Department of Neurosciences, Section of Psychiatry, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Department of Neurosciences and Mental Health, IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
Epidemiol Psychiatr Sci. 2019 Sep 26;29:e57. doi: 10.1017/S2045796019000532.
Impairments in neuro and social cognition are considered core features of schizophrenia (SCZ) since they affect patients' functioning and contribute to poor socio-occupational outcomes. Therefore, the improvement of cognitive performances has become a primary goal in the care of patients with SCZ, especially in the first phases of the disease, as early interventions may favour better long-term outcomes. Cognitive remediation (CR) is a behavioural training aimed at improving cognitive functions with the goal of durability and generalisation in everyday life. Neuroimaging studies suggest that CR leads to neuroplasticity in chronic SCZ, whereas only a few studies tested the neural effects of CR in the early phase of the disease. Thus, in this review, we aimed at summarising CR-induced structural and functional brain changes in early SCZ. Existing evidence showed a protective effect of CR on grey matter volume in selected medial-temporal (i.e. hippocampus, parahippocampus and amygdala) and thalamic regions whereas functional changes affected mostly dorsolateral prefrontal and insular cortices both associated with improvements in cognitive performance and emotion regulation. Overall, CR in early SCZ appears to be associated with neural adaptations mostly allocated in prefrontal and limbic regions, however future longitudinal studies are needed to clarify whether the positive effects of cognitive training persist over time. It may also be interesting to investigate whether the application of CR in the early v. the late stage of the disease may lead to incremental benefits.
神经认知和社会认知损伤被认为是精神分裂症（SCZ）的核心特征，因为它们影响患者的功能，并导致较差的社会职业结果。因此，改善认知表现已成为 SCZ 患者护理的主要目标，尤其是在疾病的早期阶段，因为早期干预可能有利于更好的长期结果。认知矫正（CR）是一种旨在改善认知功能的行为训练，目标是在日常生活中具有持久性和普遍性。神经影像学研究表明，CR 可导致慢性 SCZ 中的神经可塑性，而只有少数研究测试了 CR 在疾病早期阶段的神经效应。因此，在这篇综述中，我们旨在总结 CR 诱导的早期 SCZ 中的结构和功能脑变化。现有证据表明，CR 对选定的内侧颞叶（即海马体、海马旁回和杏仁核）和丘脑区域的灰质体积具有保护作用，而功能变化主要影响背外侧前额叶和岛叶皮质，这两者都与认知表现和情绪调节的改善有关。总体而言，早期 SCZ 中的 CR 似乎与主要分配在前额叶和边缘区域的神经适应有关，但是需要进行未来的纵向研究来阐明认知训练的积极效果是否随时间持续存在。研究 CR 在疾病早期阶段和晚期阶段的应用是否会带来额外的益处可能也很有趣。
