Enhancing Executive Function and Neural Health in Bipolar Disorder through Reasoning Training

Erin E Venza, Sandra B Chapman, Sina Aslan, Jennifer E Zientz, David L Tyler, Jeffrey S Spence, Erin E Venza, Sandra B Chapman, Sina Aslan, Jennifer E Zientz, David L Tyler, Jeffrey S Spence

Abstract

Cognitive deficits in executive function and memory among individuals with bipolar disorder (BD) are well-documented; however, only recently have efforts begun to address whether such cognitive deficits can be ameliorated through cognitive training. This pilot study examined the effects of a top-down, cognitive reasoning training program in adults with BD on both brain and cognitive measures. Twenty-seven participants (11 males, 16 females), aged 21-70 years old, completed the study. Participants completed neurocognitive testing and functional magnetic resonance imaging (fMRI) before and after training, consisting of 8 h (2 h/week) of training in small groups. The training delivered information processing strategies that were implemented and applicable to a variety of daily living contexts. Results indicated that participants showed significant gains in the primary outcome measure of complex abstraction, also referred to as gist reasoning, as well as in untrained domains of executive function and memory. We found a significant increase in resting cerebral blood flow (CBF) in left inferior frontal gyrus after cognitive training. We also found that resting CBF in the right frontal middle gyrus correlated positively with performance on the measure of complex abstraction. This feasibility study provides promising evidence that short-term reasoning training can enhance cognitive performance and brain health in adults with BD. These data motivate further efforts to explore adjuvant therapeutics to improve cognitive performance and underlying brain systems in bipolar, as well as other psychiatric disorders. Clinicaltrials.gov Identifier: NCT02843282, http://www.clinicaltrials.gov/ct2/show/NCT02843282.

Keywords: bipolar disorder; cerebral blood flow; cognition; cognitive training; executive function; frontal networks; memory.

Figures

FIGURE 1
FIGURE 1
Results of cerebral blood flow (CBF) voxel based comparison superimposed on T1 image. Bipolar disorder (BD) participants showed a CBF increase in left inferior frontal gyrus from T1 to T2 after cognitive training, p < 0.05 (FWE cluster corrected) and k ≥ 11,592 mm3.
FIGURE 2
FIGURE 2
Bipolar disorder group showed significant association between gains in regional CBF and behavioral measures. The BD group’s TOSL complex abstraction score difference showed significant association to right middle frontal CBF increase at T2, cluster-level p < 0.01 (FWE corrected).

References

    1. Anand R., Chapman S. B., Rackley A., Keebler M., Zientz J., Hart J. (2011). Gist reasoning training in cognitively normal seniors. Int. J. Geriatr. Psychiatry 26 961–968. 10.1002/gps.2633
    1. Aslan S., Xu F., Wang P. L., Uh J., Yezhuvath U. S., van Osch M., et al. (2010). Estimation of labeling efficiency in pseudocontinuous arterial spin labeling. Magn. Reson. Med. 63 765–771. 10.1002/mrm.22245
    1. Badre D., Wagner A. D. (2007). Left ventrolateral prefrontal cortex and the cognitive control of memory. Neuropsychologia 45 2883–2901. 10.1016/j.neuropsychologia.2007.06.015
    1. Benabarre A., Vieta E., Martínez-Arán A., Garcia-Garcia M., Martín F., Lomeña F., et al. (2005). Neuropsychological disturbances and cerebral blood flow in bipolar disorder. Aust. N. Z. J. Psychiatry 39 227–234. 10.1080/j.1440-1614.2004.01558.x
    1. Benton A. L., Hamsher K. D., Sivan A. B. (1994). Multilingual Aphasia Examination: Manual of Instructions. Iowa City, IA: AJA Associates Inc.
    1. Blumberg H. P., Leung H.-C., Skudlarski P., Lacadie C. M., Fredericks C. A., Harris B. C., et al. (2003). A functional magnetic resonance imaging study of bipolar disorder: state-and trait-related dysfunction in ventral prefrontal cortices. Arch. Gen. Psychiatry 60 601–609. 10.1001/archpsyc.60.6.601
    1. Burdick K. E., Braga R. J., Nnadi C. U., Shaya Y., Stearns W. H., Malhotra A. K. (2012). Placebo-controlled adjunctive trial of pramipexole in patients with bipolar disorder: targeting cognitive dysfunction. J. Clin. Psychiatry 73 103–112. 10.4088/JCP.11m07299
    1. Chapman S. B., Aslan S., Spence J., Keebler M. W., DeFina L. F., Didehbani N., et al. (2016). Distinct brain and behavioral benefits from cognitive versus physical training: a randomized trial in aging adults. Front. Hum. Neurosci. 10:338 10.3389/fnhum.2016.00338
    1. Chapman S. B., Aslan S., Spence J. S., Hart J. J., Jr, Bartz E. K., Didehbani N., et al. (2015). Neural mechanisms of brain plasticity with complex cognitive training in healthy seniors. Cereb. Cortex 25 396–405. 10.1093/cercor/bht234
    1. Chapman S. B., Gamino J. F., Mudar R. A. (2012). “Higher-order strategic gist reasoning in adolescence,” in The Adolescent Brain: Learning, Reasoning, and Decison Making, eds Reyna V., Chapman S. B., Dougherty M. R., Confrey J. (Washington, DC: American Psychological Association; ), 123–151.
    1. Chapman S. B., Kirkland S. (2014). Make Your Brain Smarter: Increase Your Brain’s Creativity, Energy, and Focus. New York City, NY: Simon and Schuster.
    1. Chapman S. B., Mudar R. A. (2014). Enhancement of cognitive and neural functions through complex reasoning training: evidence from normal and clinical populations. Front. Syst. Neurosci. 8:69 10.3389/fnsys.2014.00069
    1. Chapman S. B., Zientz J., Weiner M., Rosenberg R., Frawley W., Burns M. H. (2002). Discourse changes in early Alzheimer disease, mild cognitive impairment, and normal aging. Alzheimer Dis. Assoc. Disord. 16 177–186. 10.1097/00002093-200207000-00008
    1. Chen C. H., Suckling J., Lennox B. R., Ooi C., Bullmore E. T. (2011). A quantitative meta-analysis of fMRI studies in bipolar disorder. Bipolar Disord. 13 1–15. 10.1111/j.1399-5618.2011.00893.x
    1. Chen J. J., Rosas H. D., Salat D. H. (2013). The relationship between cortical blood flow and sub-cortical white-matter health across the adult age span. PLoS ONE 8:e56733 10.1371/journal.pone.0056733
    1. Chiu Wong S. B., Chapman S. B., Cook L. G., Anand R., Gamino J. F., Devous M. D. Sr. (2006). A SPECT study of language and brain reorganization three years after pediatric brain injury. Prog. Brain Res. 157 173–394. 10.1016/S0079-6123(06)57011-6
    1. Cook L. G., Chapman S. B., Elliott A. C., Evenson N. N., Vinton K. (2014). Cognitive gains from gist reasoning training in adolescents with chronic-stage traumatic brain injury. Front. Neurol. 5:87 10.3389/fneur.2014.00087
    1. Corbetta M., Patel G., Shulman L. (2008). The reorienting system of the human brain: from environment to theory of mind. Neuron 58 306–324. 10.1016/j.neuron.2008.04.017
    1. Danker J. F., Gunn P., Anderson J. R. (2008). A rational account of memory predicts left prefrontal activation during controlled retrieval. Cereb. Cortex 18 2674–2685. 10.1093/cercor/bhn027
    1. Deckersbach T., Nierenberg A. A., Kessler R., Lund H. G., Ametrano R. M., Sachs G., et al. (2010). RESEARCH: cognitive rehabilitation for bipolar disorder: an open trial for employed patients with residual depressive symptoms. CNS Neurosci. Ther. 16 298–307. 10.1111/j.1755-5949.2009.00110.x
    1. Delis D. C., Kaplan E., Kramer J. H. (2001). Delis-Kaplan Executive Function System (D-KEFS). San Antonio, TX: Psychological Corporation.
    1. Demant K. M., Vinberg M., Kessing L. V., Miskowiak K. W. (2015). Effects of short-term cognitive remediation on cognitive dysfunction in partially or fully remitted individuals with bipolar disorder: results of a randomised controlled trial. PLoS ONE 10:e0127955 10.1371/journal.pone.0127955
    1. Didehbani N., Cullum C. M., Mansinghani S., Conover H., Hart J. (2013). Depressive symptoms and concussions in aging retired NFL players. Arch. Clin. Neuropsychol. 28 418–424. 10.1093/arclin/act028
    1. Fisher M., Holland C., Merzenich M. M., Vinogradov S. (2009). Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am. J. Psychiatry 166 805–811. 10.1176/appi.ajp.2009.08050757
    1. Gamino J. F., Chapman S. B., Hull E. L., Lyon G. R. (2010). Effects of higher-order cognitive strategy training on gist-reasoning and fact-learning in adolescents. Front. Psychol. 1:188 10.3389/fpsyg.2010.00188
    1. Gold B. T., Balota D. A., Jones S. J., Powell D. K., Smith C. D., Andersen A. H. (2006). Dissociation of automatic and strategic lexical-semantics: functional magnetic resonance imaging evidence for differing roles of multiple frontotemporal regions. J. Neurosci. 26 6523–6532. 10.1523/jneurosci.0808-06.2006
    1. Green M. J., Cahill C. M., Malhi G. S. (2007). The cognitive and neurophysiological basis of emotion dysregulation in bipolar disorder. J. Affect. Disord. 103 29–42. 10.1016/j.jad.2007.01.024
    1. Kronhaus D. M., Lawrence N. S., Williams A. M., Frangou S., Brammer M. J., Williams S. C. R., et al. (2006). Stroop performance in bipolar disorder: further evidence for abnormalities in the ventral prefrontal cortex. Bipolar Disord. 8 28–39. 10.1111/j.1399-5618.2006.00282.x
    1. Martinez-Aran A., Vieta E., Colom F., Torrent C., Sanchez-Moreno J., Reinares M., et al. (2004). Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord. 6 224–232. 10.1111/j.1399-5618.2004.00111.x
    1. Max J. E., Lopez A., Wilde E. A., Bigler E. D., Schachar R. J., Saunders A., et al. (2015). Anxiety disorders in children and adolescents in the second six months after traumatic brain injury. J. Pediatr. Rehabil. Med. 8 345–355. 10.3233/PRM-150352
    1. Michalak E. E., Murray G. (2010). Development of the QoL. BD: a disorder-specific scale to assess quality of life in bipolar disorder. Bipolar Disord. 12 727–740. 10.1111/j.1399-5618.2010.00865.x
    1. Motes M. A., Gamino J. F., Chapman S. B., Rao N. K., Maguire M. J., Brier M. R., et al. (2014). Inhibitory control gains from higher-order cognitive strategy training. Brain Cogn. 84 44–62. 10.1016/j.bandc.2013.10.007
    1. Mozolic J. L., Hayaska S., Laurienti P. J. (2010). A cognitive training intervention increases resting cerebral blood flow in healthy older adults. Front. Hum. Neurosci. 4:16 10.3389/neuro.09.016.2010
    1. Mudar R., Chiang H.-S., Eroh J., Rackley A., Venza E., Martin-Cook K., et al. (2013). “Benefits of cognitive training in individuals with mild cognitive impairment,” in Poster Presentation – Cognitive Neuroscience Society Annual Meeting, San Francisco, CA.
    1. Mudar R. A., Chapman S. B., Rackley A., Eroh J., Chiang H. S., Perez A., et al. (2016). Enhancing latent cognitive capacity in mild cognitive impairment with gist reasoning training: a pilot study. Int. J. Geriatr. Psychiatry 10.1002/gps.4492 [Epub ahead of print].
    1. O’Connell R. A., Van Heertum R. L., Luck D., Yudd A. P., Cueva J. E., Billick S. B., et al. (1995). Single-photon emission computed tomography of the brain in acute mania and schizophrenia. J. Neuroimag. 5 101–104. 10.1111/jon199552101
    1. Phillips M. L., Drevets W. C., Rauch S. L., Lane R. (2003). Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol. Psychiatry 54 504–514. 10.1016/S0006-3223(03)00168-9
    1. Phillips M. L., Ladouceur C. D., Drevets W. C. (2008). A neural model of voluntary and automatic emotion regulation: implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Mol. Psychiatry 13 833–857. 10.1038/mp.2008.65
    1. Poldrack R. A., Wagner A. D., Prull M. W., Desmond J. E., Glover G. H., Gabrieli J. D. E. (1999). Functional specialization for semantic and phonological processing in the left inferior prefrontal cortex. Neuroimage 10 15–35. 10.1006/nimg.1999.0441
    1. Preiss M., Shatil E., Cermakova R., Cimermanova D., Ram I. (2013). Personalized cognitive training in unipolar and bipolar disorder: a study of cognitive functioning. Front. Hum. Neurosci. 7:108 10.3389/fnhum.2013.00108
    1. Quraishi S., Frangou S. (2002). Neuropsychology of bipolar disorder: a review. J. Affect. Disord. 72 209–226. 10.1016/S0165-0327(02)00091-5
    1. Race E. A., Shanker S., Wagner A. D. (2009). Neural priming in human frontal cortex: multiple forms of learning reduce demands on the prefrontal executive system. J. Cogn. Neurosci. 21 1766–1781. 10.1162/jocn.2009.21132
    1. Raichle M. E., Gusnard D. A. (2002). Appraising the brain’s energy budget. Proc. Natl. Acad. Sci. U.S.A. 99 10237–10239. 10.1073/pnas.172399499
    1. Rey A. (1964). L’examen Clinique en Psychologie [The clinical psychological examination]. Paris: Presses Universitaires de France.
    1. Robinson L. J., Ferrier I. N. (2006). Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disord. 8 103–116. 10.1111/j.1399-5618.2006.00277.x
    1. Schmidt M. (1996). Rey Auditory Verbal Learning Test: A Handbook. Los Angeles, CA: Western Psychological Services.
    1. Sojkova J., Beason-Held L., Zhou Y., An Y., Kraut M. A., Ye W., et al. (2008). Longitudinal cerebral blood flow and amyloid deposition: an emerging pattern? J. Nucl. Med. 49 1465–1471. 10.2967/jnumed.108.051946
    1. Spreen O., Strauss E. (1998). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. New York, NY: Oxford University Press.
    1. Takeuchi H., Taki Y., Nouchi R., Hashizume H., Sekiguchi A., Kotozaki Y., et al. (2013). Effects of working memory training on functional connectivity and cerebral blood flow during rest. Cortex 49 2106–2125. 10.1016/j.cortex.2012.09.007
    1. Torrent C., del Mar Bonnin C., Martínez-Arán A., Valle J., Amann B. L., González-Pinto A., et al. (2013). Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. Am. J. Psychiatry 170 852–859. 10.1176/appi.ajp.2012.12070971
    1. van Gorp W. G., Altshuler L., Theberge D. C., Wilkins J., Dixon W. (1998). Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence. A preliminary study. Arch. Gen. Psychiatry 55 41–46. 10.1001/archpsyc.55.1.41
    1. Vas A., Chapman S., Aslan S., Spence J., Keebler M., Rodriguez-Larrain G., et al. (2016a). Reasoning training in veteran and civilian traumatic brain injury with persistent mild impairment. Neuropsychol. Rehabil. 26 502–531. 10.1080/09602011.2015.1044013
    1. Vas A., Spence J., Eschler B., Chapman S. (2016b). Sensitivity and specificity of abstraction using gist reasoning measure in adults with traumatic brain injury. J. Appl. Biobehav. Res.
    1. Vas A. K., Chapman S. B., Cook L. G. (2015). Language impairments in traumatic brain injury: a window into complex cognitive performance. Handb. Clin. Neurol. 128 497–510. 10.1016/b978-0-444-63521-1.00031-5
    1. Vas A. K., Chapman S. B., Cook L. G., Elliott A. C., Keebler M. (2011). Higher-order reasoning training years after traumatic brain injury in adults. J. Head Trauma Rehabil. 26 224–239. 10.1097/HTR.0b013e318218dd3d
    1. Vreeker A., van Bergen A. H., Kahn R. S. (2015). Cognitive enhancing agents in schizophrenia, and bipolar disorder. Eur. Neuropsychopharmacol. 25 969–1002. 10.1016/j.euroneuro.2015.04.014
    1. Wechsler D. (1997a). Manual for the Wechsler Adult Intelligence Scale-III. San Antonio, TX: Psychological Corporation.
    1. Wechsler D. (1997b). Wechsler Memory Scale (WMS-III). San Antonio, TX: Psychological Corporation.

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