A recent study clarified how cognitive behavioral therapy improves symptoms of depression and post-traumatic stress disorder (PTSD). The participants were 62 adult women. One group had depression, one had PTSD, and the third was made up of healthy volunteers. None were taking medication at the time of the study. The researchers, led by Yvette Shelive, used functional magnetic resonance imaging (fMRI) to analyze participants’ amygdala connectivity.
At the start of the study, participants with depression or PTSD showed diminished connectivity between the amygdala and brain areas related to cognitive control, the process by which the brain can vary behavior and how it processes information in the moment based on current goals. The lack of connectivity reflected the severity of the participants’ depression. Twelve weeks of cognitive behavioral therapy improved mood and connectivity between the amygdala and these control regions, including the dorsolateral prefrontal cortex and the inferior frontal cortex. These regions also allow for executive functioning, which includes planning, implementation, and focus.
People with disorders on the schizophrenia spectrum often suffer cognition problems that affect skills such as the processing of information about people and social situations (social cognition) and the execution of plans (executive function). At the 2015 meeting of the Society for Biological Psychiatry, researcher Larry J. Siever reported that the drug guanfacine improved these types of thinking in people with disorders on the schizophrenic spectrum compared to placebo. Participants were enrolled in a 7.5-week training program to improve cognition.
At the 2015 meeting of the International Society for Bipolar Disorders, Ben Goldstein described a study of cognitive dysfunction in pediatric bipolar disorder. Children with bipolar disorder were three years behind in executive functioning (which covers abilities such as planning and problem-solving) and verbal memory.
There were other abnormalities. Youth with bipolar disorder had smaller amygdalas, and those with larger amygdalas recovered better. Perception of facial emotion was another area of weakness for children (and adults) with bipolar disorder. Studies show increased activity of the amygdala during facial emotion recognition tasks.
Goldstein reported that nine studies show that youth with bipolar disorder have reduced white matter integrity. This has also been observed in their relatives without bipolar disorder, suggesting that it is a sign of vulnerability to bipolar illness. This could identify children who could benefit from preemptive treatment because they are at high risk for developing bipolar disorder due to a family history of the illness.
There are some indications of increased inflammation in pediatric bipolar disorder. CRP, a protein that is a marker of inflammation, is elevated to a level equivalent to those in kids with juvenile rheumatoid arthritis before treatment (about 3 mg/L). CRP levels may be able to predict onset of depression or mania in those with minor symptoms, and is also associated with depression duration and severity. Goldstein reported that TNF-alpha, another inflammatory marker, may be elevated in children with psychosis.
Goldstein noted a study by Ghanshyam Pandey that showed that improvement in pediatric bipolar disorder was related to increases in BDNF, a protein that protects neurons. Cognitive flexibility interacted with CRP and BDNF—those with low BDNF had more cognitive impairment as their CRP increased than did those with high BDNF.
Low levels of vitamin D levels are common, particularly in older adults and in African Americans and Hispanics. Unfortunately, low vitamin D is associated with decline in two types of cognitive functioning: episodic memory (memories of autobiographical events) and executive function (reasoning, problem-solving, planning, etc.).
A recent study with a particularly diverse group of participants, over half of whom were African American or Hispanic, found that over a period of about 5 years, episodic memory and executive function declined faster in older adults with low levels of vitamin D.
Average vitamin D levels for the entire group of 382 adults were below national standards. Levels of 25-hydroxy vitamin D should be between 20 and 50 nanograms per milliliter of blood. The average fell just below this, at 19.2 ng/mL. Over a quarter of participants had vitamin D deficiency, with levels below 12 ng/mL, and another 35.1% had vitamin D insufficiency, with levels between 12 and 20 ng/mL.
African Americans and Hispanics had lower levels of vitamin D (17.9 ng/mL and 17.2 ng/mL, respectively) than whites (21.7 ng/mL). Average vitamin D levels were lower in participants with dementia compared with those who had mild cognitive impairment or normal cognitive function.
Vitamin D levels can depend on factors such as dairy intake, sun exposure, and exercise. It has not been determined whether taking vitamin D supplements could slow down cognitive decline, but vitamin D supplementation has several benefits. Compared to placebo, supplementation with vitamin D increases response to antidepressants. A high percentage of children with major psychiatric disorders are vitamin D deficient, and it is also estimated that about 40% of adults in the US have a vitamin D deficiency.
The study by researcher Joshua W. Miller and colleagues was published in the journal JAMA Neurology in September.