Cognitive remediation for individuals with psychosis: efficacy and mechanisms of treatment effects

Abstract

Background: Deficits in social cognition are prominent features of schizophrenia that play a large role in functional impairments and disability. Performance deficits in these domains are associated with altered activity in functional networks, including those that support social cognitive abilities such as emotion recognition. These social cognitive deficits and alterations in neural networks are present prior to the onset of frank psychotic symptoms and thus present a potential target for intervention in early phases of the illness, including in individuals at clinical high risk (CHR) for psychosis. This study assessed changes in social cognitive functional networks following targeted cognitive training (TCT) in CHR individuals. Methods: 14 CHR subjects (7 male, mean age = 21.9) showing attenuated psychotic symptoms as assessed by the SIPS were included in the study. Subjects underwent a clinical evaluation and a functional MRI session prior to and subsequent to completing 40 hours (8 weeks) of targeted cognitive and social cognitive training using Lumosity and SocialVille. 14 matched healthy control (HC) subjects also underwent a single fMRI session as a comparison group for functional activity. Resting state fMRI was acquired as well as fMRI during performance of an emotion recognition task. Group level differences in BOLD activity between HC and CHR group before TCT, and CHR group before and after TCT were computed. Changes in social cognitive network functional connectivity at rest and during task performance was evaluated using seed-based connectivity analyses and psychophysiological interaction (PPI). Results: Prior to training, CHR individuals demonstrated hyperactivity in the amygdala, posterior cingulate, and superior temporal sulcus (STS) during emotion recognition, suggesting inefficient processing. This hyperactivity normalized somewhat after training, with CHR individuals showing less hyperactivity in the amygdala in response to emotional faces. In addition, training was associated with increased connectivity in emotion processing networks, including greater STS-medial prefrontal connectivity and normalization of amygdala connectivity patterns. Conclusion: These results suggest that targeted cognitive training produced improvements in emotion recognition and may be effective in altering functional network connectivity in networks associated with psychosis risk. TCT may be a useful tool for early intervention in individuals at risk for psychotic disorders to address behaviors that impact functional outcome. CAN AEROBIC EXERCISE BOOST THE IMPACT OF COGNITIVE TRAINING?Keith Nuechterlein*, Sarah McEwen, Joseph Ventura, Kenneth Subotnik, Luana Turner, Michael Boucher, Laurie Casaus, and Jacqueline Hayata University of California, Los Angeles Background: Systematic cognitive training has led to significant gains in cognition in schizophrenia, but methods of enhancing learning during such training could greatly increase its impact. Aerobic exercise stimulates synaptic plasticity and may be an effective w...

What variables predict cognitive remediation associated improvement in individuals with psychosis?

“…For details of the original study, please refer to Fiszdon et al (2016). Briefly, participants were randomized (2:1 ratio) to two months of either cognitive remediation (CR), or treatment as usual (TAU) condition.…”

Cognitive training to improve memory in individuals undergoing electroconvulsive therapy: Negative findings

“…Cognitive remediation is a behavioral treatment which has been used to improve cognitive function in brain injury, stroke, dementia, epilepsy, schizophrenia, and other psychiatric populations (Choi and Twamley, 2013; Fiszdon et al, 2016; Cicerone et al, 2011; Wykes et al, 2011). Emerging literature on the recovery of memory deficits in seizure disorder is the most pertinent to the use of CR with ECT (Mangaoang and Lucey, 2007), since the pattern of memory impairments associated with ECT can be similar to the memory loss associated with temporal lobe epilepsy (Ponds and Hendriks, 2006).…”

Cognitive Remediation for Schizophrenia with Focus on NEAR

“…Cognitive remediation has been reported to improve cognition such as attention ( 1 ) processing speed ( 2 ), immediate learning and memory ( 1 ), verbal working memory ( 3 ), and problem-solving ( 4 ).…”

“…NEAR has improved cognition such as attention ( 8 ), processing speed ( 21 , 22 ), immediate learning and memory ( 1 ), and delayed verbal memory ( 22 ). NEAR outcome studies have been conducted at a variety of settings such as outpatient psychiatric facilities ( 1 , 13 ), inpatient psychiatric units ( 4 ), intensive psychiatric rehabilitation ( 23 ), supportive housing facility ( 24 ), and its controlled trials have been conducted ( 3 , 13 ): in these studies, computer sessions were provided once or twice a week, and the duration of the treatment differed from 4 to 15 weeks. Longer treatment duration is recommended to achieve clinically significant change ( 12 ).…”