Cognitive Remediation: A Promising Avenue for Patients with Schizophrenia?

While we often picture hallucinations and delusions when thinking about the clinical presentation of schizophrenia, cognitive symptoms are an incredibly impairing aspect of the disorder. For example, they make it difficult for patients to perform everyday tasks, to function on the job, and to interact socially. Though antipsychotic medications were an important breakthrough in the treatment of psychotic disorders, they generally target positive symptoms and have shown little effect on cognitive impairment. Given the major impact of cognitive symptoms on patients’ daily functioning and quality of life, recent research on a novel application of cognitive remediation training may hold great promise for improving the lives of patients with schizophrenia. What exactly is cognitive remediation training? It involves repeated training on cognitive tasks, somewhat like playing a challenging computer game every day. However, these tasks are specifically targeted to enhance neurocognitive abilities, such as working memory. The idea behind this research is based on our knowledge of neural plasticity, and that connections in the brain can actually be strengthened through repeated experience with a task. A meta-analysis of 26 studies on cognitive remediation demonstrated improvements in cognitive performance and positive effects on functioning when combined with other forms of treatment (McGurk et al., 2007). Recent research suggests that gains were maintained six months after the intervention, with patients who performed 100 hours of computerized training showing the broadest improvements (Fisher et al., 2010).

Given that this area of research is relatively new, many questions remain to be answered. For example, what is the appropriate “dose” of training (i.e., how often do patients need to practice in order to improve)? To what extent will gains generalize to other areas of cognition or functioning? Might medication enhance the effects of training? Stay tuned, as future research on these topics will be critical to understanding the potential of this novel treatment and may provide great promise for the treatment of schizophrenia.

 

Fisher, M., Holland, C., Subramaniam, K., Vinogradov, S. (2010). Neuroplasticity-Based Cognitive Training in Schizophrenia: An Interim Report on the Effects 6 Months Later. Schizophrenia Bulletin, 36(4), 869-879.

McGurk, S.R., Twamley, E.W., Sitzer, D.I., McHugo, G.J, Mueser, K.T. (2007). A Meta-Analysis of Cognitive Remediation in Schizophrenia. American Journal of Psychiatry, 164, 1791-1802.