Neuroplasticity-based auditory training via laptop computer improves cognition in young individuals with recent onset schizophrenia.
OBJECTIVE
Cognitive deficits that characterize schizophrenia are present in the prodrome, worsen with illness onset, and predict functional outcome. Cognitive dysfunction is thus a critical target for early intervention in young individuals with recent onset schizophrenia.


METHODS
This 2-site double-blind randomized controlled trial investigated cognitive training of auditory processing/verbal learning in 86 subjects with recent onset schizophrenia (mean age of 21 years). Subjects were given laptop computers to take home and were asked to perform 40 hours of training or 40 hours of commercial computer games over 8 weeks. We examined cognitive measures recommended by the Measurement and Treatment Research to Improve Cognition in Schizophrenia initiative (MATRICS), symptoms, and functioning. We also assessed baseline reward anticipation to index motivational system functioning and measured changes in auditory processing speed after 20 hours of training to assess target engagement.


RESULTS
Auditory training subjects demonstrated significant improvements in global cognition, verbal memory, and problem solving compared with those of computer games control subjects. Both groups showed a slight but significant decrease in symptoms and no change in functional outcome measures. Training-induced cognitive gains at posttraining showed significant associations with reward anticipation at baseline and with improvement in auditory processing speed at 20 hours.


CONCLUSIONS
Neuroscience-informed cognitive training via laptop computer represents a promising treatment approach for cognitive dysfunction in early schizophrenia. An individual's baseline motivational system functioning (reward anticipation), and ability to engage in auditory processing speed improvement, may represent important predictors of treatment outcome. Future studies must investigate whether cognitive training improves functioning and how best to integrate it into critical psychosocial interventions.
Department of Psychiatry, University of California, San Francisco, CA; Department of Psychiatry, San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA;
Melissa
M
Fisher
Department of Psychiatry, University of California, San Francisco, CA;
Rachel
R
Loewy
Department of Psychiatry, University of California, Davis, CA.
Cameron
C
Carter
Department of Psychiatry, University of California, San Francisco, CA;
Ashley
A
Lee
Department of Psychiatry, University of California, Davis, CA.
J Daniel
JD
Ragland
Department of Psychiatry, University of California, Davis, CA.
Tara
T
Niendam
Department of Psychiatry, University of California, San Francisco, CA;
Danielle
D
Schlosser
Department of Psychiatry, University of California, Davis, CA.
Lien
L
Pham
Department of Psychiatry, University of California, Davis, CA.
Tara
T
Miskovich
Department of Psychiatry, University of California, San Francisco, CA; Department of Psychiatry, San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA; Sophia.vinogradov@ucsf.edu.
Sophia
S
Vinogradov
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001307:Auditory Perception; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D009473:Neuronal Plasticity; D011340:Problem Solving; D012559:Schizophrenia / Q000150:complications / Q000628:therapy*; D012565:Schizophrenic Psychology; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014706:Verbal Learning; D055815:Young Adult
D014150:Antipsychotic Agents
cognitive remediation; cognitive training; early psychosis; first-episode schizophrenia; motivation