An fMRI study of cognitive remediation in drug-naïve subjects diagnosed with first episode schizophrenia

Abstract

Summary Objective The purpose of our functional magnetic resonance imaging (fMRI) study was to examine brain activity using a “1-back” paradigm as working memory task in drug-naïve subjects with first episode schizophrenia before and after cognitive remediation training. Methods In this study 15 drug-naïve first episode subjects who met DSM-IV criteria for schizophrenia were randomized to receive either atypical antipsychotics (AP, n = 8) or atypical antipsychotics in combination with cognitive remediation therapy (AP + CR, n = 7), 11 subjects had a follow-up fMRI examination after therapy (AP, n = 5; AP + CR, n = 6). Results In 4 of the 6 AP + CR subjects the number of activation clusters increased, whereas in 4 out of the 5 AP subjects the number of clusters decreased (mean number of clusters: AP + CR = 5.53, SD 12.79, AP = −5.8, SD 6.9). Conclusion In this randomized study the number of activation clusters during a working memory task increased after cognitive remediation training. Our data show that neurobiological effects of cognitive remediation can be identified in the very early course of schizophrenia.

Functional magnetic resonance imaging in schizophrenia: current evidence, methodological advances, limitations and future directions

“…Cognitive remediation and related psychosocial interventions have also been associated with increases in functional connectivity in frontal cortex 272 and increased frontal activation during task‐based fMRI 273‐275 . Activation in areas other than the frontal cortex have also been observed, including the anterior cingulate and parietal cortex 275,276 . Recent reviews investigating cognitive remediation in individuals with schizophrenia revealed positive associations between cognitive improvements and functional and structural changes in frontal brain regions 277,278 .…”

Dimensionality analysis of the German version of the Screen for Cognitive Impairment in Psychiatry (SCIP-G)

“…Cognitive impairment is a key feature of patients with schizophrenia, involving deficits in attention, information processing, executive function, language and in memory, especially in verbal learning ( Green and Harvey, 2014 ). Cognitive dysfunction can already manifest itself during the initial manifestation of schizophrenia ( Furtner et al, 2021 ); it often persists in the course even after acute symptoms have subsided ( Green et al, 2004 ) and can influence the functional outcome in schizophrenia as well as in affective disorders ( Sachs et al, 2020 ). Despite such findings, screening for cognitive deficits frequently still is insufficient in routine clinical practice.…”