title: Report on ISCTM Consensus Meeting on Clinical Assessment of Response to Treatment of Cognitive Impairment in Schizophrenia.
abstract: If treatments for cognitive impairment are to be utilized successfully, clinicians must be able to determine whether they are effective and which patients should receive them. In order to develop consensus on these issues, the International Society for CNS Clinical Trials and Methodology (ISCTM) held a meeting of experts on March 20, 2014, in Washington, DC. Consensus was reached on several important issues. Cognitive impairment and functional disability were viewed as equally important treatment targets. The group supported the notion that sufficient data are not available to exclude patients from available treatments on the basis of age, severity of cognitive impairment, severity of positive symptoms, or the potential to benefit functionally from treatment. The group reached consensus that cognitive remediation is likely to provide substantial benefits in combination with procognitive medications, although a substantial minority believed that medications can be administered without nonpharmacological therapy. There was little consensus on the best methods for assessing cognitive change in clinical practice. Some participants supported the view that performance-based measures are essential for measurement of cognitive change; others pointed to their cost and time requirements as evidence of impracticality. Interview-based measures of cognitive and functional change were viewed as more practical, but lacking validity without informant involvement or frequent contact from clinicians. The lack of consensus on assessment methods was viewed as attributable to differences in experience and education among key stakeholders and significant gaps in available empirical data. Research on the reliability, validity, sensitivity, and practicality of competing methods will facilitate consensus.
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, NC; richard.keefe@duke.edu.
authors.forename: Richard S E
authors.initials: RS
authors.lastname: Keefe
authors.affiliation: Department of Neuroscience Clinical Development, Abbvie, North Chicago, IL;
authors.forename: George M
authors.initials: GM
authors.lastname: Haig
authors.affiliation: Semel Institute for Neuroscience at UCLA, and VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA ;
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Marder
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Miami, FL;
authors.forename: Philip D
authors.initials: PD
authors.lastname: Harvey
authors.affiliation: Clinical Development, Takeda, Los Angeles, CA;
authors.forename: Eduardo
authors.initials: E
authors.lastname: Dunayevich
authors.affiliation: Department of Psychiatry, Columbia University, New York, NY;
authors.forename: Alice
authors.initials: A
authors.lastname: Medalia
authors.affiliation: Department of Psychiatry, The Chaim Sheba Medical Center, Tel Hashomer, Israel;
authors.forename: Michael
authors.initials: M
authors.lastname: Davidson
authors.affiliation: Clinical Research, FORUM Pharmaceuticals, Waltham, MA;
authors.forename: Ilise
authors.initials: I
authors.lastname: Lombardo
authors.affiliation: Department of Psychology, Queen's University, Kingston, Ontario, Canada;
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Bowie
authors.affiliation: Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD;
authors.forename: Robert W
authors.initials: RW
authors.lastname: Buchanan
authors.affiliation: Department of Psychiatry, F. Hoffmann-La Roche Ltd., Basel, Switzerland;
authors.forename: Dragana
authors.initials: D
authors.lastname: Bugarski-Kirola
authors.affiliation: Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD;
authors.forename: William T
authors.initials: WT
authors.lastname: Carpenter
authors.affiliation: Department of Psychiatry, Northwestern University Feinberg School of Medicine, Evanston, IL;
authors.forename: John T
authors.initials: JT
authors.lastname: Csernansky
authors.affiliation: Department of Psychiatry, Northwestern University Feinberg School of Medicine, Evanston, IL;
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Dago
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Miami, FL;
authors.forename: Dante M
authors.initials: DM
authors.lastname: Durand
authors.affiliation: Department of Psychiatry, Northeast Ohio Medical University, Rootstown, OH;
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Frese
authors.affiliation: Department of Psychiatry, Nathan Kline Institute, and New York University School of Medicine New York, NY;
authors.forename: Donald C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD;
authors.forename: James M
authors.initials: JM
authors.lastname: Gold
authors.affiliation: Harvard University;
authors.forename: Christine I
authors.initials: CI
authors.lastname: Hooker
authors.affiliation: Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA;
authors.forename: Alex
authors.initials: A
authors.lastname: Kopelowicz
authors.affiliation: Global Clinical Development, Sunovion, Ft. Lee, NJ;
authors.forename: Antony
authors.initials: A
authors.lastname: Loebel
authors.affiliation: Center for Psychiatric Rehabilitation, Boston University, Boston, MA;
authors.forename: Susan R
authors.initials: SR
authors.lastname: McGurk
authors.affiliation: Department of Psychiatry, Columbia University, New York, NY;
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Opler
authors.affiliation: School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX;
authors.forename: Amy E
authors.initials: AE
authors.lastname: Pinkham
authors.affiliation: Essex County Hospital Center, Cedar Grove, NJ.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Stern
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000627:therapeutic use*; D018579:Patient Selection; D000067250:Psychiatric Rehabilitation / Q000379:methods*; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index
chemical_list: D014150:Antipsychotic Agents; D018697:Nootropic Agents
keywords: cognitive assessment; neuropsychology; treatment