Jahshan Carol, Rassovsky Yuri, Green Michael F
VISN-22 Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Front Psychiatry. 2017 Sep 27;8:191. doi: 10.3389/fpsyt.2017.00191. eCollection 2017.
There is a burgeoning need for innovative treatment strategies to improve the cognitive deficits in schizophrenia. Cognitive remediation (CR) is effective at the group level, but the variability in treatment response is large. Given that CR may depend on intact neuroplasticity to produce cognitive gains, it is reasonable to combine it with strategies that harness patients' neuroplastic potential. In this review, we discuss two non-pharmacological approaches that can enhance neuroplasticity and possibly augment the effects of CR in schizophrenia: physical exercise and transcranial direct current stimulation (tDCS). Substantial body of evidence supports the beneficial effect of physical exercise on cognition, and a handful of studies in schizophrenia have shown that physical exercise in conjunction with CR has a larger impact on cognition than CR alone. Physical exercise is thought to stimulate neuroplasticity through the regulation of central growth factors, and current evidence points to brain-derived neurotrophic factor as the potential underlying mechanism through which physical exercise might enhance the effectiveness of CR. tDCS has emerged as a potential tool for cognitive enhancement and seems to affect the cellular mechanisms involved in long-term potentiation (LTP). A few reports have demonstrated the feasibility of integrating tDCS with CR in schizophrenia, but there are insufficient data to determine if this multimodal approach leads to incremental performance gain in patients. Larger randomized controlled trials are necessary to understand the mechanisms of the combined tDCS-CR intervention. Future research should take advantage of new developments in neuroplasticity paradigms to examine the effects of these interventions on LTP.
对于创新治疗策略以改善精神分裂症认知缺陷的需求正迅速增长。认知康复（CR）在群体水平上是有效的，但治疗反应的变异性很大。鉴于CR可能依赖于完整的神经可塑性来产生认知改善，将其与利用患者神经可塑性潜力的策略相结合是合理的。在本综述中，我们讨论两种可以增强神经可塑性并可能增强CR对精神分裂症疗效的非药物方法：体育锻炼和经颅直流电刺激（tDCS）。大量证据支持体育锻炼对认知的有益作用，并且在精神分裂症方面的一些研究表明，体育锻炼与CR相结合对认知的影响比单独的CR更大。体育锻炼被认为通过调节中枢生长因子来刺激神经可塑性，目前的证据表明脑源性神经营养因子是体育锻炼可能增强CR有效性的潜在潜在机制。tDCS已成为一种潜在的认知增强工具，似乎会影响与长时程增强（LTP）相关的细胞机制。一些报告已经证明了在精神分裂症中将tDCS与CR相结合的可行性，但没有足够的数据来确定这种多模式方法是否会使患者的表现得到逐步提高。需要更大规模的随机对照试验来了解联合tDCS-CR干预的机制。未来的研究应该利用神经可塑性范式的新进展来研究这些干预对LTP的影响。
