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Scores on the BACS and cognitive training process and engagement variables: Presented by diagnosis and baseline cognitive status.
Source publication
Computerized cognitive training (CCT) interventions are increasing in their use in outpatient mental health settings. These interventions have demonstrated efficacy for improving functional outcomes when combined with rehabilitation interventions. It has recently been suggested that patients with more cognitive impairment have a greater therapeutic...
Context in source publication
Context 1
... regression models were used to identify independent contributions of all variables found to be correlated with changes in cognitive performance. Table 1 Pearson correlations between changes in BACS performance from baseline to endpoint, days trained, levels achieved, and the training engagement variable are presented in Table 2. Changes in the BACS from baseline to endpoint were significantly correlated with training engagement, p < .05, but not with either days trained or levels achieved. ...Similar publications
Objective: This study aims to explore the relationships among hopelessness, cognitive flexibility, intolerance of uncertainty, and perceived stress in a non-clinical sample by proposing a multiple mediation model. It was suggested that hopeless individuals have low cognitive flexibility and high intolerance of uncertainty; consequently, they are mo...
Citations
... P = 0.002) were unique contributors to the model, accounting for 48% of TU variance (P < 0.001). 60 Harvey et al. 63 examined the single effects and interaction of diagnosis and cognitive status (i.e., BACS <41 and BACS >41) on training engagement and found no significant effects (all P > 0.20). ...
Objectives
Neurocognitive deficits are central in schizophrenia. Cognitive remediation has proven effective in alleviating these deficits, with medium effect sizes. However, sizeable attrition rates are reported, with the reasons still uncertain. Furthermore, cognitive remediation is not part of routine mental health care. We conducted a systematic review to investigate factors that influence access and engagement of cognitive remediation in schizophrenia.
Methods
We systematically searched the PubMed, Web of Science, and PsycINFO databases for peer-reviewed articles including a cognitive remediation arm, access, and engagement data, and participants with schizophrenia spectrum disorders aged 17–65 years old. Duplicates and studies without a distinct cognitive remediation component, protocol papers, single case studies, case series, and reviews/meta-analyses were excluded.
Results
We included 67 studies that reported data on access and engagement, and extracted quantitative and qualitative data. Access data were limited, with most interventions delivered on-site, to outpatients, and in middle- to high-income countries. We found a median dropout rate of 14.29%. Only a small number of studies explored differences between dropouts and completers ( n = 5), and engagement factors ( n = 13). Dropouts had higher negative symptomatology and baseline self-efficacy, and lower baseline neurocognitive functioning and intrinsic motivation compared to completers. The engagement was positively associated with intrinsic motivation, self-efficacy, perceived usefulness, educational level, premorbid intelligence quotient, baseline neurocognitive functioning, some neurocognitive outcomes, and therapeutic alliance; and negatively associated with subjective cognitive complaints. Qualitative results showed good acceptability of cognitive remediation, with some areas for improvement.
Conclusions
Overall, access and engagement results are scarce and heterogeneous. Further investigations of cognitive remediation for inpatients, as well as remote delivery, are needed. Future clinical trials should systematically explore attrition and related factors. Determining influential factors of access and engagement will help improve the implementation and efficacy of cognitive remediation, and thus the recovery of people with schizophrenia.
... Evaluable patients were separated into two groups based on cognitive impairment at study baseline using a CBB composite Z-score cutoff of -1 SD, relative to the normative mean. This cutoff was selected based on its previous use to differentiate clinically significant cognitive impairment from non-/minimal impairment in both patients with schizophrenia and more broadly in clinical neuropsychological assessment [30][31][32]. Patients with CBB composite Z-scores equal to or above this cutoff (Z-score ≥ -1) were designated as minimally impaired, whereas patients below the cutoff (Z-score < -1) were designated as clinically impaired. ...
... For example, patients who exhibit minimal to no cognitive impairment have been shown to respond differentially to both pharmacological and behavioural treatments for CIAS. Higher baseline cognitive performance has been associated with reduced gains in cognitive training [31,38], with different findings in extremely chronic and currently institutionalised patients [39]. Additionally, differing relationships with functional outcomes in these two groups have been observed. ...
The muscarinic receptor agonist xanomeline improved cognition in phase 2 trials in Alzheimer’s disease and schizophrenia. We present data on the effect of KarXT (xanomeline–trospium) on cognition in schizophrenia from the 5-week, randomised, double-blind, placebo-controlled EMERGENT-1 trial (NCT03697252). Analyses included 125 patients with computerised Cogstate Brief Battery (CBB) subtest scores at baseline and endpoint. A post hoc subgroup analysis evaluated the effects of KarXT on cognitive performance in patients with or without clinically meaningful cognitive impairment at baseline, and a separate outlier analysis excluded patients with excessive intraindividual variability (IIV) across cognitive subdomains. ANCOVA models assessed treatment effects for completers and impairment subgroups, with or without removal of outliers. Sample-wide, cognitive improvement was numerically but not statistically greater with KarXT (n = 60) than placebo (n = 65), p = 0.16. However, post hoc analyses showed 65 patients did not exhibit clinically meaningful cognitive impairment at baseline, while eight patients had implausibly high IIV at one or both timepoints. Significant treatment effects were observed after removing outliers (KarXT n = 54, placebo n = 63; p = 0.04). Despite the small sample size, a robust (d = 0.50) and significant effect was observed among patients with cognitive impairment (KarXT n = 23, placebo n = 37; p = 0.03). These effects did not appear to be related to improvement in PANSS total scores (linear regression, R2 = 0.03). Collectively, these findings suggest that KarXT may have a separable and meaningful impact on cognition, particularly among patients with cognitive impairment.
... One factor that may mediate the effect of dose is the extent of training engagement. Several studies have suggested that training engagement predicts the extent of training gains in CCT (149,150). Even large doses of CCT may be ineffective if participants are not actually participating in the procedure (151). ...
Technology is ubiquitous in society and is now being extensively used in mental health applications. Both assessment and treatment strategies are being developed and deployed at a rapid pace. The authors review the current domains of technology utilization, describe standards for quality evaluation, and forecast future developments. This review examines technology-based assessments of cognition, emotion, functional capacity and everyday functioning, virtual reality approaches to assessment and treatment, ecological momentary assessment, passive measurement strategies including geolocation, movement, and physiological parameters, and technology-based cognitive and functional skills training. There are many technology-based approaches that are evidence based and are supported through the results of systematic reviews and meta-analyses. Other strategies are less well supported by high-quality evidence at present, but there are evaluation standards that are well articulated at this time. There are some clear challenges in selection of applications for specific conditions, but in several areas, including cognitive training, randomized clinical trials are available to support these interventions. Some of these technology-based interventions have been approved by the U.S. Food and Drug administration, which has clear standards for which types of applications, and which claims about them, need to be reviewed by the agency and which are exempt.
... It remains to be seen whether improvements in short-term memory may be observed in a healthy young adult population in such a short amount of time, as their short-term memory ability typically has less room for improvement. Prior research has indicated that the benefits of behavioral interventions may be most pronounced in populations with the greatest need (93,94). It is possible that longer durations of training may be needed as ability approaches ceiling. ...
Playing a musical instrument engages numerous cognitive abilities, including sensory perception, selective attention, and short-term memory. Mounting evidence indicates that engaging these cognitive functions during musical training will improve performance of these same functions. Yet, it remains unclear the extent these benefits may extend to nonmusical tasks, and what neural mechanisms may enable such transfer. Here, we conducted a preregistered randomized clinical trial where nonmusicians underwent 8 wk of either digital musical rhythm training or word search as control. Only musical rhythm training placed demands on short-term memory, as well as demands on visual perception and selective attention, which are known to facilitate short-term memory. As hypothesized, only the rhythm training group exhibited improved short-term memory on a face recognition task, thereby providing important evidence that musical rhythm training can benefit performance on a nonmusical task. Analysis of electroencephalography data showed that neural activity associated with sensory processing and selective attention were unchanged by training. Rather, rhythm training facilitated neural activity associated with short-term memory encoding, as indexed by an increased P3 of the event-related potential to face stimuli. Moreover, short-term memory maintenance was enhanced, as evidenced by increased two-class (face/scene) decoding accuracy. Activity from both the encoding and maintenance periods each highlight the right superior parietal lobule (SPL) as a source for training-related changes. Together, these results suggest musical rhythm training may improve memory for faces by facilitating activity within the SPL to promote how memories are encoded and maintained, which can be used in a domain-general manner to enhance performance on a nonmusical task.
... A non-commercial attentional control CCT improved selective attention, WM, and decision-making [147]. In this vein, some researchers in their clinical trials conclude that the effect of distant transfer after EF training is far from clear [148].In young adults with schizophrenia, training with Brain HQ affected processing speed, WM, and attention [149], with more significant changes and better effects in patients with low or impaired initial performance, than in patients with high performance [150]. In patients with mood disorders, the intervention with Cogtrain improved executive functioning and processing speed, with a decrease in cognitive depressive symptoms, but without improvements in the mood [151]. ...
This article presents a systematic review of studies on cognitive training programs based on artificial cognitive systems and digital technologies and their effect on executive functions. The aim has been to identify which populations have been studied, the characteristics of the implemented programs, the types of implemented cognitive systems and digital technologies, the evaluated executive functions, and the key findings of these studies. The review has been carried out following the PRISMA protocol; five databases have been selected from which 1889 records were extracted. The articles were filtered following established criteria, to give a final selection of 264 articles that have been used for the purposes of this study in the analysis phase. The findings showed that the most studied populations were school-age children and the elderly. The most studied executive functions were working memory and attentional processes, followed by inhibitory control and processing speed. Many programs were commercial, customizable, gamified, and based on classic tasks. Some more recent initiatives have begun to incorporate user-machine interfaces, robotics, and virtual reality, although studies on their effects remain scarce. The studies recognize multiple benefits of computerized neuropsychological stimulation and rehabilitation programs for executive functions in different age groups, but there is a lack of studies in specific population sectors and with more rigorous research designs.
Supplementary information:
The online version contains supplementary material available at 10.1007/s13369-022-07292-5.
... Several studies have investigated the cognitive and social functioning of patients with schizophrenia. Improvements in cognitive function have been reported to affect social function in schizophrenia [11][12][13][14]. According to Green prognosis in schizophrenia is influenced by cognitive functions, such as attention, language, memory, and information processing [15]. ...
Background:
Social dysfunction is associated with decreased activity, employment difficulties, and poor prognosis in patients with schizophrenia. Cognitive functions, such as attention and processing speed, have been implicated in the social functions of schizophrenia patients; however, the relationship between cognitive functions and social functions remains unclear. Thus, understanding the factors that influence social functioning can aid the development of therapeutic strategies for schizophrenia. Herein, we retrospectively analyzed factors that influence social functioning in patients with schizophrenia.
Methods:
Patient background, intelligence quotient (IQ) scores, Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J) scores, the dose of antipsychotic drugs, Positive and Negative Syndrome Scale (PANSS) scores, and the factors influencing each subscale of the Japanese version of the Social Functioning Scale (SFS-J) were evaluated using univariate and multivariate analyses. The Bonferroni correction was applied to evaluate the correlation between each factor in the univariate analysis. In multivariate analysis, independent variables were selected using a stepwise method. In each model, considering the sample size, the maximum number of variables extracted using the stepwise method was set to three. We then calculated the standard partial regression coefficient (standard β) between the SFS-J subscale scores and each factor.
Results:
Data from 36 patients were analyzed. The average age, illness duration, and total length of hospitalization were 57.8 years, 34.8 years, and 196.7 months, respectively. Of the seven significant correlations with the SFS-J subscale in the univariate analysis, only three were significant in the multivariate analysis model. According to the multivariable model, BACS-J verbal fluency positively correlated with SFS-J withdrawal, interpersonal communication, and employment/occupation. Moreover, BACS-J token motor and educational history were positively correlated with SFS-J recreation and SFS-J employment/occupation, respectively. PANSS scores, IQ scores, and doses of antipsychotic drugs did not show clear associations with SFS-J scores.
Conclusions:
In conclusion, there were significant correlations between BACS-J subscale scores for cognitive functioning and SFS-J subscale scores for social functioning in patients with schizophrenia.
... training was a significant independent predictor of cognitive gains, irrespective of simple exposure (Harvey et al., 2020). Given that individuals with PD experience decreased reward sensitivity in an off-dopaminergic medication state, as well as increased apathy (Muhammed et al., 2016), this may be a particularly relevant concern for use of CT in this population. ...
Technological Advancements in Aging and Neurological Conditions to Improve Physical Activity, Cognitive Functions, and Postural Control.
... training was a significant independent predictor of cognitive gains, irrespective of simple exposure (Harvey et al., 2020). Given that individuals with PD experience decreased reward sensitivity in an off-dopaminergic medication state, as well as increased apathy (Muhammed et al., 2016), this may be a particularly relevant concern for use of CT in this population. ...
Whilst Parkinson's disease (PD) is typically thought of as a motor disease, a significant number of individuals also experience cognitive impairment (CI), ranging from mild-CI to dementia. One technique that may prove effective in delaying the onset of CI in PD is cognitive training (CT); however, evidence to date is variable. This may be due to the implementation of CT in this population, with the motor impairments of PD potentially hampering the ability to use standard equipment, such as pen-and-paper or a computer mouse. This may, in turn, promote negative attitudes toward the CT paradigm, which may correlate with poorer outcomes. Consequently, optimizing a system for the delivery of CT in the PD population may improve the accessibility of and engagement with the CT paradigm, subsequently leading to better outcomes. To achieve this, the NeuroOrb Gaming System was designed, coupling a novel accessible controller, specifically developed for use with people with motor impairments, with a "Serious Games" software suite, custom-designed to target the cognitive domains typically affected in PD. The aim of the current study was to evaluate the usability of the NeuroOrb through a reiterative co-design process, in order to optimize the system for future use in clinical trials of CT in individuals with PD. Individuals with PD (n = 13; mean age = 68.15 years; mean disease duration = 8 years) were recruited from the community and participated in three co-design loops. After implementation of key stakeholder feedback to make significant modifications to the system, system usability was improved and participant attitudes toward the NeuroOrb were very positive. Taken together, this provides rationale for moving forward with a future clinical trial investigating the utility of the NeuroOrb as a tool to deliver CT in PD.
... It is very difficult to determine the level of effectiveness of an intervention to treat this impairment [20]. Primarily the focus of this rehabilitation is on restoring the lost brain functions and CBCI proved it's the best efficacy for this work [21]. To our knowledge, no other study exists comparing CBCI through ...
Objective: The main purpose of this study was to investigate the effectiveness of computer based cognitive intervention (CBCI) on the functional independence level, anxiety and depression level and disability levels in post stroke patients in comparison with conventional cognitive intervention (CCI). Methods: This study includes sample of 80 acute (up to 6 months) post stroke patients. No recurrent stroke patients were included. Cognitive impairment with MMSE score>10, age between 18 to 65 years, were selected as inclusion criteria. Both groups (N=40 in each group) were trained in session of 30 minutes per day, 5 days a week, for 4 weeks. One group named as Group A performing the computer based cognitive intervention and the other group performing conventional cognitive intervention named as Group B. The main outcome Measures-The relative levels of functional independence, anxiety and depression and disability were measured before and after intervention (after 4 weeks) using the Barthel Index (BI),Hospital Anxiety and Depression Scale (HADS), World Health Organization Disability Assessment Scale 2.0 (WHODAS 2.0). Findings: After 4 weeks of intervention both the groups showed significant improvement in levels of functional independence, anxiety and depression and disability. The group A showed better therapeutic effects in a time-dependent manner in comparison to the group B on levels of anxiety and depression and disability but there was no significant difference observed in the levels of functional independence. Conclusion: These findings suggest that computer based cognitive intervention may have effects on the improvements of levels of functional independence, anxiety and depression and disability in comparison with conventional cognitive intervention in stroke.
... It will be important for such assessments to include standardized measures that are sensitive to detect change, that are not hampered by floor or ceiling effects, and that consider premorbid functioning. For example, it is questionable whether individuals with cognitive performance in the normal, but below expected range, would benefit from cognitive interventions to the same extent as lower functioning individuals with schizophrenia, given that participants with greater cognitive impairment benefit differentially more from cognitive remediation than less cognitively impaired participants (DeTore et al., 2019;Harvey et al., 2020;Strassnig et al., 2018). Through the implementation of standard cognitive evaluation, it will become easier to capture whether patients experience clinically meaningful decline and to detect 'islands' of preserved functions. ...
Cognitive impairment is a well-recognized key feature of schizophrenia. Here we review the evidence on (1) the onset and sensitive periods of change in cognitive impairment before and after the first psychotic episode, and (2) heterogeneity in neurocognitive presentations across cognitive domains between and within individuals. Overall, studies suggest that mild cognitive impairment in individuals who develop schizophrenia or related disorders is already present during early childhood. Cross-sectional studies further suggest increasing cognitive impairments from pre- to post-psychosis onset, with the greatest declines between adolescence, the prodrome, and the first psychotic episode and with some variability between domains. Longitudinal studies with more than 10 years of observation time are scarce but support mild cognitive declines after psychosis onset until late adulthood. Whether and how much this cognitive decline exceeds normal aging, proceeds further in older patients, and is specific to certain cognitive domains and subpopulations of patients remains to be investigated. Finally, studies show substantial heterogeneity in cognitive performance in schizophrenia and suggest a variety of impairment profiles.
This review highlights a clear need for long-term studies that include a control group and individuals from adolescence to old age to better understand critical windows of cognitive change and its predictors. The available evidence stresses the importance of interventions that aim to counter cognitive decline during the prodromal years, as well as careful assessment of cognition in order to determine who will profit most from which cognitive training.
