Keshavan Matcheri S, Eack Shaun M, Prasad Konasale M, Haller Chiara S, Cho Raymond Y
Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, USA.
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, USA; School of Social Work, University of Pittsburgh, USA.
Neuroimage. 2017 May 1;151:55-64. doi: 10.1016/j.neuroimage.2016.11.060. Epub 2016 Nov 26.
Schizophrenia is characterized by impaired -social and non social cognition both of which lead to functional deficits. These deficits may benefit from cognitive remediation, but the neural underpinnings of such improvements have not been clearly delineated.
We conducted a functional magnetic resonance (fMRI) study in early course schizophrenia patients randomly assigned to cognitive enhancement therapy (CET) or enriched supportive therapy (EST) and treated for two years. Imaging data over three time points including fMRI blood oxygen level dependent (BOLD) data were acquired during performance of a cognitive control paradigm, the Preparing to Overcome Prepotency (POP) task, and functional connectivity data, were analyzed.
During the two years of treatment, CET patients showed a continual increase in BOLD activity in the right dorsolateral prefrontal cortex (DLPFC), whereas EST patients tended to show no change in prefrontal brain function throughout treatment. Increases in right DLPFC activity were modestly associated with improved neurocognition (β = .14, p = .041), but not social cognition. Functional connectivity analyses showed reduced connectivity between the DLPFC and the anterior cingulate cortex (ACC) in CET compared to EST over the two years of treatment, which was associated with neurocognitive improvement.
These findings suggest that CET leads to enhanced neural activity in brain regions mediating cognitive control and increased efficiency in prefrontal circuits; such changes may be related to the observed therapeutic effects of CET on neurocognitive function.
精神分裂症的特征是社交和非社交认知受损，这两者都会导致功能缺陷。这些缺陷可能受益于认知矫正，但这种改善的神经基础尚未明确界定。
我们对早期精神分裂症患者进行了一项功能磁共振成像（fMRI）研究，这些患者被随机分配到认知增强疗法（CET）或强化支持疗法（EST）组，并接受了两年的治疗。在执行认知控制范式即克服优势反应准备（POP）任务期间，采集了包括fMRI血氧水平依赖（BOLD）数据在内的三个时间点的成像数据，并分析了功能连接数据。
在两年的治疗期间，CET组患者右侧背外侧前额叶皮质（DLPFC）的BOLD活动持续增加，而EST组患者在整个治疗过程中前额叶脑功能倾向于无变化。右侧DLPFC活动的增加与神经认知改善有适度关联（β = 0.14，p = 0.041），但与社交认知无关。功能连接分析显示，在两年的治疗期间，与EST组相比，CET组中DLPFC与前扣带回皮质（ACC）之间的连接减少，这与神经认知改善有关。
这些发现表明，CET可导致介导认知控制的脑区神经活动增强以及前额叶回路效率提高；这种变化可能与观察到的CET对神经认知功能的治疗效果有关。
