Computer-assisted cognitive remediation in schizophrenia: What is the active ingredient?

Abstract

An emerging body of research has shown that computer-assisted cognitive remediation, consisting of training in attention, memory, language and/or problem-solving, produces improvement in neurocognitive function that generalizes to untrained neurocognitive tests and may also impact symptoms and work functioning in patients with schizophrenia. The active ingredient of these interventions, however, remains unknown as control groups in these studies have typically included few, if any, of the elements of these complex behavioral treatments. This study compared the effects of an extended (12-month), standardized, computer-assisted cognitive remediation intervention with those of a computer-skills training control condition that consisted of many of the elements of the experimental intervention, including hours spent on a computer, interaction with a clinician and nonspecific cognitive stimulation. Forty-two patients with schizophrenia were randomly assigned to one of two conditions and were assessed with a comprehensive neuropsychological test battery before and after treatment. Results revealed that cognitive-remediation training produced a significant improvement in working memory, relative to the computers-skills training control condition, but that there was overall improvement in both groups on measures of working memory, reasoning/executivefunction, verbal and spatial episodic memory, and processing speed. Taken together, these findings suggest that specific practice in neurocognitive exercises targeted at attention, memory and language, produce improvements in neurocognitive function that are not solely attributable to non-specific stimulation associated with working with a computer, interacting with a clinician or cognitive challenge, but that non-specific stimulation has a salutary effect on neurocognition as well.

Symptoms versus neurocognition as predictors of change in life skills in schizophrenia after outpatient rehabilitation

“…Patients who agreed to take part in the study gave written, informed consent at the time of their entry to outpatient rehabilitation and were randomly assigned to one of two computerized cognitive rehabilitation groups (cognitive remediation or computer-skills training). The results comparing the relative effects of these interventions on neuropsychological test performance in a subset of the patients described in this paper were previously reported (Kurtz et al, 2007). In the present paper we describe results collapsed across computer interventions.…”

Improved cognitive function in schizophrenia after one year of cognitive training and vocational services

“…We cannot determine the relative contribution of each of these activities to observed benefits, and they may work synergistically. However, a recent study, using some of the same computer exercises employed in this study, also found that the patients receiving the exercises showed greater improvement on Digit Span than did a comparison group (Kurtz et al, 2007). Since that study did not include additional groups or employment in the intervention, it suggests that the most important factor in the present results may be the computerized cognitive remediation.…”

“…(Twamley, Jeste, Bellack, 2003;Kurtz et al, 2001). Cognitive training has been shown to improve sustained attention and language processing (Wexler et al, 1997), executive function (Bell et al, 2001, Wykes et al, 1999, affect recognition (Bell et al, 2001), verbal memory (Hogarty et al, 2004;McGurk & Mueser, 2004), working memory (Bell et al, 2001;Kurtz et al, 2007), processing speed (Hogarty et al, 2004) and social problem solving (Kern et al, 2005).…”

Computer-based Cognitive and Socio-emotional Training in Psychopathology

“…Two theoretical arguments support this view. Firstly, literature states that computer exercises hold opportunities for learning novel strategies that enable bypassing impaired abilities (Kurtz et al, 2007). Secondly, repeated practice in a multimedia environment is believed to hasten cortical reorganization (Butti et al, 1998).…”

“…Hence, the studies presented here have been selected on the basis that they employ assessment tasks that are different from tasks used during training. Several randomized controlled trials have been conducted to evaluate the effectiveness of CACR in schizophrenia (Bell et al, 2001;Bellucci et al, 2002;Burda et al, 1994;Field et al, 1997;Greig et al, 2007;Hogarty et al, 2004;Kurtz et al, 2007;Medalia et al, 2000;Medalia et al, 2001;Sartory et al, 2005;Vauth et al, 2005). Most have reported improvements of cognitive performances, with some exceptions as for example Field and colleagues (1997) and Medalia and colleagues (2000).…”