Abstract
BackgroundCognitive deficits are stable features of schizophrenia that are linked to functional outcome. Cognitive remediation approaches have been proven successful in ameliorating these deficits, although effect sizes vary considerably. Whether cognitive deficits are serious predictors of clinical outcome is less clear.MethodsSixty patients suffering from schizophrenia were included in our sample, thirty of them received computer-assisted cognitive training, and thirty received occupational therapy. For a subsample of 55 patients, who could be traced over a period of five years after the end of the cognitive remediation intervention, time until first relapse and time in psychosis were determined retrospectively from their medical records.ResultsCognitive remediation significantly improved problem solving, memory and attention with high effect sizes. Employment status, a post test verbal memory performance measure and a measure of executive functioning outperformed all other measures in the prediction of time to relapse, while allocation to treatment group outperformed all other variables in the prediction of both cognitive measures.ConclusionsCognitive remediation of neurocognitive deficits thus makes sense in a twofold fashion: It enhances cognition directly and positively acts on clinical course indirectly via improved neurocognition.Trial registrationGerman Clinical Trials Register: DRKS00004880
Highlights
Cognitive deficits are stable features of schizophrenia that are linked to functional outcome
There is empirical evidence that cognitive impairment can be found before first onset [4] and in persons at risk for schizophrenia [5,6] while there is currently some debate about whether these cognitive deficits are specific enough to serve as diagnostic criteria for schizophrenia
Even linkages to further clinical course of illness have been reported by some authors [14,15,16,17,18], predictive power was limited and there are several studies that could not find any significant relations with neurocognition [19,20,21]
Summary
Cognitive deficits are stable features of schizophrenia that are linked to functional outcome. Whether cognitive deficits are serious predictors of clinical outcome is less clear. A huge number of studies were conducted to answer several key questions: Do schizophrenia patients suffer from stable cognitive deficits? A substantial number of studies - as summarized in several meta-analyses [1,2,3] - report stable deficits in many cognitive domains, such as attention, verbal and visual (working-) memory and executive functions. Many studies have analyzed functional consequences of cognitive deficits and have found small to moderate correlations with functional outcome [9,10,11]: Cognitive performance seems to be linked to social skills, community functioning, social behavior, social problem solving [12] and even the probability of returning to work or school [13] regardless of potential moderator variables such as age, gender, inpatient status and illness chronicity. Even linkages to further clinical course of illness have been reported by some authors [14,15,16,17,18], predictive power was limited and there are several studies that could not find any significant relations with neurocognition [19,20,21]
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