Cognitive Training for Impaired Neural Systems in Neuropsychiatric Illness

Abstract

Neuropsychiatric illnesses are associated with dysfunction in distributed prefrontal neural systems that underlie perception, cognition, social interactions, emotion regulation, and motivation. The high degree of learning-dependent plasticity in these networksFcombined with the availability of advanced computerized technologyFsuggests that we should be able to engineer very specific training programs that drive meaningful and enduring improvements in impaired neural systems relevant to neuropsychiatric illness. However, cognitive training approaches for mental and addictive disorders must take into account possible inherent limitations in the underlying brain 'learning machinery' due to pathophysiology, must grapple with the presence of complex overlearned maladaptive patterns of neural functioning, and must find a way to ally with developmental and psychosocial factors that influence response to illness and to treatment. In this review, we briefly examine the current state of knowledge from studies of cognitive remediation in psychiatry and we highlight open questions. We then present a systems neuroscience rationale for successful cognitive training for neuropsychiatric illnesses, one that emphasizes the distributed nature of neural assemblies that support cognitive and affective processing, as well as their plasticity. It is based on the notion that, during successful learning, the brain represents the relevant perceptual and cognitive/affective inputs and action outputs with disproportionately larger and more coordinated populations of neurons that are distributed (and that are interacting) across multiple levels of processing and throughout multiple brain regions. This approach allows us to address limitations found in earlier research and to introduce important principles for the design and evaluation of the next generation of cognitive training for impaired neural systems. We summarize work to date using such neuroscience-informed methods and indicate some of the exciting future directions of this field.

Cognitive deficits, obesity and disability in schizophrenia

“…As recently reviewed to patients who did not receive cognitive remediation. It is critical to point out, as did commentators on both our study and the Vinogradov studies [10] that patients improved, and while some improved more substantially than others, they were not recovered. These treatments also worked fairly rapidly -12 weeks in our study -particularly when the lifelong nature of schizophrenia is considered.…”

Problematic Alcohol Use Among Individuals with HIV: Relations with Everyday Memory Functioning and HIV Symptom Severity

“…In addition, although the cross-sectional nature of these data does not permit us to draw conclusions about causality, interventions to remediate cognitive functioning may also improve outcomes in this particularly vulnerable population. For instance, computerized neuroscience-based cognitive remediation programs that target attention, memory and executive functioning (e.g., PssCogRehab, Psychological Services Inc; BrainHQ, Posit Science) could help augment existing treatments by enhancing patients' cognitive reserve and mental flexibility to adhere to complex treatment regimens and encode, retrieve and employ HIV transmission-prevention skills [e.g., 87,88]. As hypothesized, perceived memory functioning provided an indirect pathway for the relation between problematic alcohol use and HIV symptom severity.…”

Cognitive Remediation for Schizophrenia

“…57) Non-specific mechanisms, such as temporary changes in cortical representations, top-down organization related to task performance, and the increases in synaptic efficiency and neuronal excitability discussed above mediate this initial phase of performance improvement. 58,59) Topographically, the rapid phase of learning is associated with activation and increased functional connectivity of regions involved in directed attention, such as the prefrontal cortex, anterior cingulate cortex, and posterior parietal cortex. 60,61) These changes are not task-specific, but rather reflect generic heightened attention and effort resulting in activation of a set of regions now known as the task-positive network.…”

“…Errorless learning takes advantage of implicit (learning without conscious awareness) learning processes that may be intact in schizophrenia; 84,85) treatment induced improvements in implicit learning systems may thus help to restore impaired working memory and explicit memory processes. 58) Errorless learning has been demonstrated to be effective in schizophrenia patients in both formal memory assessments and a study of work performance carried out in a community mental health center setting. 86,87) Learning is also enhanced by personally salient stimuli.…”