Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Schizophr Res. 2011 Aug;130(1-3):123-9. doi: 10.1016/j.schres.2011.05.001. Epub 2011 Jun 8.
Cognitive rehabilitation can improve cognition in schizophrenia and prevent disability. It is unknown, however, whether a greater neurobiologic reserve, as measured by cortical volumes, will predict a favorable response to rehabilitation. We investigated this question in early course schizophrenia patients treated with Cognitive Enhancement Therapy (CET).
Outpatients in the early course of schizophrenia or schizoaffective disorder were randomly assigned to CET (n=29) or an Enriched Supportive Therapy control (n=21) and treated for two years. Cortical surface area and gray matter volume data were collected before treatment using structural magnetic resonance imaging. Neurocognition and social cognition were assessed before, and after one and two years of treatment. Moderator analyses examined the impact of pre-treatment cortical surface area and gray matter volume on differential neurocognitive and social-cognitive response to CET.
Pre-treatment, whole brain cortical surface area and gray matter volume significantly moderated the effects of CET on social cognition, but not neurocognition. Greater neurobiologic reserve predicted a rapid social-cognitive response to CET in the first year of treatment; patients with less neurobiologic reserve achieved a comparable social-cognitive response by the second year. While nearly every regional measurement significantly contributed to this accelerated social-cognitive treatment response, effects were the strongest in the temporal cortex.
A broad cortical surface area and gray matter reserve is associated with an accelerated social-cognitive response to CET in early schizophrenia, yet the benefits of cognitive rehabilitation are achieved in those with less initial cognitive resources after a longer duration of treatment.
认知康复可以改善精神分裂症患者的认知功能，并预防残疾。然而，目前尚不清楚皮质体积等神经生物学储备是否可以预测康复的效果。我们在接受认知增强治疗（CET）的早期精神分裂症患者中对此进行了研究。
将早期精神分裂症或分裂情感障碍患者随机分配至 CET 组（n=29）或强化支持治疗对照组（n=21），并接受为期两年的治疗。在治疗前使用结构磁共振成像采集皮质表面积和灰质体积数据。在治疗前、治疗 1 年和 2 年后评估神经认知和社会认知。采用调节分析，检测治疗前皮质表面积和灰质体积对 CET 引起的神经认知和社会认知差异反应的影响。
治疗前，全脑皮质表面积和灰质体积显著调节了 CET 对社会认知的影响，但对神经认知没有影响。更大的神经生物学储备预示着患者对 CET 的社会认知反应更快，这种快速反应在治疗的第一年就出现；而神经生物学储备较低的患者则在第二年达到了类似的社会认知反应。尽管几乎所有区域的测量结果都对这种加速的社会认知治疗反应有显著贡献，但颞叶皮质的影响最强。
广泛的皮质表面积和灰质储备与早期精神分裂症患者对 CET 的快速社会认知反应有关，但在更长的治疗时间后，认知康复的益处在初始认知资源较少的患者中实现。
