Neural changes following cognitive remediation therapy for schizophrenia

• Published in: Psychiatry and clinical neurosciences Vol. 73; no. 11; pp. 676 - 684
• Main Authors: Matsuda, Yasuhiro, Makinodan, Manabu, Morimoto, Tsubasa, Kishimoto, Toshifumi
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.11.2019; Wiley Subscription Services, Inc
• Subjects: Anisotropy; Basal ganglia; Cognition Disorders - etiology; Cognition Disorders - psychology; Cognition Disorders - therapy; Cognitive ability; Cognitive Behavioral Therapy - methods; cognitive dysfunction; cognitive remediation; Cognitive Remediation - methods; Cortex (cingulate); Cortex (parietal); Drug therapy; Executive function; Functional plasticity; Humans; Medical imaging; Mental disorders; Motivation; Nervous system; Neural networks; Neural plasticity; Neuroimaging; Neuronal Plasticity; Neurosciences; Occipital lobe; Prefrontal cortex; Schizophrenia; Schizophrenia - complications; Schizophrenia - therapy; Schizophrenic Psychology; Short term memory; Structure-function relationships; Substantia grisea; Temporal cortex; neuronal plasticity; schizophrenia; cognitive dysfunction; cognitive remediation; neuroimaging
• ISSN: 1323-1316; 1440-1819
• DOI: 10.1111/pcn.12912

Patients with schizophrenia experience cognitive impairments that relate to poorer social functioning even after amelioration of positive symptoms. Pharmacological treatment and cognitive remediation are the two important therapeutic approaches for cognitive impairment in schizophrenia. Cognitive remediation therapy (CRT) for schizophrenia improves cognitive functioning and induces neuroplasticity, but different approaches and durations of CRT and different neuroimaging devices have led to varying results in meta‐analyses. The objective of this review was to explore the impact of CRT on neurobiology. Several studies have provided evidence of increased activation in the frontal brain regions, such as the prefrontal cortex, anterior cingulate cortex, and parietal and occipital regions during working memory or executive function tasks after CRT. Two studies have shown alterations in resting‐state connectivity between the prefrontal cortex and temporal regions. Two studies have reported that CRT induces changes in gray matter volume in the hippocampus. Further, one study observed that patients who had received CRT had elevated fractional anisotropy in the basal ganglia. We conclude that neuroimaging studies assessing CRT in patients with schizophrenia showed functional, structural, and connectivity changes that were positively correlated with cognitive improvements despite heterogeneous CRT approaches. Future studies that combine multiple modalities are required to address the differences, effects of intrinsic motivation, and pharmacological augmentation of CRT. Further understanding of the biological basis might lead to predictions of the CRT response in patients with schizophrenia and contribute to identification of schizophrenia patients for future interventions.