A Short Course Computer-assisted Cognitive Remediation in Patients with Schizophrenia Spectrum Disorders: A Randomized Clinical Trial

Abstract

Introduction: Cognitive remediation is used to improve cognitive functioning in patients with schizophrenia. Most of the previous studies had incorporated a long duration of a rehabilitation program. This study aims to evaluate the effect of a short course and easy to implement computer-based cognitive remediation on the cognitive performance in patients with schizophrenia spectrum disorders using a randomized controlled trial design. Method: Sixty-two patients with schizophrenia spectrum disorders were enrolled in Roozbeh Hospital (Tehran, Iran) and were randomized to either receive a cognitive remediation program added to the standard pharmacological treatment (n=31) or the standard treatment alone (n=31). The remediation consisted of ten sessions of the cognitive training provided 2-3 times a week by applying the Cogpack software. The cognitive performance was assessed in attention, memory and executive function before and after the interventions by using the respective tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Results: This study did not demonstrate any significant improvement in attention and executive function in the experimental vs control group. Nonetheless, we observed modest improvements in some aspects of visual memory (first trial memory score, F=9.152, P< 0.001, Cohen’s d=0.40; Mean errors to success, F= 6.991, P= 0.011, Cohen’s d=0.14; stages completed on first trial, F= 7.155, P= 0. 010, Cohen’s d=0.71; Total errors, F= 5.730, P= 0.020, Cohen’s d=0.53). Conclusion: We observed only modest improvements in the patients' cognitive functioning after a short-course of cognitive remediation. The short duration of the training and lack of a comprehensive rehabilitation plan may explain the findings.

Advances in Cognitive Remediation Training in Schizophrenia: A Review

“…Out of the 26 studies included, two included a paper-and-pencil format that had dropout rates of 0 [ 9 ] and 8 [ 15 ]. Twenty-three studies included a computerized CRT program with dropout rates ranging from 0 to 53 [ 7 , 8 , 10 , 11 , 12 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. One study compared paper-and-pencil and computerized CRT to one another and had 9 total dropouts [ 25 ].…”

“…Both group and individual formats implementing CRT were found from our search. Of the 26 articles, nine studies used an individual format [ 7 , 11 , 12 , 13 , 14 , 23 , 24 , 29 , 31 ] and 17 used a group format [ 8 , 9 , 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 25 , 26 , 27 , 28 , 30 , 32 ]. One study [ 22 ] had participants complete homework exercises in their own homes, but the CRT program itself was implemented in a group outpatient setting.…”

“…While participants were partaking in the cognitive exercises, therapists guided the process by asking questions aimed at enhancing metacognition and information processing. Such a strategy-based approach was implemented in several other studies that included performance feedback, encouragement to practice new strategies in future sessions, and compensatory strategies relevant to the individual’s needs [ 9 , 15 , 16 , 22 , 26 , 28 , 30 , 31 , 32 ]. One study allotted 10 min before and after each CRT session for participants to socially interact and share learning strategies [ 25 ].…”

“…Gharaeiour et al (2012) also found a significant improvement in visual learning ( p = 0.014). Visual memory, measured by the Neuropsychological Test Automated Battery, was improved in one study [ 31 ] with effect sizes ranging from 0.14 to 0.71 on various subscales of the measure.…”