Visuospatial Learning Selectively Enhanced by Personalized Transcranial Magnetic Stimulation over Parieto-Hippocampal Network among Patients at Clinical High-Risk for Psychosis

Abstract Background and Hypothesis Cognitive deficits in visuospatial learning (VSL) are highly associated with an increased risk of developing psychosis among populations with clinical high risk (CHR) for psychosis. Early interventions targeting VSL enhancement are warranted in CHR but remain rudim...

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Bibliographic Details
Published in:Schizophrenia bulletin 2023-07, Vol.49 (4), p.923-932
Main Authors: Tang, Yingying, Xu, Lihua, Zhu, Tianyuan, Cui, Huiru, Qian, Zhenying, Kong, Gai, Tang, Xiaochen, Wei, Yanyan, Zhang, Tianhong, Hu, Yegang, Sheng, Jianhua, Wang, Jijun
Format: Article
Language:English
Subjects:
Cognition Disorders
Cognitive Dysfunction - etiology
Cognitive Dysfunction - prevention & control
Humans
Psychotic Disorders
Regular
Schizophrenia - complications
Schizophrenia - therapy
Transcranial Magnetic Stimulation - methods
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Summary:Abstract Background and Hypothesis Cognitive deficits in visuospatial learning (VSL) are highly associated with an increased risk of developing psychosis among populations with clinical high risk (CHR) for psychosis. Early interventions targeting VSL enhancement are warranted in CHR but remain rudimentary. We investigated whether personalized transcranial magnetic stimulation (TMS) over the left parieto-hippocampal network could improve VSL performance in CHR patients and if it could reduce the risk of psychosis conversion within 1 year. Study Design Sixty-five CHR patients were randomized to receive active or sham TMS treatments using an accelerated TMS protocol, consisting of 10 sessions of 20 Hz TMS treatments within 2 days. TMS target was defined by individual parieto-hippocampal functional connectivity and precisely localized by individual structural magnetic resonance imaging. VSL performance was measured using Brief Visuospatial Memory Test-Revised included in measurement and treatment research to improve cognition in schizophrenia consensus cognitive battery (MCCB). Fifty-eight CHR patients completed the TMS treatments and MCCB assessments and were included in the data analysis. Study Results We observed significant VSL improvements in the active TMS subgroup (Cohen’s d = 0.71, P < .001) but not in the sham TMS subgroup (Cohen’s d = 0.07, P = .70). In addition, active TMS improved the precision of VSL performance. At a 1-year follow-up, CHR patients who received active TMS showed a lower psychosis conversion rate than those who received sham TMS (6.7% vs 28.0%, χ2 = 4.45, P = .03). Conclusions Our findings demonstrate that personalized TMS in the left parieto-hippocampal network may be a promising preventive intervention that improves VSL in CHR patients and reduces the risk of psychosis conversion at follow-up.
ISSN:0586-7614
1745-1701
DOI:10.1093/schbul/sbad015