Universität zu Köln

Völkel, Laura ORCID: 0009-0005-6937-8401 (2024). The influence of a computerized social cognitive training on the functional connectivity of the brain in major depressive disorder. PhD thesis, Universität zu Köln.

PDF (Dissertation Laura Völkel) PromotionLaura_Voelkel_06_2024.pdf Download (1MB)

Abstract

Background Cognitive impairment is common in major depressive disorder (MDD) 1,2 and influences multiple domains of daily living such as maintaining relationships or work performance 3 . A promising approach that demonstrated an effect on cognitive deficits is computerized cognitive training (CCT) 1,4. This therapy method induces neuroplastic changes in the brain representational system of cognitive and emotional processes to reduce cognitive impairment and reach functional recovery 1,5,6 . The exercises of CCT focus on early perceptual processes, whereby the processing of socially relevant stimuli is on the forefront in social cognitive training (SCT) interventions 6-8 . However, treatment response to CCT varies between the participants, and current research shifted the attention towards the identification of behavioral and neural markers to measure the target engagement and to predict future outcome 6 . Preliminary results now suggest the individual sensory processing behavior as a potential marker for target engagement and treatment response to CCT 9,10 . Aims In this randomized controlled trial (RCT) we examined the effect of a computerized SCT on (1) the cognitive performance and psychosocial functioning (2) the rsFC of a priori selected brain regions (dorsolateral prefrontal cortex [dlPFC], caudate nucleus and amygdala) and the rest of the brain and (3) the relationship between the change in the cognitive performance and the rsFC as compared to TAU. We were further interested in the role of distinct patterns of sensory processing behavior and therefore analyzed the effect of a SCT on (1) the cognitive performance and psychosocial functioning (2) the rsFC of a priori selected brain regions (dlPFC, caudate nucleus and amygdala) and the rest of the brain and (3) the relationship between the change in the cognitive performance and the rsFC between groups with diverging sensory processing behavior. Methods Participants were screened for MDD with the SCID-IV. Included subjects (n=40) underwent a standardized clinical and cognitive assessment and a neuroimaging scan and were then randomized to the SCT or the TAU group. Participants in the former received a ten hours computerized SCT over four to six weeks additional to TAU. At the end of the study, both the clinical and the cognitive assessment and the neuroimaging scan were replicated, and participants in the SCT group were additionally classified as Maintainers (perceived baseline sensory processing efficiency) or Improvers (impaired baseline sensory processing efficiency) depending on the individual performance in the EMT. To examine group differences between (1) the SCT and the TAU group and (2) Maintainers and Improvers on the cognitive performance and psychosocial functioning from baseline to follow-up, we used an analysis of covariance (ANCOVA). Correlation maps of the rsFC between the a priori selected brain regions (dlPFC, caudate nucleus and amygdala) and the rest of the brain were further 15 calculated with SPM-12 to investigate (1) the effect of the SCT on the rsFC of MDD patients as compared to TAU and (2) the effect of the SCT on the rsFC of Maintainers and Improvers across the study. Lastly, Pearsons’s correlation tests were performed to analyze the association between the change in the rsFC and the cognitive performance in each group. Results SCT did not show an additional effect on cognition or psychosocial functioning as compared to TAU in this study. However, Maintainers exhibited significantly higher scores on social cognition at baseline (F = 1.72; p = 0.05) while Improvers enhanced the sensory processing efficiency and showed significantly increased social cognitive abilities across the study (F = 7.78; p = 0.01; η 2 G = 0.34). Moreover, Maintainers showed significantly more benefit on a social functioning score (GF-S: F = 5.42; p = 0.03; η 2 G = 0.27). On the neural level, we found a significant increase of the rsFC between the right caudate and the left superior temporal lobe (STL) (p-corr. = <0.01) in the SCT group compared to TAU across the study. On the contrary, participants in the TAU group exhibited a significantly enhanced rsFC between the right caudate and the bilateral superior frontal lobe (SFL) (right SFL: p-corr. = 0.04; left SFL: p-corr. = < 0.01) as well as between the right dlPFC and the left medial cingulum (p-corr. = <0.01) and the right precuneus (p-corr. = 0.02) compared to SCT over the follow-up period. We further identified a significant group by time interaction on the rsFC between the left amygdala and the left SFL (p-corr. = < 0.01) and the left medial frontal lobe (MFL) (p-corr.= <0.01) in the Improvers group compared to Maintainers. Likewise, the rsFC between the left Amygdala and the left MFL (p-corr. = < 0.01) was significantly increased in the Maintainers group compared to Improvers across the study. There was neither a significant correlation between the cognitive and the neural changes in 1) the SCT and the TAU group nor 2) Maintainers and Improvers. Conclusion The results of our study indicate that the effect of SCT on cognition and psychosocial functioning probably depends on individual characteristics of the participants whereby the sensory processing efficiency might be one of the mediators of therapy response. Consecutively, individuals with reduced sensory processing efficiency, who additionally presented impaired baseline cognitive functions, seem to benefit more clearly from SCT. Hereinafter the individual sensory processing efficiency might serve as a behavioral measure of target engagement to predict the treatment response to SCT. On the neural level, increased rsFC between neural structures that are integrated in the processing of emotional stimuli underline the potential of SCT to induce neuroplastic changes in the brain. Since we additionally identified altered rsFC between distributed brain regions in the TAU group over the follow-up period, further studies are needed to precisely identify the neuroplastic mechanism underlying SCT. However, the reorganization of fronto-limbic pathways, which plays an important role in the pathophysiology of depression 11 , might be an appropriate neural target 16 for cognitive training interventions. Finally, future studies on the relation of cognitive and neural changes after SCT in depression are needed.

Item Type:	Thesis (PhD thesis)
Translated title:	Title Language Der Einfluss von computergestütztem sozial-kognitivem Training auf die funktionelle Konnektivität des Gehirns bei der Major Depression. German
Creators:	Creators Email ORCID ORCID Put Code Völkel, Laura laura-voelkel@gmx.de orcid.org/0009-0005-6937-8401 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-730667
Date:	2024
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Psychiatrie und Psychotherapie > Klinik und Poliklinik für Psychiatrie und Psychotherapie
Subjects:	Psychology Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Depression English Cognitive training English Functional connectivity English
Date of oral exam:	6 May 2024
Referee:	Name Academic Title Kambeitz, Joseph Universitätsprofessor Dr. med. Dipl.-Psych. Koenig, Julian Universitätsprofessor Dr. sc. hum.
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/73066