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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    • "To date, only a few studies have exclusively targeted WM training (particularly auditory WM) in psychosis. Results have been promising, with WM training being associated with improvements in both verbal WM and general cognitive ability (Fisher et al., 2009; Hubacher et al., 2013; Subramaniam et al., 2014; Wexler et al., 2000; Haut et al., 2010). Whether a targeted approach such as this is more beneficial , either in terms of size or cost effectiveness of effect, however, remains uncertain (Wykes et al., 2011). "
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    ABSTRACT: Background: Cognitive deficits are a core feature of schizophrenia and related psychotic disorders and are associated with decreased levels of functioning. Behavioural interventions have shown success in remediating these deficits; determining how best to maximise this benefit while minimising the cost is an important next step in optimising this intervention for clinical use. Aims: To examine the effects of a novel working-memory focused cognitive remediation (CR) training on cognitive difficulties based on internet delivery of training and weekly telephone support. Method: Participants with a diagnosis of psychosis (n=56) underwent either 8weeks of CR (approximately 20h) or 8weeks of treatment as usual (TAU). General cognitive ability, working memory and episodic memory were measured both pre and post intervention for all participants. Results: In addition to improvements on trained working memory tasks, CR training was associated with significant improvements in two tests of verbal episodic memory. No association between CR and changes in general cognitive ability was observed. Effect sizes for statistically significant changes in memory were comparable to those reported in the literature based primarily on 1:1 training. Conclusions: The cognitive benefits observed in this non-randomised preliminary study indicate that internet-based working memory training can be an effective cognitive remediation therapy. The successes and challenges of an internet-based treatment are discussed.
    Schizophrenia Research 09/2015; DOI:10.1016/j.schres.2015.09.004 · 3.92 Impact Factor
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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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