Abstract
Computerized cognitive remediation therapy (CCRT) is generally effective for the cognitive deficits of schizophrenia. However, there is much uncertainty about what factors mediate or moderate effectiveness and are therefore important to personalize treatment and boost its effects. In total, 311 Chinese inpatients with Diagnostic and Statistical Manual of Mental Disorders-IV schizophrenia were randomized to receive CCRT or Active control for 12 weeks with four to five sessions per week. All participants were assessed at baseline, post-treatment and 3-month follow-up. The outcomes were cognition, clinical symptoms and functional outcomes. There was a significant benefit in the MATRICS Consensus Cognitive Battery (MCCB) total score for CCRT (F1,258 = 5.62; p = 0.02; effect size was 0.27, 95% confidence interval 0.04-0.49). There were no specific moderators of CCRT improvements. However, across both groups, Wisconsin Card Sort Test improvement mediated a positive effect on functional capacity and Digit Span benefit mediated decreases in positive symptoms. In exploratory analyses younger and older participants showed cognitive improvements but on different tests (younger on Symbol Coding Test, while older on the Spatial Span Test). Only the older age group showed MSCEIT benefits at post-treatment. In addition, cognition at baseline negatively correlated with cognitive improvement and those whose MCCB baseline total score was around 31 seem to derive the most benefit. CCRT can improve the cognitive function of patients with schizophrenia. Changes in cognitive outcomes also contributed to improvements in functional outcomes either directly or solely in the context of CCRT. Age and the basic cognitive level of the participants seem to affect the cognitive benefits from CCRT.
Highlights
Cognitive impairment in schizophrenia is common and accounts for significant variation in real-world outcomes such as work performance even when supportive recovery programs are provided (Green et al, 2000; Bell et al, 2007)
All participants who consented and fulfilled the inclusion criteria were randomly allocated to Computerized cognitive remediation therapy (CCRT) or Active control group in two hospitals (Beijing Anding Hospital and the Peking University Sixth Hospital) and at Beijing Huilongguan Hospital they were randomly allocated to three conditions (CCRT, Active control and Paper and pencil cognitive remediation)
The primary cognitive outcome was MATRICS Consensus Cognitive Battery (MCCB) total score assessed at baseline, post-treatment and follow-up
Summary
Cognitive impairment in schizophrenia is common and accounts for significant variation in real-world outcomes such as work performance even when supportive recovery programs are provided (Green et al, 2000; Bell et al, 2007). These impairments constitute a key component of recovery and are logical treatment targets. There were no specific moderators of CCRT improvements Across both groups, Wisconsin Card Sort Test improvement mediated a positive effect on functional capacity and Digit Span benefit mediated decreases in positive symptoms.
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