Optimizing Cognitive Remediation Outcomes in Schizophrenia
| Status: | Completed |
|---|---|
| Conditions: | Schizophrenia, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 4/6/2019 |
| Start Date: | December 2009 |
| End Date: | July 26, 2016 |
The purpose of this study is to drive an optimal response to neuroplasticity-based cognitive
remediation in schizophrenia in order to maximize treatment response. The investigators will
investigate factors that have generally been ignored in prior computer-based cognitive
remediation programs—those related to social cognition-- and will delineate their
relationship to motivation, functional outcome, and the neural substrates of reward
anticipation and emotion processing. Current research indicates that, unless the
investigators fully understand and harness these factors, the investigators will not achieve
meaningful treatment gains for individuals with schizophrenia.
remediation in schizophrenia in order to maximize treatment response. The investigators will
investigate factors that have generally been ignored in prior computer-based cognitive
remediation programs—those related to social cognition-- and will delineate their
relationship to motivation, functional outcome, and the neural substrates of reward
anticipation and emotion processing. Current research indicates that, unless the
investigators fully understand and harness these factors, the investigators will not achieve
meaningful treatment gains for individuals with schizophrenia.
The purpose of this study is to explicitly and aggressively drive an optimal response to
neuroplasticity- based cognitive remediation in schizophrenia in order to maximize treatment
response. We will investigate factors that have generally been ignored in computer-based
cognitive remediation programs—those related to social cognition-- and will delineate their
relationship to motivation, functional outcome, and the neural substrates of reward
anticipation and emotion processing. Current research indicates that, unless we fully
understand and harness these factors, we will not achieve meaningful treatment gains for
individuals with schizophrenia.
Our specific aims are:
1. To perform an RCT in which 100 schizophrenia subjects are assigned to either 60 hours of
neuroplasticity- based computerized targeted cognitive training (TCT) that focuses
exclusively on "cold cognition" (a program which trains early sensory processing,
attention, working memory and cognitive control in auditory and visual domains), or to
60 hours of training that combines the TCT program with 20 minutes per day of adaptive
computerized social cognition training (SCT) exercises.
2. To compare the outcomes of these two groups of subjects on measures of neurocognition,
social cognition, motivation, and functional outcome.
3. To assess subjects six months after the intervention to determine the durability of
training effects.
4. To identify changes in brain activation patterns in key neural regions as a result of
TCT alone vs. TCT+SCT: during reward anticipation, and during emotion recognition.
The timeliness of this approach is supported by recent evidence demonstrating only weak
associations between traditional cognitive remediation approaches and functional outcome in
schizophrenia, but a strong, direct relationship between social cognition and functional
outcome. Thus we must now examine the clinical, functional, and neural effects of a
well-designed state-of-the-art cognitive training program that combines neurocognition with
social cognition training.
neuroplasticity- based cognitive remediation in schizophrenia in order to maximize treatment
response. We will investigate factors that have generally been ignored in computer-based
cognitive remediation programs—those related to social cognition-- and will delineate their
relationship to motivation, functional outcome, and the neural substrates of reward
anticipation and emotion processing. Current research indicates that, unless we fully
understand and harness these factors, we will not achieve meaningful treatment gains for
individuals with schizophrenia.
Our specific aims are:
1. To perform an RCT in which 100 schizophrenia subjects are assigned to either 60 hours of
neuroplasticity- based computerized targeted cognitive training (TCT) that focuses
exclusively on "cold cognition" (a program which trains early sensory processing,
attention, working memory and cognitive control in auditory and visual domains), or to
60 hours of training that combines the TCT program with 20 minutes per day of adaptive
computerized social cognition training (SCT) exercises.
2. To compare the outcomes of these two groups of subjects on measures of neurocognition,
social cognition, motivation, and functional outcome.
3. To assess subjects six months after the intervention to determine the durability of
training effects.
4. To identify changes in brain activation patterns in key neural regions as a result of
TCT alone vs. TCT+SCT: during reward anticipation, and during emotion recognition.
The timeliness of this approach is supported by recent evidence demonstrating only weak
associations between traditional cognitive remediation approaches and functional outcome in
schizophrenia, but a strong, direct relationship between social cognition and functional
outcome. Thus we must now examine the clinical, functional, and neural effects of a
well-designed state-of-the-art cognitive training program that combines neurocognition with
social cognition training.
Inclusion Criteria:
- Clinical diagnosis of schizophrenia or schizoaffective disorder
- Between 18-65 years of age
- Clinically stable
- Fluent in English
Exclusion Criteria:
- Recent hospitalization, in the past 3 months
- History of traumatic brain injury
- Neurological disorders
- Inability to participate in the study soberly
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