scholarly journals No Effects of Cognitive Remediation on Cerebral White Matter in Individuals at Ultra-High Risk for Psychosis—A Randomized Clinical Trial

2020 ◽  
Vol 11 ◽  
Author(s):  
Tina D. Kristensen ◽  
Bjørn H. Ebdrup ◽  
Carsten Hjorthøj ◽  
René C. W. Mandl ◽  
Jayachandra M. Raghava ◽  
...  
Keyword(s):  
Clinical Trial ◽  
White Matter ◽  
High Risk ◽  
Randomized Clinical Trial ◽  
Cognitive Remediation ◽  
Cerebral White Matter ◽  
Ultra High Risk

scholarly journals T18. EFFECTS OF COGNITIVE REMEDIATION ON WHITE MATTER IN INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS – A RANDOMIZED, CONTROLLED CLINICAL TRIAL

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S237-S238
Author(s):  
Tina Kristensen ◽  
Bjørn H Ebdrup ◽  
Carsten Hjorthøj ◽  
Rene C W Mandl ◽  
Jayachandra Mitta Raghava ◽  
...  
Keyword(s):  
White Matter ◽  
High Risk ◽  
Negative Symptoms ◽  
Cognitive Remediation ◽  
Attrition Rate ◽  
Healthy Controls ◽  
Whole Brain ◽  
Ultra High Risk ◽  
Secondary Outcomes ◽  
Post Hoc

Abstract Background Individuals at ultra-high risk for psychosis (UHR) present with subtle white matter alterations, which have been associated with clinical and functional outcome. The effect of cognitive remediation on white matter (WM) in UHR-individuals has not been investigated. Methods In a randomized, clinical intervention-trial (FOCUS), UHR-individuals aged 18–40 years were assigned to treatment as usual (TAU) or TAU plus cognitive remediation (CR) for 20 weeks. CR comprised 20 x 2-hour sessions of neurocognitive and social-cognitive training (SCIT). Primary outcome was whole brain fractional anisotropy (FA) derived from diffusion weighted imaging. Secondary outcomes pertained to regions of interest analyses. Planned post-hoc analyses explored dose-response effects of CR on WM. Main analyses of treatment effect of CR on primary and secondary outcomes were conducted using linear mixed models, assessing the interaction of timepoint by group (CR and TAU). Analyses were conducted according to the intention-to-treat principle. Results 111 UHR-individuals and 59 healthy controls were included. Attrition-rate was 30% at 6 months post-treatment follow-up. The CR group completed a mean of 12 hours of neurocognitive training. We found no effect of CR on whole-brain or regional FA. Planned post-hoc analyses revealed significant time*group (high- and low-attendance to CR) interactions in left superior corona radiata (p<0.01), left cingulum cingulate gyrus (P=0.03), and right superior longitudinal fasciculus (P<0,01), corrected. Specifically, when compared to UHR-individuals with high attendance (UHR-high >12 hours), those with low attendance (UHR-low <12 hours) had more co-morbid diagnoses, larger recreational smoking (nicotine and cannabis), more depressive and negative symptoms, and had significantly lower global FA at baseline, and showed a significant increase in FA after treatment. Furthermore, UHR-low displayed large effect-size (ES) improvements on depressive and negative symptoms, and moderate to large ES improvements in several cognitive functions (verbal fluency, verbal working memory, and processing speed). In contrast, UHR-high displayed large ES improvements in UHR-symptoms, and moderate ES improvement on social and occupational functioning. Discussion Contradicting our main hypothesis, we found no effect of CR on whole-brain or regional FA after six months. This may be explained by both the low number of neurocognitive training sessions and the attrition rate. The average of 12 hours of neurocognitive training is considerably lower than the recommended dosage of 25–30 hours necessary for cognitive improvements. The continuous need to develop feasible interventions and enhance adherence is stressed. Nevertheless, non-specific treatment may improve WM-integrity in UHR-individuals with lower global baseline FA in those with more severe psychopathology. The UHR-low subgroup exhibited improvements with large ES in levels of depressive and negative symptoms, as well as cognitive functions. We speculate, whether our results reflect that UHR-individuals with higher baseline FA (approaching the healthy controls), present with a preserved structural capacity for increased demands and new learning, while UHR-individuals characterized by lower FA at baseline may be more amendable to neuroplastic treatment-effects. The results support the value of subgrouping in a clinically heterogenous UHR-population, which also applies to examining WM integrity.

scholarly journals T46. THE EFFECT OF COMPREHENSIVE COGNITIVE REMEDIATION IN INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS: A SINGLE-BLIND, RANDOMISED, CLINICAL TRIAL (FOCUS)

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S249-S249
Author(s):  
Louise Birkedal Glenthoej ◽  
Mariegaard Lise ◽  
Birgitte Fagerlund ◽  
Jens Richardt Jepsen ◽  
Tina Dam Kristensen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Social Cognitive ◽  
Intervention Group ◽  
Cognitive Remediation ◽  
Randomised Clinical Trial ◽  
Treatment As Usual ◽  
Ultra High Risk ◽  
Social Cognitive Remediation

Abstract Background Individuals at ultra-high risk (UHR) for psychosis display significant cognitive deficits that constitute a barrier to functional recovery. Applying cognitive remediation (CR) before the onset of manifest psychosis may improve cognition and the clinical and functional prognosis of UHR individuals. Methods This randomised, clinical trial randomly assigned 146 UHR individuals aged 18–40 years to treatment as usual (TAU) or TAU plus cognitive remediation. The cognitive remediation consisted of 20-weeks of neurocognitive and social cognitive remediation. Assessments were carried out at 6- and 12-months post baseline. Primary outcome was composite score on the Brief Assessment of Cognition in Schizophrenia (BACS) battery at 6-months. Results Between April 2014 and January 2017, 73 UHR individuals were assigned to TAU and 73 were assigned to TAU + cognitive remediation. Compared to the control group, cognitive remediation did not result in significant improvement on the BACS composite score at 6-month follow-up (b=-0.125, 95%CI: -0.23 to 0.172, p=0.41). Nor did the intervention improve secondary outcomes in clinical symptoms or functioning. Exploratory analyses found emotion recognition latencies to be significantly more reduced in the intervention group than the TAU group at 6-months follow-up. At 12-month follow-up the intervention group exhibited significantly better performance on two exploratory outcomes of executive function and visual memory. The participants in the intervention group attended an average of 12 sessions out of 20. No adverse events were reported relating to the intervention. Discussion While the brief course of treatment did not impact global cognition, symptoms and functioning measures, treatment related benefit was found in exploratory component neuro- and social cognitive measures. Future studies should evaluate whether more personalized interventions such as the separate application of neurocognitive and social cognitive remediation may produce beneficial effect on cognition and functioning compared to treatment as usual, along with establishing the optimal number of training hours to produce cognitive and functional gains.

scholarly journals Cognitive functioning in ultra-high risk for psychosis individuals with and without depression: Secondary analysis of findings from the NEURAPRO randomized clinical trial

2020 ◽  
Vol 218 ◽  
pp. 48-54
Author(s):  
Sumudu Rasangi Mallawaarachchi ◽  
G. Paul Amminger ◽  
John Farhall ◽  
Luke K. Bolt ◽  
Barnaby Nelson ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Cognitive Functioning ◽  
Randomized Clinical Trial ◽  
Secondary Analysis ◽  
Ultra High Risk
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