connectivity in the pathophysiology of schizophrenia and mechanisms of cognitive impairment. PFC-thalamic anatomical connectivity may be an important target for procognitive interventions. Further work is needed to determine the implications of increased thalamic connectivity with sensory cortex.
Collapse
Affiliation(s)
- Monica Giraldo-Chica
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN
| | - Baxter P. Rogers
- Vanderbilt University Institute of Imaging Science, Nashville, TN
| | | | - Bennett A. Landman
- Vanderbilt University Institute of Imaging Science, Nashville, TN,Vanderbilt University School of Engineering, Nashville, TN
| | - Neil D. Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
47
|
Bon L, Franck N. The impact of cognitive remediation on cerebral activity in schizophrenia: Systematic review of the literature. Brain Behav 2018; 8:e00908. [PMID: 29541534 PMCID: PMC5840451 DOI: 10.1002/brb3.908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT cognitive remediation involves either intensive training of impaired functions or implementing strategies to compensate for these impairments. In cases of schizophrenia, both methods have demonstrated benefits in terms of behavior and cerebral activity. However, despite the major differences between these two approaches, their impact has not yet been compared. METHOD We searched the PsychInfo, Pubmed, and ScienceDirect databases using the key words "cognitive remediation," "schizophrenia," "cerebral activity," and "magnetic resonance imaging," in order to select studies investigating the effects of cognitive remediation on patients with schizophrenia. The studies selected had to present their approach in detail and measure its impact in terms of both cerebral activity and cognitive function, both before and after therapy. We divided the studies into two groups, those using the strategy method and those using the training method. RESULTS Eight studies were included in the review, four for the strategy method (88 patients, 44 of whom underwent remediation) and 4 for the training method (87 patients, 43 of whom underwent remediation). The analysis of the results of this study indicates that the training method is capable of activating more the targeted brain areas than the strategy method. However, the latter appears to encourage more extensive activation of the cerebral networks. DISCUSSION The studies used for this review vary widely in terms of the imaging methods and protocol. However, differences were found between the two methods and lead us to suggest that further studies, with proper bias control, should be conducted to systematically compare the two approaches.
Collapse
Affiliation(s)
- Laura Bon
- Centre Ressource de Réhabilitation psychosociale et de Remédiation Cognitive Centre Hospitalier Le Vinatier Lyon France
| | - Nicolas Franck
- Centre Ressource de Réhabilitation psychosociale et de Remédiation Cognitive Centre Hospitalier Le Vinatier Lyon France
| |
Collapse
|
48
|
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
|
49
|
Response to Targeted Cognitive Training Correlates with Change in Thalamic Volume in a Randomized Trial for Early Schizophrenia. Neuropsychopharmacology 2018; 43:590-597. [PMID: 28895568 PMCID: PMC5770762 DOI: 10.1038/npp.2017.213] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/20/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023]
Abstract
Reduced thalamic volume is consistently observed in schizophrenia, and correlates with cognitive impairment. Targeted cognitive training (TCT) of auditory processing in schizophrenia drives improvements in cognition that are believed to result from functional neuroplasticity in prefrontal and auditory cortices. In this study, we sought to determine whether response to TCT is also associated with structural neuroplastic changes in thalamic volume in patients with early schizophrenia (ESZ). Additionally, we examined baseline clinical, cognitive, and neural characteristics predictive of a positive response to TCT. ESZ patients were randomly assigned to undergo either 40 h of TCT (N=22) or a computer games control condition (CG; N=22 s). Participants underwent MRI, clinical, and neurocognitive assessments before and after training (4-month interval). Freesurfer automated segmentation of the subcortical surface was carried out to measure thalamic volume at both time points. Left thalamic volume at baseline correlated with baseline global cognition, while a similar trend was observed in the right thalamus. The relationship between change in cognition and change in left thalamus volume differed between groups, with a significant positive correlation in the TCT group and a negative trend in the CG group. Lower baseline symptoms were related to improvements in cognition and left thalamic volume preservation following TCT. These findings suggest that the cognitive gains induced by TCT in ESZ are associated with structural neuroplasticity in the thalamus. Greater symptom severity at baseline reduced the likelihood of response to TCT both with respect to improved cognition and change in thalamic volume.
Collapse
|
50
|
Guimond S, Béland S, Lepage M. Strategy for Semantic Association Memory (SESAME) training: Effects on brain functioning in schizophrenia. Psychiatry Res Neuroimaging 2018; 271:50-58. [PMID: 29102504 DOI: 10.1016/j.pscychresns.2017.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/05/2017] [Accepted: 10/23/2017] [Indexed: 12/17/2022]
Abstract
Self-initiation of semantic encoding strategies is impoverished in schizophrenia and contributes to memory impairments. Recently, we observed that following a brief training, schizophrenia patients had the potential to increase the self-initiation of these strategies. In this study, we investigated the neural correlates underlying such memory improvements. Fifteen schizophrenia patients with deficits in self-initiation of semantic encoding strategies were enrolled in a Strategy for Semantic Association Memory (SESAME) training. Patients underwent a memory task in an fMRI scanner. Memory performance and brain activity during the task were measured pre- and post- training, and changes following training were assessed. We also investigated if structural preservation measured by the cortical thickness of the left dorsolateral prefrontal cortex (DLPFC) predicted memory improvement post-training. Memory training led to significant improvements in memory performance that were associated with increased activity in the left DLPFC, during a task in which patients needed to self-initiate semantic encoding strategies. Furthermore, patients with more cortical reserve in their left DLPFC showed greater memory improvement. Our findings provide evidence of neural malleability in the left DLPFC in schizophrenia using cognitive strategies training. Moreover, the brain-behavioural changes observed in schizophrenia provide hope that memory performance can be improved with a brief intervention.
Collapse
Affiliation(s)
- Synthia Guimond
- Department of psychology, McGill University, Montréal, Canada; Douglas Mental Health University Institute, Montréal, Canada; Department of psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Sophie Béland
- Douglas Mental Health University Institute, Montréal, Canada; Integrated Program in Neuroscience, McGill University, Montréal, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Montréal, Canada; Department of psychiatry, McGill University, Montréal, Canada.
| |
Collapse
|