Ramsay Ian S, MacDonald Angus W
Department of Psychology, University of Minnesota, Minneapolis, MN;
Department of Psychology, University of Minnesota, Minneapolis, MN; Department of Psychiatry, University of Minnesota, Minneapolis, MN
Schizophr Bull. 2015 Nov;41(6):1276-84. doi: 10.1093/schbul/sbv025. Epub 2015 Mar 23.
Cognitive remediation training (CRT) for schizophrenia has been found to improve cognitive functioning and influence neural plasticity. However, with various training approaches and mixed findings, the mechanisms driving generalization of cognitive skills from CRT are unclear. In this meta-analysis of extant imaging studies examining CRT's effects, we sought to clarify whether varying approaches to CRT suggest common neural changes and whether such mechanisms are restorative or compensatory. We conducted a literature search to identify studies appropriate for inclusion in an activation likelihood estimation (ALE) meta-analysis. Our criteria required studies to consist of training-based interventions designed to improve patients' cognitive or social functioning, including generalization to untrained circumstances. Studies were also required to examine changes in pre- vs posttraining functional activation using functional magnetic resonance imaging or positron emission tomography. The literature search identified 162 articles, 9 of which were appropriate for inclusion. ALE analyses comparing pre- and posttraining brain activation showed increased activity in the lateral and medial prefrontal cortex (PFC), parietal cortex, insula, and the caudate and thalamus. Notably, activation associated with CRT in the left PFC and thalamus partially overlapped with previous meta-analytically identified areas associated with deficits in working memory, executive control, and facial emotion processing in schizophrenia. We conclude that CRT interventions from varying theoretic modalities elicit plasticity in areas that support cognitive and socioemotional processes in this early set of studies. While preliminary, these changes appear to be both restorative and compensatory, though thalamocortical areas previously associated with dysfunction may be common sources of plasticity for cognitive remediation in schizophrenia.
已发现针对精神分裂症的认知康复训练（CRT）可改善认知功能并影响神经可塑性。然而，由于训练方法多样且研究结果不一，CRT认知技能泛化的驱动机制尚不清楚。在这项对现有影像学研究进行的荟萃分析中，我们旨在阐明不同的CRT方法是否表明存在共同的神经变化，以及这些机制是恢复性的还是代偿性的。我们进行了文献检索，以确定适合纳入激活可能性估计（ALE）荟萃分析的研究。我们的标准要求研究包括旨在改善患者认知或社会功能的基于训练的干预措施，包括向未训练情境的泛化。研究还需要使用功能磁共振成像或正电子发射断层扫描检查训练前与训练后功能激活的变化。文献检索共识别出162篇文章，其中9篇适合纳入。ALE分析比较训练前和训练后脑激活情况，结果显示外侧和内侧前额叶皮质（PFC）、顶叶皮质、岛叶以及尾状核和丘脑的活动增加。值得注意的是，左PFC和丘脑中与CRT相关的激活部分与先前荟萃分析确定的与精神分裂症工作记忆、执行控制和面部情绪处理缺陷相关的区域重叠。我们得出结论，在这组早期研究中，来自不同理论模式的CRT干预在支持认知和社会情感过程的区域引发了可塑性。虽然这些变化是初步的，但它们似乎既是恢复性的也是代偿性的，尽管先前与功能障碍相关的丘脑皮质区域可能是精神分裂症认知康复可塑性的常见来源。
