Cognitive rehabilitation in mental health
Strategies based on cognitive rehabilitation or remediation play a relevant role in the comprehensive treatment of people with psychiatric illnesses.
Alteration of the cognitive function like memory, concentration, decision making or planning difficulties are frequent in people suffering from different mental disorders. It is common for people with diseases such as schizophrenia, bipolar disorder or depression to express complaints about their functioning and present an objective decrease in cognitive performance.
It is estimated that around 40% of people with schizophrenia may have severe or moderate cognitive shortfall, and it is estimated that similar percentages of people with bipolar disorder or major depression may also have significant cognitive deficits. These alterations appear during episodes of these diseases, but it is common that, to a greater or lesser degree, they persist after the reduction of symptoms, or even in clinical remission. The presence of these cognitive disorders directly affects the daily functioning of these people, which clearly hinders their work performance and negatively influences their social and family relationships.
Although the cause of these symptoms or cognitive deficits is unknown in depth, there is solid scientific evidence that suggests that people with psychiatric illnesses present alterations in cerebral circuits that, in turn, support certain cognitive functions. By this we mean that we know that regions of the brain such as the hippocampus or the prefrontal cortex show alterations in their structure and function that, in addition to being associated with different psychiatric diseases, play a fundamental role in cognitive functioning. For example, the hippocampus is an essential region for memory, and the prefrontal cortex plays a crucial role in decision making or task planning. In other words, alterations in the functioning of these brain regions or circuits are associated with the development and progress of psychiatric diseases and, at the same time, lead to the development and progression of cognitive difficulties.
Following the same line of study, new strategies have been developed aimed at training cognitive skills, such as rehabilitation or cognitive remediation. Cognitive remediation is defined as an intervention aimed at improving cognitive deficits through the performance of exercises designed to increase or facilitate neuronal activity in specific areas or circuits of the brain and, therefore, increase performance in associated cognitive function. Repeated exercises help to development of changes in the plastic properties of the nervous system, which modify the function involved in the stimulated region, thus improving its functioning. Cognitive remediation can also develop compensatory capacities, that is, if it is not feasible to recover a certain function, improvement of functioning can be promoted by developing alternative cognitive strategies that will end up compensating for this deficit.
Given this reality, efforts have been intensified to develop treatment strategies aimed at improving the cognitive performance of people with severe mental illness. In this context, the potential procognitive effect of different drugs has been studied, that is, how these drugs could improve cognitive functions. However, most studies show that the procognitive role of these drugs is not very relevant and that the results are very poor and inconsistent. In other words, we know that effective drugs for the treatment of schizophrenia, bipolar disorder or depression do not show a positive effect in improving the cognitive symptoms associated with these pathologies. Similarly, other more specific medications, which generally have a positive effect on cognition, have not shown favorable results either, or, if they appear, their effect on daily functioning or in the real world ends up being highly anecdotal.