Predicting clinical outcome using brain activation associated with set-shifting and central coherence skills in XXXX .

@entity1 @entity51 @entity1442 @entity1278
BACKGROUND: @entity1 with @entity1278 ( @entity1278 ) have @entity51 in @entity1442 ( @entity1442 ) and central coherence (CC) consistent with an inflexible thinking style and overly detailed processing style, respectively. This study investigates brain activation during @entity1442 and CC tasks in @entity1 with @entity1278 and tests whether this activation is a biomarker that predicts response to treatment. METHODS: FMRI data were collected from 21 females with @entity1278 while performing an @entity1442 task (the Wisconsin Card Sort) and a CC task (embedded figures), and used to predict outcome following 16 weeks of treatment (either 16 weeks of cognitive behavioral therapy or 8 weeks cognitive remediation therapy followed by 8 weeks of cognitive behavioral therapy). RESULTS: Significant activation during the @entity1442 task included bilateral dorsolateral and ventrolateral prefrontal cortex and left anterior middle frontal gyrus. Higher scores on the neuropsychological test of @entity1442 (measured outside the scanner at baseline) were correlated with greater DLPFC and VLPFC/insula activation. Improvements in @entity1442 following treatment were significantly predicted by a combination of low VLPFC/insula and high anterior middle frontal activation (R squared  =  .68, p  =  .001). For the CC task, visual and parietal cortical areas were activated, but were not significantly correlated with neuropsychological measures of CC and did not predict outcome. CONCLUSION: Cognitive flexibility requires the support of several prefrontal cortex resources. As previous studies suggest that the VLPFC is important for selecting context-appropriate responses, @entity1 who have difficulties with this skill may benefit the most from cognitive therapy with or without cognitive remediation therapy. The ability to sustain inhibition of an unwanted response, subserved by the anterior middle frontal gyrus, is a cognitive feature that predicts favorable outcome to cognitive treatment. @entity51 may not be an effective predictor of clinical outcome.
