Targeted cognitive training improves auditory and verbal outcomes among treatment refractory schizophrenia patients mandated to residential care

Abstract

Computerized targeted cognitive training (TCT) of auditory processing has been shown to improve verbal learning in several clinical trials of schizophrenia outpatients. Less is known, however, about the effectiveness of this promising intervention in more chronic, treatment-refractory patients who are treated in non-academic settings. This study aimed to determine whether TCT improves auditory processing, verbal learning, and clinical symptoms in SZ patients mandated to receive care at a locked residential rehabilitation center. Secondarily, potential factors that moderate TCT's effectiveness including age, symptom severity, antipsychotic medication load, and duration of illness were examined. Schizophrenia patients were randomized to treatment as usual (TAU; n = 22) or TAU augmented with TCT (TAU + TCT; n = 24). Outcomes included a measure of auditory perception (Word-In-Noise test, WIN), verbal learning domain scores from the MATRICS Consensus Cognitive Battery (MCCB), and clinical symptoms (Scale for the Assessment of Positive Symptoms, SAPS; Scale for the Assessment of Negative Symptoms, SANS). TCT produced significant improvements in auditory perception (d = 0.67) and verbal learning (d = 0.65); exploratory analyses revealed a statistically significant reduction in auditory hallucinations (d = -0.64). TCT's effects were only weakly, and mostly non-significantly, moderated by age, clinical symptoms, medication, and illness duration. These findings indicate that even highly symptomatic, functionally disabled patients with chronic illness benefit from this emerging treatment. Ongoing studies will examine the predictive utility of neurophysiological biomarkers and other characteristics assessed at baseline.

Neurophysiologic measures of target engagement predict response to auditory-based cognitive training in treatment refractory schizophrenia

“…[37]), and determine whether this malleability predicts TCT outcomes after a 30 h course of treatment. We have previously reported a favorable TCT response in this cohort [15], with significant improvements in MCCB verbal learning t-scores (d = 0.65-082), and reductions in auditory hallucinations (d = −0.58), consistent with existing literature [6]. Based on our previous report [37], we hypothesized that there would be significant changes in MMN and P3a in recordings completed immediately before and after the 1st hour of TCT, and that the degree of this initial change would predict post-treatment improvements in verbal learning and positive symptom severity.…”

“…The "bottom up" approach of TCT is congruent with mounting evidence that abnormalities in early auditory information processing (EAIP) substantially contribute to impairments in higher-order cognitive and psychosocial functioning [10][11][12][13][14][15][16]. Efficacy trials in schizophrenia patients have shown that TCT improves higher-order cognitive functioning [6,9,15,[17][18][19][20], particularly in the domain of verbal learning. However, individual responses to TCT vary, with up to 45% of patients exhibiting minimal or no benefit even after extended therapeutic "doses" [21].…”

“…One promising intervention, auditory-based targeted cognitive training (TCT), aims to drive improvements in higher-order cognitive function (i.e., verbal learning) via enhancement of basic auditory information processing [6][7][8][9]. The "bottom up" approach of TCT is congruent with mounting evidence that abnormalities in early auditory information processing (EAIP) substantially contribute to impairments in higher-order cognitive and psychosocial functioning [10][11][12][13][14][15][16]. Efficacy trials in schizophrenia patients have shown that TCT improves higher-order cognitive functioning [6,9,15,[17][18][19][20], particularly in the domain of verbal learning.…”

“…However, individual responses to TCT vary, with up to 45% of patients exhibiting minimal or no benefit even after extended therapeutic "doses" [21]. Although factors such as illness severity and age have been proposed as potential moderators of patient response to cognitive remediation, strong and reliable predictors of treatment success have not yet been identified [8,15,22,23].…”

Regulation of perceptual learning by chronic chemogenetic manipulation of parvalbumin-positive interneurons

“…These will improve our understanding of adult plasticity and help devise better rehabilitation strategies for patients with perceptual and cognitive impairments (Kantrowitz et al, 2018;Thomas et al, 2018).…”