A groundbreaking new study published in Biological Psychiatry links cognitive impairments in psychotic disorders to brain organization.
“This link between cognition and brain networks is present even prior to the first psychotic break, suggesting an opportunity for early diagnosis and intervention for the treatment-resistant symptoms of psychotic disorders like schizophrenia and bipolar disorder,” said first author Heather Burrell Ward, MD, director of Neuromodulation Research.
Using data collected by two consortia of researchers — the Human Connectome Project for Early Psychosis (HCP-EP) and the North American Prodrome Longitudinal Study (NAPLS) — plus a cutting-edge MRI analysis approach and cognitive tests, Ward and her team observed that, in individuals with psychotic disorders, cognitive impairment is linked to brain network organization.
Taking it one step further, they looked for the same brain signature of cognitive impairment even before the onset of psychosis. After analyzing data from individuals considered at risk for psychotic disorders, but who had not yet had their first psychotic episode, they identified the same brain network-cognition relationship only in those who would eventually develop psychosis in the future.
Ward was surprised by the results.
“Recently there had been a concern that this kind of brain imaging study wasn’t possible at all and that this kind of brain-wide association study linking fMRI signals to cognition/behavior would require thousands of participants to identify reliable findings. This would be an extraordinary obstacle to doing research with individuals diagnosed with psychiatric illness,” she said. “We hypothesized that this limitation could be overcome with careful choices about cognitive testing and MRI analysis. We were very excited to see that, not only could our results be replicated, but that we could observe these strong brain network-cognition links in at-risk individuals even before they were diagnosed with psychosis.”
Ward said there are currently no medications to treat cognitive impairment that comes with schizophrenia and other psychotic disorders, resulting in significant disability.
“This impairment is frequently present by the time an individual has their first psychotic break, making early detection and intervention critical,” she said. “Our discovery of a link between cognition and brain networks, observed even prior to their first psychotic break, suggests an opportunity for early diagnosis and intervention via non-invasive neuromodulation.”
As Director of Neuromodulation Research, Ward is currently the principal investigator leading an NIH-funded clinical trial testing repetitive transcranial magnetic stimulation (rTMS, a form of non-invasive neuromodulation) for people with psychotic disorders.
“While this is an exciting finding, the next step is to test if this brain signature is malleable — that is, can we modulate this circuit with rTMS and improve cognitive performance,” she said. “The goal of my research program is to develop and test novel, personalized neuromodulation interventions for symptoms of psychosis, including cognitive impairment, to improve the lives of people living with psychosis.”
