From The Quarterly, Fall 2012

Schizophrenia-associated deficits in cognition are not substantially improved by medication, but have been shown to improve with remedial cognitive training. The mechanisms that support this improvement have been largely unknown. Social cognition skills, such as being able to recognize what emotions faces are expressing, are severely impaired in people with schizophrenia and significantly affect their ability to interact appropriately with others in daily life.



Until recently, most cognitive remediation studies have concentrated on basic cognitive skills, such as attention and memory, in which schizophrenia patients showed significant improvements but they did not show improvement in social cognition. Neuroplasticity-based rehabilitation models suggest that in order for cognitive remediation to produce long-lasting functional benefits, behavioral training needs to restore the neural mechanisms that support the cognitive skill.



Recent research led by 2005 NARSAD Young Investigator Grantee, Christine I. Hooker, Ph.D., now an Associate Professor in Psychology at Harvard, sought to identify whether a cognitive remediation intervention that targeted both cognitive and social cognitive skills would induce beneficial neural changes in regions that specifically support social cognition.



Reporting her findings in the journal Schizophrenia Research (online June 2012), Dr. Hooker explains: “Cognitive remediation holds tremendous promise as a functionally beneficial treatment for schizophrenia. To maximize these benefits, it is imperative to understand how cognitive training contributes to behavioral improvement.”



Her multi-institutional study included 22 patients with schizophrenia who were randomly selected to receive either remedial intervention or placebo treatment in the form of nonspecific computer games. The study was a collaborative effort between the University of California, Berkeley, where Dr. Hooker was doing her research and the University of California, San Francisco (UCSF). NARSAD Independent Investigator Grantee Sophia Vinogradov, M.D., Vice Chair of the Department of Psychiatry at UCSF was also part of the research team.



Pre- and post-intervention assessments included a functional MRI task of positive and negative facial emotion recognition as well as standard behavioral assessments. The project focused largely on facial emotion recognition because the neural regions that process facial emotion are clearly defined and distinct from regions that process non-emotional information. In comparison to patients who participated in computer games for an equal number of hours, the patients who participated in the cognitive plus social-cognitive training showed significant improvements in behavioral and neural measures of emotion processing. On an fMRI facial emotion task, the cognitive plus social-cognitive intervention was associated with an increase in neural activity and the increase in neural activity predicted behavioral improvement in emotion recognition.



Since emotion recognition skills have been shown to predict broader measures of social functioning in schizophrenia, the findings suggest that targeted training which includes emotion recognition could have downstream functional benefits for individuals with schizophrenia. The findings also suggest that even among patients with chronic schizophrenia, dysfunctional neural circuits are malleable and can potentially benefit from neuroplasticity-based cognitive training.