The impact of cognitive remediation on cerebral activity in schizophrenia: Systematic review of the literature

Abstract

Contextcognitive 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.MethodWe 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.ResultsEight 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.DiscussionThe 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.

Factors Associated With Response and Resistance to Cognitive Remediation in Schizophrenia: A Critical Review

“…CR methods based on strategy are very different from those based on training (drill and practice), and these two types of CR techniques almost certainly have different effects on brain activity. In their recent review, Bon and Franck (2018) showed an increase brain activity for the training-based method, but a broader network activation for the strategy-based one. Vita et al (2013) showed that the type of CR treatment—cognitive subprograms of Integrated Psychological Therapy (IPT-cog) vs. CACR (Cogpack)—was not associated with cognitive gain in schizophrenia patients, but predicted functional improvement (CACR > IPT-cog) in this population.…”

Neural changes following cognitive remediation therapy for schizophrenia

“…While the bottom‐up approach of CRT restored activation in regions that are involved in specifically trained cognitive tasks, the CRT top‐down approach activated a broader compensatory network . This might be because higher‐level cognitive training required a greater variety of cognitive functions . Finally, the duration of observed neural activity changes following CRT remains unclear because no studies have included follow‐up neuroimaging data.…”

“…Recently, the number of neuroimaging studies of CRT using single‐photon emission computed tomography (SPECT), near‐infrared spectroscopy (NIRS), magnetic resonance imaging (MRI), and functional MRI (fMRI) have increased to investigate the neural mechanisms underlying cognitive improvement. To date, several neuroimaging systematic reviews have indicated neuroanatomical changes upon CRT . The use of different tools and approaches of neuroimaging devices and of CRT intensity and duration of CRT, however, has led meta‐analyses to produce different results.…”

Psychosocial interventions in schizophrenia: Focus on guidelines

“…Schizophrenia leads to deficits in a large number of cognitive domains (Keefe et al, 2005), such as attention/vigilance, working memory, processing speed, visual and verbal learning, reasoning and problem-solving, abstract thinking, verbal comprehension and social cognition (Heinrichs & Zakzanis, 1998). Psychopharmacological treatments are not specifically effective on cognitive impairment, and a pattern of cognitive trainings have been developed and tested for improving cognition among schizophrenia patients (Bon & Franck, 2018). Cognitive remediation is defined as a rehabilitation treatment based on a combination of interventions and exercises aimed at improving attention, memory, language and/or executive functions in the long term (Vita et al, 2013).…”