39.1 Baseline Early Auditory Processing as a Tailoring Variable to Personalize Cognitive Remediation for Schizophrenia
Year: 2019
Type: conference-abstract
Abstract: Schizophrenia is associated with cognitive deficits that negatively impact essential areas of daily functioning. Evidence of learning-dependent plasticity in the distributed neural systems that underlie perception and cognition has opened up a burgeoning field of research in cognitive remediation (CR). While the aggregate literature on CR for schizophrenia indicates moderate effect for cognitive and functional outcomes, questions about personalized delivery and essential training elements remain. These shortcomings have constrained the translation of CR research into practical application. Baseline early auditory processing (EAP) holds promise as a way to personalize treatment for the cognitive deficits in schizophrenia. EAP deficits are present in about half of diagnosed patients and are associated with poor functional outcome via impaired cognition. Results of CR studies that target EAP have been mixed, possibly because a systematic method of identifying who needs EAP training was not utilized. Further, not all CR programs- even those that provide restorative, hierarchically organized cognitive training exercises- provide EAP training. Some begin training at the level of attention or even proceed directly to training problem solving and other higher order cognitive abilities. Baseline assessment of EAP could optimize CR outcomes by personalizing treatment of EAP to need. This study examined the differential benefit of EAP training for those with and without baseline EAP deficits as defined by performance on the Tone Matching Test. 103 outpatients aged 18–65, diagnosed with schizophrenia spectrum disorder, were first classified as having intact (48.5%) or impaired (51.5%) EAP and then randomized to a CR program with restorative exercise plans that either included EAP training (N=49) or did not (N=54). Cognitive and functional outcomes were measured with the MCCB and UPSA B post 30 sessions treatment and 3 months later. Only the EAP impaired (EAP-) group had significant benefit from EAP training on verbal learning, with moderate treatment effect sizes (0.46) for overall cognition. Treatment condition did not significantly impact functional outcomes for either EAP group. Whereas both EAP- and EAP+ subgroups showed similar Number Needed to Treat (NNT) for functional outcome (1.3 and 1.5 respectively) the NNT for cognitive gain was less than half for the EAP- (2.4) compared to the EAP+ (6.0). Post CR, change in EAP had a significant effect on change in functional outcome (β = 0.878, p<0.001) and change in cognition (β = 0.381, p=0.001). Cognitive gains partially mediated the relationship between gains in EAP and functional capacity. These findings support the importance of identifying and addressing basic auditory deficits when attempting to remediate higher order auditory impairments such as verbal learning. In addition, they highlight the need for routine assessment of EAP in cognitive remediation participants, as well as the need for more effective programs to reverse these impairments.
Source: Schizophrenia Bulletin
Institutions: Columbia University, New York State Psychiatric Institute
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2938765937