Abstract
BackgroundCognitive deficits are common in people with schizophrenia and have a negative impact on functioning. Cognitive Remediation (CR) is an effective approach to reduce the burden of cognitive difficulties however there are individual differences in therapy response. Previous research suggests that participants age may be a significant moderator of therapy efficacy but results are inconclusive. This study attempts to fill this gap by exploring how age may influence CR outcomes.MethodsData from ten trials from the NIMH Database of Cognitive Training and Remediation Studies (DoCTRS) were used. We considered the following therapy outcomes: Executive function as assessed by the Trail making test part B (TMTB), the Wisconsin Card Sorting Test (WCST) and Verbal fluency (FAS) scores. Working memory was assessed with the Letter-Number Span (LNS) and the Digit span. Symptoms were evaluated with the Positive, Negative and General scores from the Positive and Negative Syndrome Scale (PANSS). Functioning was assessed using the Heinrichs-Carpenter quality of life (HCQOL) scale. To evaluate the effect of age on outcomes we classified participants into under 40 and over 40 years old. We compared outcomes across age groups using mixed linear models.ResultsWe considered data from 711 people with schizophrenia (407 received CR and 304 the control condition). For the under 40 group the average age was 29.26 (SD 6.83) while the average yeas spent in education was 12.11 (2.61). The over 40 group had a mean age of 40.09 (SD 6.09) and 12.11 (2.54) years of education.We found a significant interaction between age and working memory and functioning improvement for the over 40 group. The younger group showed a larger effect of CR in term of general symptoms reduction. We did not find an effect of age on executive function, positive and negative symptom.DiscussionThe results indicate that CR may benefit people with schizophrenia in different way depending on their age. Age may represent a large number of complex factors and more work is needed in this area to better understand how individual characteristics and illness history may influence CR response. Work in this sense will help to reduce CR response heterogeneity and improve therapy personalisation.
Highlights
Social impairment is a core feature of schizophrenia presenting a major barrier to recovery
We tested whether 10 sessions of a novel, virtual reality (VR)-based social simulation computer game would indirectly improve facial emotion recognition in SZ, and whether potential gains were associated with changes in gaze patterns
At pre- and post-training visits, emotion recognition was assessed with a novel dynamic facial affect recognition task (DFAR) and the Bell Lysaker Emotion Recognition Task (BLERT)
Summary
Relapse of schizophrenia is common, has profound, adverse consequences for patients and is costly to health services. Signs interventions aim to use warning signs of deterioration to prevent full relapse. This study aimed to evaluate the feasibility and acceptability of using the ExPRESS smartphone app to monitor both conventional early signs and basic symptoms as possible predictors of relapse. Methods: Patients who had experienced a relapse of schizophrenia within the past year took part in a screening interview. Those with at least one basic symptom emerging prior to a previous relapse were eligible for the longitudinal feasibility study. Consenting participants were asked to use the ExPRESS smartphone app once a week for 6 months, answering questions on their experience of conventional early signs, basic symptoms and psychotic symptoms. Initial findings from sixteen qualitative interviews are discussed, including interviews with the two participants who met relapse criteria and two study drop-outs
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