Prefrontal Cortical Changes Following Cognitive Training in Patients with Chronic Schizophrenia: Effects of Practice, Generalization, and Specificity

Abstract

Cognitive training is increasingly used in the treatment of schizophrenia, but it remains unknown how this training affects functional neuroanatomy. Practice on specific cognitive tasks generally leads to automaticity and decreased prefrontal cortical activity, yet broadbased cognitive training programs may avoid automaticity and increase prefrontal cortex (PFC) activity. This study used quasirandomized, placebo-control design and pre/post neuroimaging to examine functional plasticity associated with attention and working memory-focused cognitive training in patients with schizophrenia. Twenty-one participants with schizophrenia or schizoaffective disorder split into two demographically and performance matched groups (nine scanned per group) and nine control participants were tested 6-8 weeks apart. Compared with both patient controls and healthy controls, patients receiving cognitive training increased activation significantly more in attention and working memory networks, including dorsolateral prefrontal cortex, anterior cingulate and frontopolar cortex. The extent to which activity increased in a subset of these regions predicted performance improvements. Although this study was not designed to speak to the efficacy of cognitive training as a treatment, it is the first study to show that such training can increase the ability of patients to activate the PFC regions subserving attention and working memory.

Fast Effects of Cognitive Restructuring Training on Neurocognitive Functions in Opioid Addicts

“…Similar to other neuropsychiatric functions, there is not much information on the effectiveness of cognitive-behavioral therapy in the improvement of cognitive flexibility, and all relevant studies are into specific phobias and schizophrenia. In the current study blood flow and metabolism in anteriorlateral parts, which are both involved in cognitive flexibility, were improved during psychotherapy [31][32][33]. However, this is inconsistent with previous research, which is due to the differences in samples, damaging effect of substance abuse on brain structure, and therapy techniques.…”

Cognitive Training for Impaired Neural Systems in Neuropsychiatric Illness

“…Haut et al performed an RCT with 21 schizophrenia patients who received 25 h of intensive computerized training in attention and working memory (CogPack Marker Software) plus training in verbal and picture N-back tasks (training followed some but not all of the neuroscience-informed elements described above); participants were compared with subjects receiving groupbased social skills training. An effect size of 0.89 in verbal working memory and 1.4 in picture working memory was found, as well as increased fMRI activation in dorsolateral prefrontal cortex, anterior cingulate and frontopolar cortex (with correlations between improved performance and increased activation in a subset of regions) (Haut et al, 2010). Together with the data from Vinogradov's laboratory, these findings indicate that (1) after intensive training, individuals with schizophrenia can show significant plasticity in distributed cortical systems, with activation patterns appearing more similar to those of healthy individuals than they did at baseline and (2) training-induced increases in cortical activation are correlated with improvements in behavioral performance.…”

“…how illness-related changes in neuroplasticity mechanisms affect the capacity of the impaired brain to respond to training, evidence from persistently ill schizophrenia patients indicates that even in this disabling condition, the brain is capable of significant behavioral and neural activation improvements after appropriate training (Haut et al, 2010;Subramaniam et al, in press). (2) Training-induced enhancements in lower-level perceptual representations have a beneficial effect on higherlevel cognitive operations.…”

Animal Models of Deficient Sensorimotor Gating in Schizophrenia: Are They Still Relevant?

“…Cognitive therapies place demands on patients to develop compensatory strategies for learning and remembering information. In so doing, they specifically activate prefrontal regions subserving working memory and attention (Kumari et al 2009;Haut et al 2010). Patients will benefit most from cognitive therapies if they are able to meet the cognitive demands of these therapies, and drugs that facilitate this process-e.g., via the enhancement of sensorimotor gating, or activation of circuitries that lead to an enhancement of sensorimotor gating-should augment the benefits of cognitive therapies.…”