Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
J Affect Disord. 2022 May 15;305:196-205. doi: 10.1016/j.jad.2022.03.006. Epub 2022 Mar 10.
Cognitive Remediation (CR) is designed to halt the pathological neural systems that characterize major psychotic disorders (MPD), and its main objective is to improve cognitive functioning. The magnitude of CR-induced cognitive gains greatly varies across patients with MPD, with up to 40% of patients not showing gains in global cognitive performance. This is likely due to the high degree of heterogeneity in neural activation patterns underlying cognitive endophenotypes, and to inter-individual differences in neuroplastic potential, cortical organization and interaction between brain systems in response to learning. Here, we review studies that used neuroimaging to investigate which biomarkers could potentially serve as predictors of treatment response to CR in MPD.
This systematic review followed the PRISMA guidelines. An electronic database search (Embase, Elsevier; Scopus, PsycINFO, APA; PubMed, APA) was conducted in March 2021. peer-reviewed, English-language studies were included if they reported data for adults aged 18+ with MPD, reported findings from randomized controlled trials or single-arm trials of CR; and presented neuroimaging data.
Sixteen studies were included and eight neuroimaging-based biomarkers were identified. Auditory mismatch negativity (3 studies), auditory steady-state response (1), gray matter morphology (3), white matter microstructure (1), and task-based fMRI (7) can predict response to CR. Efference copy corollary/discharge, resting state, and thalamo-cortical connectivity (1) require further research prior to being implemented.
Translational research on neuroimaging-based biomarkers can help elucidate the mechanisms by which CR influences the brain's functional architecture, better characterize psychotic subpopulations, and ultimately deliver CR that is optimized and personalized.
认知矫正（CR）旨在阻止主要精神障碍（MPD）的病理性神经系统，其主要目标是改善认知功能。CR 引起的认知增益在 MPD 患者中差异很大，高达 40%的患者在整体认知表现上没有增益。这可能是由于认知表型的神经激活模式存在高度异质性，以及个体间神经可塑性潜力、皮质组织和大脑系统之间相互作用的差异，导致对学习的反应不同。在这里，我们综述了使用神经影像学研究哪些生物标志物可能作为 MPD 患者对 CR 治疗反应的预测因子的研究。
本系统评价遵循 PRISMA 指南。2021 年 3 月，我们对电子数据库（Embase，Elsevier；Scopus，PsycINFO，APA；PubMed，APA）进行了检索。纳入了同行评议的、英语的研究，如果它们报告了年龄在 18 岁及以上的 MPD 成年人的数据，报告了 CR 的随机对照试验或单臂试验的结果，并提供了神经影像学数据。
纳入了 16 项研究，确定了 8 个基于神经影像学的生物标志物。听觉失匹配负波（3 项研究）、听觉稳态反应（1 项）、灰质形态（3 项）、白质微观结构（1 项）和基于任务的 fMRI（7 项）可以预测对 CR 的反应。传出副本相关/放电、静息状态和丘脑皮质连接（1 项）在实施之前需要进一步研究。
基于神经影像学的生物标志物的转化研究可以帮助阐明 CR 影响大脑功能结构的机制，更好地描述精神分裂症亚群，并最终提供优化和个性化的 CR。
