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When top-down meets bottom-up: Auditory training enhances verbal memory in schizophrenia

Duke University Department of Psychiatry and Center for Cognitive Neuroscience, University of California, San Francisco, CA, USA.
Schizophrenia Bulletin (Impact Factor: 8.61). 10/2009; 35(6):1132-41. DOI: 10.1093/schbul/sbp068
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ABSTRACT A critical research priority for our field is to develop treatments that enhance cognitive functioning in schizophrenia and thereby attenuate the functional losses associated with the illness. In this article, we describe such a treatment method that is grounded in emerging research on the widespread sensory processing impairments of schizophrenia, as described elsewhere in this special issue. We first present the rationale for this treatment approach, which consists of cognitive training exercises that make use of principles derived from the past 2 decades of basic science research in learning-induced neuroplasticity; these exercises explicitly target not only the higher order or "top-down" processes of cognition but also the content building blocks of accurate and efficient sensory representations to simultaneously achieve "bottom-up" remediation. We then summarize our experience to date and briefly review our behavioral and serum biomarker findings from a randomized controlled trial of this method in outpatients with long-term symptoms of schizophrenia. Finally, we present promising early psychophysiological evidence that supports the hypothesis that this cognitive training method induces changes in aspects of impaired bottom-up sensory processing in schizophrenia. We conclude with the observation that neuroplasticity-based cognitive training brings patients closer to physiological patterns seen in healthy participants, suggesting that it changes the brain in an adaptive manner in schizophrenia.

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Available from: Corby L Dale, Aug 17, 2015
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    • "For example, following 50 h of plasticity-based auditory training , chronic schizophrenia patients made significant gains in global cognition, processing speed, verbal working memory, and learning and memory metrics (e.g., Fisher et al., 2009a,b). In parallel, brains of trained subjects compared with controls recovered more normal M100 responses to successive signals consistent with recovery of more normal perceptual abilities resulting from training (Adcock et al., 2009; Dale et al., 2010); recovered more strongly correlated (recovered) gamma frequency responses in the lower gamma frequency (Popov et al., 2012); recovered stronger responses to rapidly successive stimuli in the gamma high-frequency domain (Dale et al., under review); more strongly synchronized alpha frequency responses for target stimuli, and more strongly de-synchronized non-target domain alpha-band responses in an attention-controlled task (Popov et al., 2012; Dale et al., under review); recovered more normal sensory gating (Popov et al., 2011); recovered more normal dorsolateral frontal responses in a working memory task (Dale et al., under review); restored more normal patterns of response in an attributionof-source task (Subramaniam et al., 2012; see Figure 1); recovered more normal amygdala and ventral-lateral-frontal cortical responses in an emotion recognition task (Hooker et al., 2012, 2013); recovered more normal BDNF expression (Vinogradov et al., 2009); among other physical and functional neurological measures of plastic training-driven recovery. While these studies are still a work in progress, taken together, they indicate that this form of computerized, neuroplasticitybased training is effective for broadly driving behavioral "
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    • "One of the reasons that bottom-up influences are still underrepresented in scientific literature may be the implicit nature of sensory integration disturbances. The interplay between top-down and bottom-up processes is however evident (Adcock et al., 2009; Silverstein et al., 2012). Many mechanisms investigated from various perspectives, support our hypothesis: disturbances of neural synchrony and reduced NMDA neurotransmission (Uhlhaas et al., 2008; Woo et al., 2010), dysconnectivity and plasticity (Stephan et al., 2009), changes in brain architecture involved in self-processes (Wylie and Tregellas, 2010; Guo et al., 2012), cognitive dissonance theory (Festinger, 1957; van Veen et al., 2009), aberrant salience (Kapur, 2003), social defeat hypothesis (Selten and Cantor-Grae, 2005), and psychodynamic theories in which is surmised that psychosis can be explained as an attempt to restore the defective 'self' (Kohut and Wolfe, 1978; Schore, 2009). "
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    • "Experimental evidence in humans reveals that cognitive processes that are typically classified as topdown behavioural phenomena, such as executive control and self-monitoring, require the integration of multiple brain systems, and rely on input from both primary sensory and cortical areas (Kastner , De Weerd, Desimone, & Ungerleider, 1998; Kastner & Ungerleider, 2000). When sensory inputs are unclear, undifferentiated or 'noisy', there is a greater cognitive load involved in the processing of these inputs, which results in impaired functioning due to competition for top-down cognitive resources (Adcock et al., 2009). "
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