Abstract: Cognitive Enhancement Therapy Protects Against Gray Matter Loss in Early Schizophrenia: Preliminary Results from an Ongoing Two-Site Randomized Trial (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

Schedule:

Saturday, January 13, 2018: 9:06 AM

Marquis BR Salon 8 (ML 2) (Marriott Marquis Washington DC)

* noted as presenting author

Jessica Wojtalik, MSW, Doctoral Student, University of Pittsburgh, Pittsburgh, PA

Timothy Keller, PhD, Senior Research Psychologist, Carnegie Mellon University, Pittsburgh, PA

Matcheri Keshavan, MD, Stanley Cobb Professor and Vice-Chair for Public Psychiatry, Harvard University, Boston, MA

Shaun Eack, PhD, David E. Epperson Professor of Social Work and Professor of Psychiatry, University of Pittsburgh, Pittsburgh, PA

Background: Progressive loss of the brain’s gray matter is a neurobiological consequence of schizophrenia and a substrate of significant cognitive disability. Cognitive Enhancement Therapy (CET) is an effective social work intervention for improving cognition and functioning in schizophrenia. Eack and colleagues (2010) demonstrated exciting evidence that CET protected against gray matter loss associated with improved cognition the early course of the illness. Therefore, this study sought to again examine the neuroprotective effects of CET in a larger sample of individuals with early course schizophrenia.

Methods: A total of 98 early course schizophrenia outpatients were randomized to either 18-months of CET (n = 57) or an Enriched Supportive Therapy (EST; n = 41) comparison treatment. Structural magnetic resonance imaging, cognitive, and functional outcome assessments were collected at baseline, 9-months, and 18-months (treatment completion). A 2 (group: CET vs. EST) x 3 (time: baseline, 9-, and 18-months) intent-to-treat mixed-effects model was used to investigate differential gray matter volume changes between CET and EST. Confirmatory intent-to-treat growth curve follow-up analyses of extracted gray matter volumes were conducted, as well as examining longitudinal relationships between gray matter and composite indices of neurocognition, social cognition, and functional outcome.

Results: Significant differential gray matter volume changes between CET and EST were observed in the right superior frontal gyrus, right fusiform/parahippocampal gyrus, and the left superior temporal pole (all regions: k > 45, z > 2.98, p < .001). Follow-up confirmatory analyses demonstrated that, unlike participants in EST, participants in CET had a preservation of gray matter in the right superior frontal gyrus (F = 4.04, p = .022), right fusiform/parahippocampal gyrus (F = 4.90, p = .010), and the left superior temporal pole (F = 5.74, p = .005). Preservation of superior frontal gyrus gray matter was predictive of improved social cognition (B = 33.14, p = .019) and functioning (B = 35.56, p = .014) in CET, in addition to the right fusiform/parahippocampal gyrus and functioning (B = 37.05, p = .023). A similar trend-level relationship was observed for the left superior temporal pole and social cognition (p = .068). Apart from a negative association between the left superior temporal pole and social cognition (B = -33.71, p = .026), no significant relationships emerged in EST (all p > .105).

Conclusions and Implications: Although these data are considered preliminary, the results provide further evidence of Eack et al. (2010) that CET, a social work cognitive remediation intervention, has a protective effect on structural neurobiology in people early in the course of schizophrenia. This safeguarding against gray matter loss by CET may have a subsequent positive impact on meaningful changes in cognitive and community functioning.