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13-07-2010 | Mental health | Article

Cognitive therapy preserves gray matter in early schizophrenia

Abstract

Free abstract

MedWire News: Cognitive enhancement therapy (CET) protects against gray matter loss in schizophrenia and may even support gray matter growth in medial temporal areas of the brain, study results demonstrate.

The findings provide biological support for the previously demonstrated benefits of similar cognitive interventions.

"Given the growing appreciation of the central importance of cognitive impairments and their underlying neurobiologic mechanisms in schizophrenia, there is great interest in developing novel therapeutics that preserve or restore cognitive and brain function in the disorder," say Matcheri Keshavan (University of Pittsburgh, Pennsylvania, USA) and colleagues.

Schizophrenia is characterized by marked impairments in cognition that place profound limitations on functional recovery. Meanwhile, progressive loss of gray matter, frontal hypofunction, and decreased white matter integrity have been consistently observed in patients with schizophrenia.

In the current study, the researchers recruited 53 symptomatically stable but cognitively disabled outpatients in the early course of schizophrenia or schizoaffective disorder. Twenty-seven patients received standard supportive therapy, while 31 received CET - an integrated approach using computer-assisted neurocognitive training and group-based social-cognitive exercises.

Patients were assessed at baseline, and again at 1 and 2 years of follow-up, with cognitive assessments and structural magnetic resonance imaging.

Keshavan and colleagues report that compared with those who received supportive therapy, patients who received CET demonstrated a significantly lower rate of decline of gray matter volume over 2 years in the left hippocampus, parahippocampal gyrus, and fusiform gyrus, and gray matter increases in the left amygdale.

Gray matter preservation in the left parahippocampal and fusiform gyrus, and gray matter increases in the left amygdala were significantly related to improved cognition and mediated the beneficial cognitive effects of CET.

Keshavan et al say further studies are needed to examine the durability of these effects on the brain, as recent studies have shown that cognitive rehabilitation can continue to confer benefits to patients with schizophrenia even after completion of treatment.

In addition, studies of other neuronal mechanisms underlying cognitive remediation should be investigated, including dopaminergic function, brain derived neurotrophic factor, and genomic underpinnings.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Andrew Czyzewski

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