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CognitiveRetrainingandSchizophrenia

RashikhChoudhury

Background:

-Patientswithschizophreniademonstrateaprofounddisruptionintheircognition

-Trialsusingpsychopharmacologywithpotentialcognitionenhancingdrugshave

notshownsignificantimprovementsincognitivecapacity(MATRICS,TURNS,CNTRICS).

-Thereisgrowingbodyofevidencesuggestingthatcognitiveremediationtrainingisaneffectivemethodofimprovingperformanceintrained/untrainedtasksin

schizophreniapatients.

CognitiveTraining:

-Inverbalmemory,largereffectsareobservedwhencomputerizedtrainingisgiveninadrill-and-practiceapproachforalargernumberofhours(McGurk2007,Wykes

2009).

-Withtheexceptionofverballearningandmemory,studieshavefoundno

significantheterogeneityineffectonothercognitivedomainsbasedoneitherthe

numberofhoursoftrainingorthemethodemployed(McGurk2007).-Significantsynergyoccurswhencognitiveremediationiscombinedwitha

psychosocialintervention,suchasvocationalrehabilitationorsocialskillstraining

(McGurk2007).Highlightsthepointthatoptimaltreatmentinschizophreniawill

likelyrequiremultimodal

approaches.

-Serumanticholinergicactivity(SAA),reflectingmedication-

inducedanticholinergicburden,

showedasignificantnegative

correlationwithcognitive

improvementaftertraining.

Consistentwithbasicscience

research,thissuggeststhatthe

anticholinergicburdenreduces

theefficacyofcognitivetraining

indrivingcognitive

improvement(Vingogradov2009).

-Subjectsinthecognitive

trainingconditionshoweda

significantincreaseinserumbrain-derivedneurotrophicfactor(BDNF)levels(Vinogradov2009).

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-Subjectswererandomlyassignedtoeither50hours(1hourperday,5daysper

week)ofacomputergamescontrolcondition,orto50hoursofcomputerized

trainingthatplacesimplicit,increasingdemandsonauditoryperceptionand

accurateauralspeechreception(Genesky2010).

-Subjectswhounderwenttargetedcognitivetrainingshowedsignificantincreasesin

WorkingMemory,VerbalLearningandMemory,andGlobalCognition(Genesky2010).

References:

McGurkSR,TwamleyEW,SitzerDI,McHugoGJ,MueserKT.Ameta-analysisofcognitiveremediation

inschizophrenia.AmJPsychiatry.2007;164:1791-1802.

WykesT,HuddyV.Cognitiveremediationforschizophrenia:itisevenmorecomplicated.CurrOpin

Psychiatry.2009;22:161-167.

VinogradovS,FisherM,HollandC,ShellyW,WolkowitzO,MellonSH.Isserumbrain-derived

neurotrophicfactorabiomarkerforcognitiveenhancementinschizophrenia?BiolPsychiatry.

2009;66:549-553.

Genesky,Garrett,Alexandaer,VinogradovS.Cognitivetraininginschizophrenia:

aneuroscience-basedapproach.DialoguesinClinicalNeuroscience.2010