Sampedro Agurne, Ibarretxe-Bilbao Naroa, Peña Javier, Cabrera-Zubizarreta Alberto, Sánchez Pedro, Gómez-Gastiasoro Ainara, Iriarte-Yoller Nagore, Pavón Cristóbal, Tous-Espelosin Mikel, Ojeda Natalia
University of Deusto, Faculty of Health Sciences, Department of Psychology, Bilbao, Spain.
University of Deusto, Faculty of Health Sciences, Department of Psychology, Bilbao, Spain.
Schizophr Res. 2023 May;255:82-92. doi: 10.1016/j.schres.2023.03.021. Epub 2023 Mar 24.
Cognitive remediation has been shown to improve cognition in schizophrenia, but little is known about the specific functional and structural brain changes related to the implementation of an integrative cognitive remediation program. This study analyzed the functional and structural brain changes identified after implementing an integrative cognitive remediation program, REHACOP, in schizophrenia. The program combined cognitive remediation, social cognitive training, and functional and social skills training. The sample included 59 patients that were assigned to either the REHACOP group or an active control group for 20 weeks. In addition to a clinical and neuropsychological assessment, T1-weighted, diffusion-weighted and functional magnetic resonance images were acquired during a resting-state and during a memory paradigm, both at baseline and follow-up. Voxel-based morphometry, tract-based spatial statistics, resting-state functional connectivity, and brain activation analyses during the memory paradigm were performed. Brain changes were assessed with a 2 × 2 repeated-measure analysis of covariance for group x time interaction. Intragroup paired t-tests were also carried out. Repeated-measure analyses revealed improvements in cognition and functional outcome, but no significant brain changes associated with the integrative cognitive remediation program. Intragroup analyses showed greater gray matter volume and cortical thickness in right temporal regions at post-treatment in the REHACOP group. The absence of significant brain-level results associated with cognitive remediation may be partly due to the small sample size, which limited the statistical power of the study. Therefore, further research is needed to clarify whether the temporal lobe may be a key area involved in cognitive improvements following cognitive remediation.
认知康复已被证明可改善精神分裂症患者的认知能力，但对于与综合认知康复计划实施相关的特定大脑功能和结构变化却知之甚少。本研究分析了在精神分裂症患者中实施综合认知康复计划REHACOP后所发现的大脑功能和结构变化。该计划结合了认知康复、社会认知训练以及功能和社交技能训练。样本包括59名患者，他们被分配到REHACOP组或积极对照组，为期20周。除了进行临床和神经心理学评估外，在基线和随访时，还在静息状态和记忆范式期间采集了T1加权、扩散加权和功能磁共振图像。进行了基于体素的形态计量学、基于纤维束的空间统计学、静息态功能连接以及记忆范式期间的大脑激活分析。通过对组×时间交互作用进行2×2重复测量协方差分析来评估大脑变化。还进行了组内配对t检验。重复测量分析显示认知和功能结局有所改善，但与综合认知康复计划相关的大脑变化并不显著。组内分析显示，REHACOP组在治疗后右侧颞叶区域的灰质体积和皮质厚度更大。与认知康复相关的大脑水平结果不显著，部分原因可能是样本量较小，这限制了研究的统计效力。因此，需要进一步研究以阐明颞叶是否可能是认知康复后认知改善所涉及的关键区域。
