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

Translational Research in Cognitive and Affective Mechanisms laboratory, Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology (Impact Factor: 7.05). 08/2010; 35(9):1850-9. DOI: 10.1038/npp.2010.52
Source: PubMed


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 broad-based cognitive training programs may avoid automaticity and increase prefrontal cortex (PFC) activity. This study used quasi-randomized, 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.

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Available from: Kristen Haut, Jan 21, 2015
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    • "Cingulate activation, especially of the anterior regions, is often abnormal in schizophrenia, where one meta-analysis concluded that patients had lower activity in the right anterior cingulate, and higher activity in the left anterior cingulate (9). This was partly replicated in the reviewed studies, where Haut et al. (57) reported increased right activity and Bor et al. (58) reported an increase in left cingulate activity. The anterior cingulate cortex is associated with performance monitoring and prefrontal task engagement (9). "
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    ABSTRACT: Cognitive impairment is an important aspect of schizophrenia, where cognitive remediation therapy (CRT) is a promising treatment for improving cognitive functioning. While neurobiological dysfunction in schizophrenia has been the target of much research, the neural substrate of cognitive remediation and recovery has not been thoroughly examined. The aim of the present article is to systematically review the evidence for neural changes after CRT for schizophrenia. The reviewed studies indicate that CRT affects several brain regions and circuits, including prefrontal, parietal, and limbic areas, both in terms of activity and structure. Changes in prefrontal areas are the most reported finding, fitting to previous evidence of dysfunction in this region. Two limitations of the current research are the few studies and the lack of knowledge on the mechanisms underlying neural and cognitive changes after treatment. Despite these limitations, the current evidence suggests that CRT is associated with both neurobiological and cognitive improvement. The evidence from these findings may shed light on both the neural substrate of cognitive impairment in schizophrenia, and how better treatment can be developed and applied.
    Frontiers in Psychiatry 08/2014; 5:103. DOI:10.3389/fpsyt.2014.00103
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    • "VWM also plays a critical role in preserving and processing information, and its capacity has been suggested to be a sensitive predictor of cognitive ability [4]. For example, researchers have implicated that VWM capacity can distinguish healthy or memory-impaired individuals suffering from attention-deficit hyperactivity disorder (ADHD) [5], schizophrenia [6], stroke [7], Alzheimer's Disease [8]-[11], or age-related diseases associated with memory deficits [12] [13]. Recent evidence demonstrates that brain training can enhance an individual's VWM capacity and attention over time [12] by increasing activity in the prefrontal cortex, the parietal cortex, and the basal ganglia [14] [15]. "
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    ABSTRACT: Recent evidence demonstrates that with training, one can enhance visual working memory (VWM) capacity and attention over time in the near transfer tasks. Not only do these studies reveal the characteristics of VWM load and the influences of training, they may also provide insights into developing effective rehabilitation for patients with VWM deficiencies. Howev-er, few studies have investigated VWM over extended periods of time and evaluated transfer benefits on non-trained tasks. Here, we combined behavioral and electroencephalographical approaches to investigate VWM load, training gains, and transfer benefits. Our results reveal that VWM capacity is directly correlated to the difference of event-related potential wave-forms. In particular, the "magic number 4" can be observed through the contralateral delay amplitude and the average capacity is 3.25-item over 15 participants. Furthermore, our findings indicate that VWM capacity can be improved through training; and after training exercises, participants from the training group are able to dramatically improve their per-formance. Likewise, the training effects on non-trained tasks can also be observed at the 12th week after training. Therefore, we conclude that participants can benefit from training gains, and augmented VWM capacity sustained over long periods of time on specific variety of tasks.
    Journal of Behavioral and Brain Science 05/2014; 4(5):234-246. DOI:10.4236/jbbs.2014.45025
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    • "Cognitive remediation has been indicated to improve neuropsychological functioning (Krabbendam and Aleman, 2003; Twamley et al., 2003; McGurk et al., 2007; Wykes et al., 2011; Ikezawa et al., 2012), although not all (Ueland and Rund, 2004; Dickinson et al., 2010). However, little research has been conducted on the effects of cognitive rehabilitation on brain function (Wykes et al., 2002; Haut et al., 2010; Bor et al., 2011; Subramaniam et al., 2012). "
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    ABSTRACT: The regional neuronal changes taking place between before and after cognitive rehabilitation are still not characterized in schizophrenia patients. In addition, it is not known whether these regional changes are predictive or correlated with treatment response. We conducted a preliminary quasi-experimental study to investigate the effects of a Neuropsychological Educational Approach to Cognitive Remediation (NEAR), one of the cognitive remediation therapies, on neurocognitive functioning assessed by the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J), and on prefrontal and temporal hemodynamic responses during working memory (WM) task (2-back, letter version) using 52-channel near-infrared spectroscopy (NIRS). We assessed 19 patients with schizophrenia or schizoaffective disorder twice with an interval of 6 months. Moreover, taking into consideration the possible practice effect, we assessed 12 control patients twice with an interval of 6 months. The NEAR group, in comparison with the control group, showed significant improvement in two subcomponents of BACS-J, that is, motor speed and executive function along with the composite scores. The NEAR group also showed a significant increase in brain activation in the bilateral cortical regions associated with WM, and in comparison with the control group the between-group differences were restricted to the right frontopolar area. In addition, the amount of enhancement in some cognitive subcomponents was positively correlated with the magnitude of an increase in hemodynamic response during WM task predominantly in the right hemispheres. These findings suggest that neurocognitive deficits in schizophrenia and their neural dysfunction may be improved by NEAR, and NIRS may be a useful tool to assess the changes of the neural activity underlying the improvement of neurocognitive functioning elicited by neurocognitive rehabilitation.
    Schizophrenia Research 03/2014; 153(1-3). DOI:10.1016/j.schres.2014.01.031 · 3.92 Impact Factor
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