Enhancing Executive Function and Neural Health in Bipolar Disorder through Reasoning Training

Abstract

Cognitive deficits in executive function and memory among individuals with bipolar disorder (BD) are well-documented; however, only recently have efforts begun to address whether such cognitive deficits can be ameliorated through cognitive training. This pilot study examined the effects of a top–down, cognitive reasoning training program in adults with BD on both brain and cognitive measures. Twenty-seven participants (11 males, 16 females), aged 21–70 years old, completed the study. Participants completed neurocognitive testing and functional magnetic resonance imaging (fMRI) before and after training, consisting of 8 h (2 h/week) of training in small groups. The training delivered information processing strategies that were implemented and applicable to a variety of daily living contexts. Results indicated that participants showed significant gains in the primary outcome measure of complex abstraction, also referred to as gist reasoning, as well as in untrained domains of executive function and memory. We found a significant increase in resting cerebral blood flow (CBF) in left inferior frontal gyrus after cognitive training. We also found that resting CBF in the right frontal middle gyrus correlated positively with performance on the measure of complex abstraction. This feasibility study provides promising evidence that short-term reasoning training can enhance cognitive performance and brain health in adults with BD. These data motivate further efforts to explore adjuvant therapeutics to improve cognitive performance and underlying brain systems in bipolar, as well as other psychiatric disorders. Clinicaltrials.gov Identifier: NCT02843282, http://www.clinicaltrials.gov/ct2/show/NCT02843282

Cognitive Training and Transcranial Direct Current Stimulation in Mild Cognitive Impairment: A Randomized Pilot Trial

“…Previous work has shown that individuals manifest gains after SMART training has ended, hypothesized to emerge as individuals continue to utilize and habitually apply strategies learned during SMART in their daily life. Similar findings of SMART benefits were found across different studies in both healthy and clinical populations such as traumatic brain injury and bipolar disorders (Chapman et al, 2015; Vas et al, 2016; Venza et al, 2016). Not only does cognitive training strengthen cognitive and neural abilities but emerging evidence suggests that strategy-based cognitive training might be beneficial in mitigating dementia onset.…”

“…For instance, our group has shown that strategic memory and advanced reasoning training (SMART), previously referred to as gist reasoning training, improves top–down cognitive processes and associated training-related neural outcomes Specifically, benefits of SMART gains have been reported as increased executive functions and enhanced neural functions in cognitively normal older adults (Anand et al, 2011; Chapman et al, 2015, 2017; Motes et al, 2018) and in adults with traumatic brain injury (Vas et al, 2011, 2015; Cook et al, 2014; Han et al, 2017). Consistent findings of increased resting cerebral blood flow (rCBF) to specific areas of the brain were associated with cognitive gains following SMART in cognitively normal older adults (Chapman et al, 2016), adults with TBI (Vas et al, 2015), and adults with bipolar disorder (Venza et al, 2016). In our previous study with SMART training in healthy aging, we demonstrated increases in global and regional blood flow in bilateral medial orbital frontal cortex (mOFC), a part of inferior fontal gyrus (IFG), and posterior cingulate cortex (PCC) and associated cognitive gains (Chapman et al, 2015, 2017).…”

“…Secondly, we examined whether a-tDCS + SMART significantly altered rCBF, a measure of neural function previously identified in clinical training trials involving other clinical populations, relative to s-tDCS + SMART. We focused on rCBF to measure neural health based on a series of cognitive training trials where fMRI findings revealed that rCBF was an early and sensitive measures of improved cognitive brain health following interventions (Chapman et al, 2015, 2016, Vas et al, 2016; Venza et al, 2016). We expected that the a-tDCS + SMART would bring about greater changes to rCBF as compared to the s-tDCS + SMART, given the enhanced potential to harness neural plasticity shown by previous tDCS trials (Yun et al, 2016).…”

Higher-order cognitive training effects on processing speed–related neural activity: a randomized trial

“…Senescence-related declines in higher-order cognitive functions have been proposed to result from cascading failures originating in lower-order operations slowing overall processing speed (Jensen, 1992; Salthouse, 1996). The proposed essential role of processing speed in senescence-related change in higher-order cognitive functions (Salthouse, 1996) and previously shown transfer of higher-order cognitive training to supporting lower-order cognitive functions (Baniqued et al, 2015; Basak et al, 2008; Mudar et al, 2016; Motes et al, 2014; Vas et al, 2016, Venza et al, 2016), however, raises the possibility that effective forms of higher-order cognitive training might affect processing speed in the elderly.…”

Use of a randomized clinical trial design to study cognitive rehabilitation approaches to enhance warfighter performance

“…Particularly, SMART focuses on many of the cognitive domains that are key to cognitive readiness. In multiple clinical trials, SMART has shown to improve mental agility, strategic learning, problem solving, focus, and psychological well-being [ [12] , [13] , [14] , [15] , [16] , [17] ]. The SMART protocol has been shown to be superior to cognitive training of the same duration and dose of treatment [ 16 , 18 ].…”