Neuroplasticity-Based Cognitive Training in Schizophrenia: An Interim Report on the Effects 6 Months Later

Department of Psychiatry, University of California, San Francisco and San Francisco VA Medical Center, CA 94121, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 04/2009; 36(4):869-79. DOI: 10.1093/schbul/sbn170
Source: PubMed


New cognitive treatments for schizophrenia are needed that drive persistent gains in cognition and functioning. Using an innovative neuroplasticity-based cognitive training approach, we report our interim findings on the effects on cognition and functional outcome at 6 months after treatment.
Thirty-two clinically stable schizophrenia subjects were randomly assigned to either targeted cognitive training (TCT, N = 22) or a computer games (CGs) control condition (N = 10). Twelve TCT subjects completed 50 hours of auditory based training; 10 TCT subjects completed an additional 50 hours of training targeting visual and cognitive control processes. Subjects were assessed on neurocognition and functional outcome after training and at 6-month follow-up.
Both TCT subject groups showed significant durable gains at 6 months on measures of verbal learning/memory and cognitive control. Only TCT subjects who completed 100 hours of training showed durable gains on processing speed and global cognition, with nonsignificant improvement in functional outcome. Improved cognition was significantly associated with improved functional outcome at 6 months for TCT subjects.
A total of 50 hours of neuroplasticity-based computerized cognitive training appears sufficient to drive improvements in verbal learning/memory and cognitive control that endure 6 months beyond the intervention, but a higher "dose" and more "broad-spectrum" training may be necessary to drive enduring gains in processing speed and global cognition. Training-induced cognitive improvement is related to enhanced functioning at 6 months. These data suggest that (1) higher and "broader" doses of cognitive training may confer the most benefits for schizophrenia patients; (2) the posttraining period opens a critical window for aggressive adjunctive psychosocial rehabilitation.

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Available from: Karuna Subramaniam
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    • "In health and sickness, humans are preoccupied with their cognitive abilities and programs have been developed to train these abilities (Berry et al., 2010; Fisher et al., 2010; Kesler et al., 2013; Klingberg et al., 2005). However, many training programs are impracticable since participants need to visit the laboratory or have to sit behind a personal computer. "
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    ABSTRACT: Emerging evidence of the validity of collecting data in natural settings using smartphone applications has opened new possibilities for psychological assessment, treatment, and research. In this study we explored the feasibility and effectiveness of using a mobile application for self-supervised training of auditory attention. In addition, we investigated the neural underpinnings of the training procedure with functional magnetic resonance imaging (fMRI), as well as possible transfer effects to untrained cognitive interference tasks. Subjects in the training group performed the training task on an iPod touch two times a day (morning/evening) for three weeks; subjects in the control group received no training, but were tested at the same time interval as the training group. Behavioral responses were measured before and after the training period in both groups, together with measures of task-related neural activations by fMRI. The results showed an expected performance increase after training that corresponded to activation decreases in brain regions associated with selective auditory processing (left posterior temporal gyrus) and executive functions (right inferior frontal gyrus), indicating more efficient processing in task-related neural networks after training. Our study suggests that cognitive training delivered via mobile applications is feasible and improves the ability to focus attention with corresponding effects on neural plasticity. Future research should focus on the clinical benefits of mobile-based cognitive training. Limitations of the study are discussed including reduced experimental control and lack of transfer effects.
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    • "Through collaboration with university-based scientists, different combinations of these forms of brain plasticity-based training have been applied in a large population of chronic schizophrenia and first-episode patients (e.g., Adcock et al., 2009; Fisher et al., 2009a,b; Dale et al., 2010; Popov et al., 2011; Subramaniam et al., 2012; Keefe et al., 2012; Sacks et al., 2013; see reviews by Biagianti and Vinogradov, 2013 and Fisher et al., 2013). 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). "
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    ABSTRACT: The primary objective of this review article is to summarize how the neuroscience of brain plasticity, exploiting new findings in fundamental, integrative and cognitive neuroscience, is changing the therapeutic landscape for professional communities addressing brain-based disorders and disease. After considering the neurological bases of training-driven neuroplasticity, we shall describe how this neuroscience-guided perspective distinguishes this new approach from (a) the more-behavioral, traditional clinical strategies of professional therapy practitioners, and (b) an even more widely applied pharmaceutical treatment model for neurological and psychiatric treatment domains. With that background, we shall argue that neuroplasticity-based treatments will be an important part of future best-treatment practices in neurological and psychiatric medicine.
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    • "Drill and practice studies most commonly used computerized tasks, done individually. However, there was more variety in the methods of training, for example, at least five studies used pencil-and-paper procedures [60,67,69,73,75]; though Lopez-Luengo utilized both pen-and-paper and audio] while five others used a combination of audio and visual tasks [62,63,77,78,83] to reduce the deficits. Furthermore, most studies using drill and practice methodologies (all except [61,69]) reported between-group improvements in cognition between the experimental and control groups, at least for some measures. "
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    ABSTRACT: Background The purpose of this article was to conduct a review of the types of training offered to people with schizophrenia in order to help them develop strategies to cope with or compensate for neurocognitive or sociocognitive deficits. Methods We conducted a search of the literature using keywords such as “schizophrenia”, “training”, and “cognition” with the most popular databases of peer-reviewed journals. Results We reviewed 99 controlled studies in total (though nine did not have a control condition). We found that drill and practice training is used more often to retrain neurocognitive deficits while drill and strategy training is used more frequently in the context of sociocognitive remediation. Conclusions Hypotheses are suggested to better understand those results and future research is recommended to compare drill and strategy with drill and practice training for both social and neurocognitive deficits in schizophrenia.
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