Computerized Training Programs for Schizophrenia Improve Cognitive Functioning

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Small to moderate effect was seen for processing speed, visual learning and memory, and verbal learning and memory with computerized cognitive training.
Small to moderate effect was seen for processing speed, visual learning and memory, and verbal learning and memory with computerized cognitive training.

Computerized cognitive drill and practice training programs are efficacious for improving certain domains of cognitive functioning when performed by patients with schizophrenia spectrum disorders, according to a study published in Schizophrenia Research.

Researchers conducting this meta-analysis sought to evaluate the efficacy of computerized cognitive drill and practice training for improving neurocognitive functioning in patients with schizophrenia. Furthermore, they sought to determine the generalization of cognitive improvement on psychotic and depressive symptoms and functional outcomes.

Researchers searched 4 databases (PubMed, Embase, Cochrane Database of Systematic Reviews, and PsychINFO) for articles comparing the effect of computerized cognitive drill and practice training on patients with a schizophrenia spectrum disorder with active or passive control conditions. Twenty-four studies involving 1262 participants were included in the meta-analysis. Researchers evaluated cognitive functioning domains based on MATRICS guidelines including attention/vigilance, reasoning and problem-solving, working memory, processing speed, verbal learning and memory, visual learning and memory, and social cognition. Psychotic and depressive symptoms and functional outcomes were also measured.

Patients receiving computerized cognitive drill and practice training showed significant improvement in attention (Hedges' g=0.31; P=.001), working memory (Hedges' g=0.38; P<.001), positive symptoms (Hedges' g=0.31; P=.003), and depressive symptoms (Hedges' g=0.37; P=.002) vs the control condition. Small to moderate effect sizes were found for processing speed, verbal and visual learning along with memory, verbal fluency, negative symptoms, and functional outcomes. Computerized training programs did not affect reasoning, problem-solving, or social cognition outcomes. Meta-regression analyses showed no association between age and efficacy of cognitive training; however, illness duration was positively associated with attention and negatively associated with working memory, verbal learning and memory, and visual learning and memory.

Limitations of this meta-analysis include limited data on the amount of therapist involvement in training efficacy, and some reported outcomes were left out to increase comparability between studies. Finally, the treatment effects on social cognition were drawn from only 3 articles and therefore should be interpreted with caution.

The meta-analysis showed that computerized cognitive drill and practice training performed independently by patients with schizophrenia spectrum disorders had a superior effect on domains of attention, working memory, and positive and depressive symptoms. Although the effect was modest or absent for social cognitive and functional outcomes, these findings suggest that including learning strategies, such as reasoning and problem solving, might improve the generalizability of treatment effects.

Reference                                                                                                                       

Prikken M, Konings MJ, Lei WU, Begemann MJH, Sommer IEC. The efficacy of computerized cognitive drill and practice training for patients with a schizophrenia-spectrum disorder: a meta-analysis [published online August 7, 2018]. Schizophr Res. doi: 10.1016/j.schres.2018.07.034

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