Article

A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia.

Université de Lyon, Lyon, F-69003, France.
Schizophrenia Research (Impact Factor: 4.43). 02/2011; 125(2-3):284-90. DOI: 10.1016/j.schres.2010.10.023
Source: PubMed

ABSTRACT There is considerable interest in cognitive remediation for schizophrenia. Our study aimed to evaluate, in a large sample of patients with schizophrenia, the interest of a computer-assisted cognitive remediation program on cognitive performances of patients as well as in clinical and functional outcome.
Seventy-seven patients with remitted schizophrenia were randomly assigned to 14 2-hours individual sessions of computer-assisted cognitive remediation (n=39) or a control condition (n=38). Remediation was performed using RehaCom ® software. Four procedures were chosen to train four cognitive functions involved in different stages of the information processing: attention/concentration, working memory, logic, and executive functions. Primary outcomes were remediation exercise metrics, neuropsychological composites (episodic memory, working memory, attention, executive functioning, and processing speed), clinical and community functioning measures.
Cognitive performances concerning Attention/vigilance, verbal working memory and verbal learning memory and reasoning/problem solving improved significantly in the remediation condition when no difference was reported in the control condition between the 2 assessments. However, there were no significant benefits of cognitive remediation on non-verbal working memory and learning and speed of processing or functional outcome measures.
Cognitive remediation for people with schizophrenia was effective in improving performance, but the benefits of training did not generalize to functional outcome measures. Long term follow-up studies are needed to confirm the maintenance of such improvements.

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Available from: Jerome Brunelin, Feb 05, 2014
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    • "The present results are similar to studies finding that improvement on training tasks did not generalize to cognitive or functional outcome measures (Dickinson et al., 2010; Keefe et al., in press; Murthy et al., in press). Similarly, Field et al. (1997) attributed any performance improvement to practice effects. "
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    ABSTRACT: Cognitive impairment is a core symptom in schizophrenia that has a significant impact on psychosocial func- tion, but shows a weak response to pharmacological treatment. Consequently, a variety of cognitive remedi- ation strategies have been evaluated to improve cognitive function in schizophrenia. The efficacy of computer-based cognitive remediation as a stand-alone intervention on general measures of neuropsycholog- ical function remains unclear. We tested the effectiveness of biweekly training using computerized cognitive remediation programs on neuropsychological and event-related potential outcome measures. Schizophrenia patients were randomly assigned to cognitive remediation training (N=17), active control (TV-watching; N = 17), or treatment-as-usual (N = 10) groups for ten weeks and run in parallel. Cognitive and ERP measures revealed no differential improvement over time in the cognitive remediation group. Practice effects might explain change over time on several cognitive measures for all groups, consistent with studies indicating task-specific improvement. Computer-assisted cognitive remediation alone may not be sufficient for robust or generalized effects on cognitive and electrophysiological measures in schizophrenia patients.
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    • "Nevertheless the ultimate value of cognitive remediation as a standardized treatment procedure would rely on its potential to also impact on functional outcome providing evidence that generalization of the abilities trained is possible to improve the patient's quality of life. Data does not always support this relationship [6] [19]. Additionally, although some clinical trials have been performed in chronic samples [29] [30], to our knowledge , there are no studies which have addressed the question of efficacy in chronic treatment resistant samples who present a broader and more severe cognitive deficit (up to two standard deviations below the mean) [27] [34]. "
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