No Effects of Cognitive Remediation on Cerebral White Matter in Individuals at Ultra-High Risk for Psychosis—A Randomized Clinical Trial

Kristensen, Tina Dam; Ebdrup, Bjørn H; Hjorthøj, Carsten; Mandl, René C.W.; Raghava, Jayachandra Mitta; Jepsen, Jens Richardt Møllegaard; Fagerlund, Birgitte; Glenthøj, Louise Birkedal; Wenneberg, Christina; Krakauer, Kristine; Pantelis, Christos; Glenthøj, Birte; Nordentoft, Merete

doi:10.3389/fpsyt.2020.00873

Cited by 6 publications

(5 citation statements)

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“…At the moment, to our knowledge, no effective pharmacological or psychological interventions are available to ameliorate neurocognitive deficits in individuals at CHR-P, 35,50 and recent neurocognitive remediation trials have produced negative findings. 51,52 We tested several potential moderators of neurocognitive functioning. Younger age was associated with increased neurocognitive impairments between individuals at CHR-P and HC individuals, while more years of education were related to decreased differences.…”

Section: Discussionmentioning

confidence: 99%

“…A further downstream clinical impact of these findings may be to present an opportunity for refining preventive interventions. At the moment, to our knowledge, no effective pharmacological or psychological interventions are available to ameliorate neurocognitive deficits in individuals at CHR-P, and recent neurocognitive remediation trials have produced negative findings …”

Section: Discussionmentioning

confidence: 99%

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Neurocognitive Functioning in Individuals at Clinical High Risk for Psychosis

et al. 2021

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IMPORTANCE Neurocognitive functioning is a potential biomarker to advance detection, prognosis, and preventive care for individuals at clinical high risk for psychosis (CHR-P). The current consistency and magnitude of neurocognitive functioning in individuals at CHR-P are undetermined.OBJECTIVE To provide an updated synthesis of evidence on the consistency and magnitude of neurocognitive functioning in individuals at CHR-P. DATA SOURCES Web of Science database, Cochrane Central Register of Reviews, and Ovid/PsycINFO and trial registries up to July 1, 2020. STUDY SELECTION Multistep literature search compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology performed by independent researchers to identify original studies reporting on neurocognitive functioning in individuals at CHR-P. DATA EXTRACTION AND SYNTHESIS Independent researchers extracted the data, clustering the neurocognitive tasks according to 7 Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains and 8 CHR-P domains. Random-effect model meta-analyses, assessment of publication biases and study quality, and meta-regressions were conducted. MAIN OUTCOMES AND MEASURES The primary effect size measure was Hedges g of neurocognitive functioning in individuals at CHR-P (1) compared with healthy control (HC) individuals or (2) compared with individuals with first-episode psychosis (FEP) or (3) stratified for the longitudinal transition to psychosis. RESULTS A total of 78 independent studies were included, consisting of 5162 individuals at CHR-P (mean [SD; range] age, 20.2 [3.3; 12.0-29.0] years; 2529 [49.0%] were female), 2865 HC individuals (mean [SD; range] age, 21.1 [3.6; 12.6-29.2] years; 1490 [52.0%] were female), and 486 individuals with FEP (mean [SD; range] age, 23.0 [2.0; 19.1-26.4] years; 267 [55.9%] were female). Compared with HC individuals, individuals at CHR-P showed medium to large deficits on the Stroop color word reading task (g = −1.17; 95% CI, −1.86 to −0.48), Hopkins Verbal Learning Test-Revised (g = −0.86; 95% CI, −1.43 to −0.28), digit symbol coding test (g = −0.74; 95% CI, −1.19 to −0.29), Brief Assessment of Cognition Scale Symbol Coding (g = −0.67; 95% CI, −0.95 to −0.39), University of Pennsylvania Smell Identification Test (g = −0.55; 95% CI, −0.97 to −0.12), Hinting Task (g = −0.53; 95% CI, −0.77 to −0.28), Rey Auditory Verbal Learning Test (g = −0.50; 95% CI, −0.78 to −0.21), California Verbal Learning Test (CVLT) (g = −0.50; 95% CI, −0.64 to −0.36), and National Adult Reading Test (g = −0.52; 95% CI, −1.01 to −0.03). Individuals at CHR-P were less impaired than individuals with FEP. Longitudinal transition to psychosis from a CHR-P state was associated with medium to large deficits in the CVLT task (g = −0.58; 95% CI, −1.12 to −0.05). Meta-regressions found significant effects for age and education on processing speed.CONCLUSIONS AND RELEVANCE Findings from this meta-analysis support neurocognitive dysfunction...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neurocognitive Functioning in Individuals at Clinical High Risk for Psychosis

et al. 2021

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“…33 In short, we found no effect of cognitive remediation on primary outcome of global neurocognition, and no effect on secondary outcomes including symptoms and level of functioning, 34 nor on WM organization. 35…”

Section: Methodsmentioning

confidence: 99%

Global fractional anisotropy predicts transition to psychosis after 12 months in individuals at ultra‐high risk for psychosis

Kristensen

Glenthøj

Ambrosen

et al. 2021

Acta Psychiatr Scand

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Objective Psychosis spectrum disorders are associated with cerebral changes, but the prognostic value and clinical utility of these findings are unclear. Here, we applied a multivariate statistical model to examine the predictive accuracy of global white matter fractional anisotropy (FA) for transition to psychosis in individuals at ultra‐high risk for psychosis (UHR). Methods 110 UHR individuals underwent 3 Tesla diffusion‐weighted imaging and clinical assessments at baseline, and after 6 and 12 months. Using logistic regression, we examined the reliability of global FA at baseline as a predictor for psychosis transition after 12 months. We tested the predictive accuracy, sensitivity and specificity of global FA in a multivariate prediction model accounting for potential confounders to FA (head motion in scanner, age, gender, antipsychotic medication, parental socioeconomic status and activity level). In secondary analyses, we tested FA as a predictor of clinical symptoms and functional level using multivariate linear regression. Results Ten UHR individuals had transitioned to psychosis after 12 months (9%). The model reliably predicted transition at 12 months (χ2 = 17.595, p = 0.040), accounted for 15–33% of the variance in transition outcome with a sensitivity of 0.70, a specificity of 0.88 and AUC of 0.87. Global FA predicted level of UHR symptoms (R2 = 0.055, F = 6.084, p = 0.016) and functional level (R2 = 0.040, F = 4.57, p = 0.036) at 6 months, but not at 12 months. Conclusion Global FA provided prognostic information on clinical outcome and symptom course of UHR individuals. Our findings suggest that the application of prediction models including neuroimaging data can inform clinical management on risk for psychosis transition.

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“…Based on the documentation of successful prevention of volume decreases in the left hippocampus, parahippocampal gyrus, fusiform gyrus, etc., by cognitive rehabilitation in the early stage of schizophrenia [ 20 ], a favorable effect may also be expected on the progression of changes in the brain structure in the ARMS phase. However, in the FOCUS study, cognitive remediation did not improve global or regional white matter organization in ARMS individuals [ 21 ], and it seems that favorable results have not been obtained so far.…”

Section: Possibility Of Cognitive Rehabilitationmentioning

confidence: 99%