Compensatory Cognitive Training for Latino Youth at Clinical High Risk for Psychosis: Study Protocol for a Randomized Controlled Trial.

Background: Early psychosocial interventions targeting cognitive and functional outcomes in individuals at clinical high risk for psychosis are a research priority. An even greater need is the identification of effective interventions in underserved populations. Compensatory Cognitive Training (CCT) is a psychosocial intervention with demonstrated efficacy in chronic schizophrenia and first episode psychosis, but remains to be evaluated in pre-illness phases. The aim of this study was to describe the development and implementation of an ongoing pilot randomized controlled trial investigating the efficacy of group-based, manualized CCT, as compared to recreational therapy (RT), for Latino participants at clinical high risk for psychosis (CHR) in both the United States and Mexico. It is hypothesized that, in comparison to those receiving RT, participants receiving CCT will show significant improvements in neurocognitive performance and functional capacity (co-primary outcomes) and self-rated functioning and clinical symptoms (secondary outcomes). Methods: Latino CHR participants aged 12-30 years will be included in the study. Both CCT and RT will be delivered in either Spanish or English, depending on group preference. Additionally, all assessments will be administered in participants' preferred language. A comprehensive assessment of neurocognitive and functional performance and clinical symptomatology will be performed at baseline, mid-intervention (4 weeks, 8 weeks), post-intervention (12 weeks) and 3-month follow-up. The primary outcome measures are neurocognition and functional capacity, as assessed by the MATRICS (Measurement and Treatment Research in Cognition in Schizophrenia) Consensus Cognitive Battery and the University of California, San Diego Performance-Based Skills Assessment-Brief, respectively. Furthermore, secondary outcomes measures will be used to examine change in clinical symptoms and self-reported functioning in response to CCT versus RT. Discussion: The evaluation of a novel treatment such as CCT in CHR youth will provide empirical support for a low risk, comprehensive cognitive intervention that could have important implications for public health if it improves neurocognition and functioning

Subregional Hippocampal Thickness Abnormalities in Older Adults with a History of Heavy Cannabis Use.

Background and Aims: Legalization of cannabis (CB) for both medicinal and, in some states, recreational use, has given rise to increasing usage rates across the country. Of particular concern are indications that frequent CB use may be selectively harmful to the developing adolescent brain compared with adult-onset usage. However, the long-term effects of heavy, adolescent CB use on brain structure and cognitive performance in late-life remain unknown. A critical brain region is the hippocampus (HC), where there is a striking intersection between high concentrations of cannabinoid 1 (CB1) receptors and age-related pathology. Design: We investigated whether older adults (average age=66.6+7.2 years old) with a history of early life CB use show morphological differences in hippocampal subregions compared with older, nonusers. Methods: We performed high-resolution magnetic resonance imaging combined with computational techniques to assess cortical thickness of the medial temporal lobe, neuropsychological testing, and extensive drug use histories on 50 subjects (24 formerly heavy cannabis users [CB+ group] abstinent for an average of 28.7 years, 26 nonusers [CB- group]). We investigated group differences in hippocampal subregions, controlling for age, sex, and intelligence (as measured by the Wechsler Test of Adult Reading), years of education, and cigarette use. Results: The CB+ subjects exhibited thinner cortices in subfields cornu ammonis 1 [CA1; F(1,42)=9.96, p=0.0003], and CA2, 3, and the dentate gyrus [CA23DG; F(1,42)=23.17, p<0.0001], and in the entire HC averaged over all subregions [F(1,42)=8.49, p=0.006]. Conclusions: Negative effects of chronic adolescent CB use on hippocampal structure are maintained well into late life. Because hippocampal cortical loss underlies and exacerbates age-related cognitive decline, these findings have profound implications for aging adults with a history of early life usage. Clinical Trial Registration: ClinicalTrials.gov # NCT01874886

Effects of Motivationally Enhanced Compensatory Cognitive Training on modifiable risk factors for Mild Cognitive Impairment

Individuals diagnosed with Mild Cognitive Impairment (MCI) are at a higher risk for conversion to dementia and, therefore, may be particularly motivated/well-suited to participate in interventions to slow cognitive decline. Cognitive and lifestyle interventions targeting modifiable risk factors (e.g., physical activity [PA] and sleep) can slow the rate of cognitive decline. Psychometrically validated subjective indices of PA and sleep offer a practical and economical method of assessing these cognitively salient lifestyle factors in the context of longitudinal studies of older adults with MCI. Moreover, the burgeoning availability of inexpensive, accurate wearable devices to measure lifestyle behaviors makes valid, unobtrusive objective measurement of these outcomes possible. Thus, this dissertation study examined the efficacy of an 8-week Motivationally Enhanced Compensatory Cognitive Training (ME-CCT) intervention, compared to Goal-focused Supportive Contact (SC), in improving subjectively and objectively measured lifestyle factors in older Veterans with MCI.Self-reported sleep disturbance and PA levels were examined at baseline, mid-treatment, and post-treatment in 74 Veterans with MCI enrolled as part of a larger randomized controlled trial. Sleep and PA were objectively measured via the Fitbit Charge 2 in a subset of the sample (n=23). Mixed-effects models examined whether (1) ME-CCT, compared to SC, was associated with greater improvements in self-rated PA levels and sleep disturbance; and (2) baseline levels of self-rated PA and sleep disturbance moderated treatment effects on these outcomes. Exploratory analyses examined baseline-level correlates of Fitbit-measured PA and sleep, and the efficacy of ME-CCT in improving objective PA/sleep. There was no differential treatment-related improvement in either subjective or objective measures of PA or sleep, with no treatment-moderating effect of baseline PA/sleep (ps>.05). At baseline, greater self-reported engagement in PA (rs=0.57, p=.005) and less executive dysfunction (r=-0.43, p=.043) were associated with greater Fitbit step counts. Moreover, higher pain intensity (r=-0.49, p=.048) was associated with shorter Fitbit sleep duration. ME-CCT did not differentially improve sleep or PA levels, nor did baseline levels of sleep/PA influence treatment outcomes. The influence of pain intensity and executive deficits, such as planning and organizing, in moderating trajectories in cognitive and health behavior engagement should be considered in current rehabilitation efforts in aging