Abstract: Neuroprotective Effects of Cognitive Enhancement Therapy Against Gray Matter Loss in Early Course Schizophrenia: First Results of a 10-Year Follow-up Study (Society for Social Work and Research 23rd Annual Conference - Ending Gender Based, Family and Community Violence)

Schedule:

Friday, January 18, 2019: 2:45 PM

Golden Gate 1, Lobby Level (Hilton San Francisco)

* noted as presenting author

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

Matcheri Keshavan, MD, Stanley Cobb Professor of 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 and Purpose: Individuals with schizophrenia experience a progressive loss of the brain’s gray matter over the course of the condition, which contributes to significant cognitive and functional challenges. In 2010, Eack and colleagues demonstrated that Cognitive Enhancement Therapy (CET), a comprehensive and effective social work intervention, protected against gray matter loss associated with improved cognition among individuals with early course schizophrenia. This study examined whether such neuroprotective effects would persist a decade after treatment concluded.

Methods: A total of 23 schizophrenia outpatients (CET: n = 15, EST: n = 8) from the original 2-year randomized clinical trial of CET in the early course of the condition completed structural MRI scans and a comprehensive battery of cognitive and functional outcome assessments. All 10-year post-treatment follow-up measures were identical to those used in the original trial. Voxel-based morphometry was used to examine 10-year gray matter volume differences between participants treated with CET and those receiving an Enriched Supportive Therapy (EST) comparison. Subsequently, the relationships between regional gray matter volume differences and cognitive and functional outcomes were examined.

Results: A significant 10-year gray matter volume difference between CET and EST was observed in the right inferior frontal gyrus (k = 90, z > 2.85, p < .002), such that participants treated with CET had significantly greater gray matter volume in this region compared to those in the EST condition. A follow-up confirmatory t-test on extracted gray matter volume from the right inferior frontal gyrus demonstrated similar results (CET > EST, t = 3.04, p = .008). Greater gray matter volume in the right inferior frontal gyrus was significantly associated with better social cognitive ability at 10-years post-treatment (r = .50, p = .015). No significant relationships emerged for neurocognition or functional outcomes.

Conclusions and Implications: Although these data are the first results of a decade-long follow-up study, the findings suggest that CET may not only protect against the loss of gray matter during treatment (Eack et al., 2010), but may also help to preserve structural brain integrity in the decade after treatment has concluded. Further, this long-term neuroprotective effect may support the maintenance of gains in social abilities, even 10-years after participating in CET. Such findings suggest that the neurobehavioral impact of cognitive rehabilitation interventions may persist far longer than previously recognized.

References

Eack, S. M., Hogarty, G. E., Cho, R. Y., Prasad, K. M., Greenwald, D. P., Hogarty, S. S., & Keshavan, M. S. (2010). Neuroprotective effects of cognitive enhancement therapy against gray matter loss in early schizophrenia: Results from a 2-year randomized controlled trial. Archives of General Psychiatry, 67(7), 674-682. doi:10.1001/archgenpsychiatry.2010.63