Optimizing Cognitive Remediation Outcomes in Schizophrenia

优化精神分裂症的认知矫正结果

基本信息

批准号：
8246427
负责人：
Sophia Vinogradov
金额：
$ 57.99万
依托单位：
NORTHERN CALIFORNIA INSTITUTE/RES/EDU
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-01 至 2014-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8246427
关键词：
Affect Amygdaloid structure Attention Auditory Behavioral Brain Clinical Cognition Cognitive Cognitive remediation Computers Corpus striatum structure Cross-Sectional Studies Emotional Emotions Empathy Exercise Face Functional Magnetic Resonance Imaging Fusiform gyrus Goals Hour Individual Intelligence Intervention Label Laboratories Lateral Measures Memory Methods Motivation Neurocognition Neuronal Plasticity Neurosciences Occupational Outcome Patients Pattern Performance Pilot Projects Prefrontal Cortex Problem Solving Process Public Health Quality of life Randomized Controlled Trials Research Rewards Schizophrenia Sensory Process Short-Term Memory Social Perception Structure Task Performances Testing Training Training Programs Ventral Striatum Verbal Learning Visual base brain behavior cognitive control cognitive training computerized design executive function functional outcomes functional restoration improved neural patterning programs public health relevance relating to nervous system response reward processing social social cognition somatosensory strength training treatment response visual process visual processing

项目摘要

DESCRIPTION (provided by applicant): The purpose of this study is to explicitly and aggressively drive an optimal response to neuroplasticity- based cognitive remediation in schizophrenia in order to maximize treatment response. We will investigate factors that have generally been ignored in computer-based cognitive remediation programs-those related to social cognition-- and will delineate their relationship to motivation, functional outcome, and the neural substrates of reward anticipation and emotion processing. Current research indicates that, unless we fully understand and harness these factors, we will not achieve meaningful treatment gains for individuals with schizophrenia. Our specific aims are: 1. To perform an RCT in which 100 schizophrenia subjects are assigned to either 60 hours of neuroplasticity- based computerized targeted cognitive training (TCT) that focuses exclusively on "cold cognition" (a program which trains early sensory processing, attention, working memory and cognitive control in auditory and visual domains), or to 60 hours of training that combines the TCT program with 20 minutes per day of adaptive computerized social cognition training (SCT) exercises. 2. To compare the outcomes of these two groups of subjects on measures of neurocognition, social cognition, motivation, and functional outcome. 3. To assess subjects six months after the intervention to determine the durability of training effects. 4. To identify changes in brain activation patterns in key neural regions as a result of TCT alone vs. TCT+SCT: during reward anticipation, and during emotion recognition. The timeliness of this approach is supported by recent evidence demonstrating only weak associations between traditional cognitive remediation approaches and functional outcome in schizophrenia, but a strong, direct relationship between social cognition and functional outcome. Thus we must now examine the clinical, functional, and neural effects of a well-designed state-of-the-art cognitive training program that combines neurocognition with social cognition training. Public Health Relevance Statement (Narrative) This research is relevant to public health in that it will: 1) determine whether the addition of social cognition training exercises to neuroplasticity-based cognitive training of auditory and visual processing improves outcome for people with schizophrenia; 2) help to identify neuroplasticity-based cognitive remediation strategies for schizophrenia that provide the maximal benefit in terms of helping patients to achieve meaningful improvements in motivation and social and occupational functioning.

描述（由申请人提供）：本研究的目的是明确并积极地推动精神分裂症患者对基于神经可塑性的认知治疗的最佳反应，以最大限度地提高治疗反应。我们将研究在基于计算机的认知补救计划中通常被忽视的因素（与社会认知相关的因素），并将描述它们与动机、功能结果以及奖励预期和情绪处理的神经基础的关系。目前的研究表明，除非我们充分理解和利用这些因素，否则我们将无法为精神分裂症患者取得有意义的治疗成果。我们的具体目标是： 1. 进行一项随机对照试验，其中 100 名精神分裂症受试者被分配接受 60 小时的基于神经可塑性的计算机化有针对性的认知训练 (TCT)，该训练专门关注“冷认知”（一种训练早期感觉处理、注意力、工作记忆以及听觉和视觉领域的认知控制），或 60 小时的培训，将 TCT 计划与每天 20 分钟的适应性计算机化社会认知培训相结合（SCT）练习。 2. 比较这两组受试者在神经认知、社会认知、动机和功能结果方面的结果。 3. 干预后六个月评估受试者以确定训练效果的持久性。 4. 确定单独 TCT 与 TCT+SCT 导致关键神经区域大脑激活模式的变化：奖励预期期间和情绪识别期间。这种方法的及时性得到了最近证据的支持，这些证据表明传统的认知补救方法和精神分裂症的功能结果之间的关联性很弱，但社会认知和功能结果之间却存在很强的直接关系。因此，我们现在必须检查精心设计的最先进的认知训练计划的临床、功能和神经效应，该计划将神经认知与社会认知训练相结合。公共卫生相关性声明（叙述性）这项研究与公共卫生相关，因为它将： 1) 确定在基于神经可塑性的听觉和视觉处理认知训练中添加社会认知训练练习是否可以改善精神分裂症患者的治疗结果； 2）帮助确定针对精神分裂症的基于神经可塑性的认知补救策略，该策略在帮助患者在动机以及社交和职业功能方面实现有意义的改善方面提供最大的益处。