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Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: a meta-analytical study

Published online by Cambridge University Press:  12 April 2010

O. Grynszpan ,
S. Perbal ,
A. Pelissolo ,
P. Fossati ,
R. Jouvent ,
S. Dubal  and
F. Perez-Diaz
O. Grynszpan*
Affiliation:
Centre Emotion, CNRS USR 3246, Hôpital de La Salpêtrière, Paris, France Pierre et Marie Curie University, Paris, France
S. Perbal
Affiliation:
Centre Emotion, CNRS USR 3246, Hôpital de La Salpêtrière, Paris, France
A. Pelissolo
Affiliation:
Centre Emotion, CNRS USR 3246, Hôpital de La Salpêtrière, Paris, France
P. Fossati
Affiliation:
Centre Emotion, CNRS USR 3246, Hôpital de La Salpêtrière, Paris, France Pierre et Marie Curie University, Paris, France
R. Jouvent
Affiliation:
Centre Emotion, CNRS USR 3246, Hôpital de La Salpêtrière, Paris, France Pierre et Marie Curie University, Paris, France
S. Dubal
Affiliation:
Centre Emotion, CNRS USR 3246, Hôpital de La Salpêtrière, Paris, France
F. Perez-Diaz
Affiliation:
Centre Emotion, CNRS USR 3246, Hôpital de La Salpêtrière, Paris, France
*
*Address for correspondence: Dr O. Grynszpan, CNRS USR 3246, Service du Professeur Roland Jouvent, Pavillon Clérambault, Bâtiment de La Force, Hôpital de La Salpêtrière, 47 Bd de l'Hôpital, F-75013Paris, France. (Email: [email protected])
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Abstract

Background

Cognitive remediation is frequently based on computerized training methods that target different cognitive deficits. The aim of this article was to assess the efficacy of computer-assisted cognitive remediation (CACR) in schizophrenia and to determine whether CACR enables selective treatment of specific cognitive domains.

Method

A meta-analysis was performed on 16 randomized controlled trials evaluating CACR. The effect sizes of differences between CACR and control groups were computed and classified according to the cognitive domain assessed. The possible influences of four potential moderator variables were examined: participants' age, treatment duration, weekly frequency, and control condition type. To test the domain-specific effect, the intended goal of each study was determined and the effect sizes were sorted accordingly. The effect sizes of the cognitive domains explicitly targeted by the interventions were then compared with those that were not.

Results

CACR enhanced general cognition with a mean effect size of 0.38 [confidence interval (CI) 0.20–0.55]. A significant medium effect size of 0.64 (CI 0.29–0.99) was found for Social Cognition. Improvements were also significant in Verbal Memory, Working Memory, Attention/Vigilance and Speed of Processing with small effect sizes. Cognitive domains that were specifically targeted by the interventions did not yield higher effects than those that were not.

Conclusions

The results lend support to the efficacy of CACR with particular emphasis on Social Cognition. The difficulty in targeting specific domains suggests a ‘non-specific’ effect of CACR. These results are discussed in the light of the possible bias in remediation tasks due to computer interface design paradigms.

Keywords

Human computer interfaceneuropsychologyrehabilitationsocial cognitiontraining
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 1 , January 2011 , pp. 163 - 173
Copyright
Copyright © Cambridge University Press 2010

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References

Bell, M, Bryson, G, Greig, T, Corcoran, C, Wexler, BE (2001). Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance. Archives of General Psychiatry 58, 763–768.CrossRefGoogle ScholarPubMed
Bell, M, Bryson, G, Greig, T, Fiszdon, J, Wexler, BE (2005). Neurocognitive enhancement therapy with work therapy: productivity outcomes at 6- and 12-month follow-ups. Journal of Rehabilitation Research and Development 42, 829–838.CrossRefGoogle ScholarPubMed
Bell, M, Bryson, G, Wexler, BE (2003). Cognitive remediation of working memory deficits: durability of training effects in severely impaired and less severely impaired schizophrenia. Acta Psychiatrica Scandinavica 108, 101–109.CrossRefGoogle ScholarPubMed
Bell, M, Fiszdon, J, Bryson, G, Wexler, B (2004). Effects of neurocognitive enhancement therapy in schizophrenia: normalisation of memory performance. Cognitive Neuropsychiatry 9, 199–211.CrossRefGoogle ScholarPubMed
Bell, M, Fiszdon, J, Greig, T, Wexler, B, Bryson, G (2007). Neurocognitive enhancement therapy with work therapy in schizophrenia: 6-month follow-up of neuropsychological performance. Journal of Rehabilitation Research and Development 44, 761–770.CrossRefGoogle ScholarPubMed
Bell, M, Zito, W, Greig, T, Wexler, BE (2008). Neurocognitive enhancement therapy with vocational services: work outcomes at two-year follow-up. Schizophrenia Research 105, 18–29.CrossRefGoogle ScholarPubMed
Bellucci, DM, Glaberman, K, Haslam, N (2003). Computer-assisted cognitive rehabilitation reduces negative symptoms in the severely mentally ill. Schizophrenia Research 59, 225–232.CrossRefGoogle ScholarPubMed
Benedict, RH, Harris, AE (1989). Remediation of attention deficits in chronic schizophrenic patients: a preliminary study. British Journal of Clinical Psychology 28, 187–188.CrossRefGoogle ScholarPubMed
Benedict, RHB, Harris, AE, Markow, T, McCormick, JA, Nuechterlein, KH, Asarnow, RF (1994). Effects of attention training on information processing in schizophrenia. Schizophrenia Bulletin 20, 537–546.CrossRefGoogle ScholarPubMed
Burda, PC, Starkey, TW, Dominguez, F, Vera, V (1994). Computer-assisted cognitive rehabilitation of chronic psychiatric inpatients. Computers in Human Behavior 10, 359–368.CrossRefGoogle Scholar
Dix, AJ, Finlay, J, Abowd, GD, Beale, R (1998). Human-Computer Interaction. Pearson Education Limited: London, UK.Google Scholar
Eack, SM, Hogarty, GE, Greenwald, DP, Hogarty, SS, Keshavan, MS (2007). Cognitive enhancement therapy improves emotional intelligence in early course schizophrenia: preliminary effects. Schizophrenia Research 89, 308–311.CrossRefGoogle ScholarPubMed
Field, CD, Galletly, C, Anderson, D, Walfer, P (1997). Computer-aided cognitive rehabilitation: possible application to the attentional deficit of schizophrenia, a report of negative results. Perceptual and Motor Skills 85, 995–1002.Google Scholar
Fiszdon, JM, Choi, J, Bryson, GJ, Bell, MD (2006). Impact of intellectual status on response to cognitive task training in patients with schizophrenia. Schizophrenia Research 87, 261–269.CrossRefGoogle ScholarPubMed
Frommann, N, Streit, M, Wölwer, W (2003). Remediation of facial affect recognition impairments in patients with schizophrenia: a new training program. Psychiatry Research 117, 281–284.CrossRefGoogle ScholarPubMed
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119–135.CrossRefGoogle ScholarPubMed
Greig, TC, Zito, W, Wexler, BE, Fiszdon, J, Bell, MD (2007). Improved cognitive function in schizophrenia after one year of cognitive training and vocational services. Schizophrenia Research 96, 156–161.CrossRefGoogle ScholarPubMed
Heinrichs, RW, Zakzanis, KK (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426–445.CrossRefGoogle ScholarPubMed
Hermanutz, M, Gestrich, J (1991). Computer-assisted attention training in schizophrenics. European Archives of Psychiatry and Clinical Neuroscience 240, 282–287.CrossRefGoogle ScholarPubMed
Hogarty, GE, Flesher, S (1999). Practice principles of cognitive enhancement therapy for schizophrenia. Schizophrenia Bulletin 25, 693–708.CrossRefGoogle ScholarPubMed
Hogarty, GE, Flesher, S, Ulrich, R, Carter, M, Greenwald, D, Pogue-Geile, M, Kechavan, M, Cooley, S, DiBarry, AL, Garrett, A, Parepally, H, Zoretich, R (2004). Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. Archives of General Psychiatry 61, 866–876.CrossRefGoogle ScholarPubMed
Hogarty, GE, Greenwald, DP, Eack, SM (2006). Durability and mechanism of effects of cognitive enhancement therapy. Psychiatric Services 57, 1751–1757.CrossRefGoogle ScholarPubMed
Krabbendam, L, Aleman, A (2003). Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies. Psychopharmacology 169, 376–382.CrossRefGoogle ScholarPubMed
Kurtz, MM, Moberg, PJ, Gur, RC, Gur, RE (2001). Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis. Neuropsychology Review 11, 197–210.CrossRefGoogle ScholarPubMed
Kurtz, MM, Seltzer, JC, Shagan, DS, Thime, WR, Wexler, BE (2007). Computer-assisted cognitive remediation in schizophrenia: what is the active ingredient? Schizophrenia Research 89, 251–260.CrossRefGoogle ScholarPubMed
Lindenmayer, JP, McGurk, SR, Mueser, KT, Khan, A, Wance, D, Hoffman, L, Wolfe, R, Xie, H (2008). A randomized controlled trial of cognitive remediation among inpatients with persistent mental illness. Psychiatric Services 59, 241–247.CrossRefGoogle ScholarPubMed
McGurk, SR, Mueser, KT, Pascaris, A (2005). Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Schizophrenia Bulletin 31, 898–909.CrossRefGoogle ScholarPubMed
McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT (2007). A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry 164, 1791–1802.CrossRefGoogle ScholarPubMed
Medalia, A, Aluma, M, Tryon, W, Merriam, AE (1998). Effectiveness of attention training in schizophrenia. Schizophrenia Bulletin 24, 147–152.CrossRefGoogle ScholarPubMed
Medalia, A, Revheim, N, Casey, M (2000). Remediation of memory disorders in schizophrenia. Psychological Medicine 30, 1451–1459.CrossRefGoogle ScholarPubMed
Medalia, A, Revheim, N, Casey, M (2001). The remediation of problem-solving skills in schizophrenia. Schizophrenia Bulletin 27, 259–267.CrossRefGoogle ScholarPubMed
Medalia, A, Revheim, N, Casey, M (2002). Remediation of problem-solving skills in schizophrenia: evidence of a persistent effect. Schizophrenia Research 57, 165–171.CrossRefGoogle ScholarPubMed
Nuechterlein, KH, Barch, DM, Gold, JM, Goldberg, TE, Green, MF, Heaton, RK (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research 72, 29–39.CrossRefGoogle ScholarPubMed
Pilling, S, Bebbington, P, Kuipers, E, Garety, P, Geddes, J, Martindale, B, Orbach, G, Morgan, C (2002). Psychological treatments in schizophrenia: II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation. Psychological Medicine 32, 783–791.Google Scholar
Sartory, G, Zorn, C, Groetzinger, G, Windgassen, K (2005). Computerized cognitive remediation improves verbal learning and processing speed in schizophrenia. Schizophrenia Research 75, 219–223.Google Scholar
Silver, H, Goodman, C, Knoll, G, Isakov, V (2004). Brief emotion training improves recognition of facial emotions in chronic schizophrenia. A pilot study. Psychiatry Research 128, 147–154.CrossRefGoogle ScholarPubMed
Spitzer, RL, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Twamley, EW, Jeste, DV, Bellack, AS (2003). A review of cognitive training in schizophrenia. Schizophrenia Bulletin 29, 359–382.Google Scholar
Ueland, T, Rund, BR (2004). A controlled randomized treatment study: the effects of a cognitive remediation program on adolescents with early onset psychosis. Acta Psychiatrica Scandinavica 109, 70–74.Google Scholar
Vauth, R, Corrigan, PW, Clauss, M, Dietl, M, Dreher-Rudolph, M, Stieglitz, RD, Vater, R (2005). Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation. Schizophrenia Bulletin 31, 55–66.CrossRefGoogle ScholarPubMed
Wolf, FM (1986). Meta-Analysis: Quantitative Methods for Research Synthesis. Sage Publications Inc.: Newbury Park, CA.Google Scholar
Wölwer, W, Frommann, N, Halfmann, S, Piaszek, A, Streit, M, Gaebel, W (2005). Remediation of impairments in facial affect recognition in schizophrenia: efficacy and specificity of a new training program. Schizophrenia Research 80, 295–303.Google Scholar
Wykes, T, van der Gaag, M (2001). Is it time to develop a new cognitive therapy for psychosis – Cognitive Remediation Therapy (CRT)? Clinical Psychology Review 21, 1227–1256.CrossRefGoogle ScholarPubMed
Zakzanis, KK (2001). Statistics to tell the truth, the whole truth, and nothing but the truth. Formulae, illustrative numerical examples, and heuristic interpretation of effect size analyses for neuropsychological researchers. Archives of Clinical Neuropsychology 16, 653–667.Google Scholar
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