Who will benefit from computerized cognitive remediation therapy? Evidence from a multisite randomized controlled study in schizophrenia

BackgroundComputerized cognitive remediation therapy (CCRT) is generally effective for the cognitive deficits of schizophrenia. However, there is much uncertainty about what factors mediate or moderate effectiveness and are therefore important to personalize treatment and boost its effects.MethodIn total, 311 Chinese inpatients with Diagnostic and Statistical Manual of Mental Disorders-IV schizophrenia were randomized to receive CCRT or Active control for 12 weeks with four to five sessions per week. All participants were assessed at baseline, post-treatment and 3-month follow-up. The outcomes were cognition, clinical symptoms and functional outcomes.ResultsThere was a significant benefit in the MATRICS Consensus Cognitive Battery (MCCB) total score for CCRT (F1,258 = 5.62; p = 0.02; effect size was 0.27, 95% confidence interval 0.04–0.49). There were no specific moderators of CCRT improvements. However, across both groups, Wisconsin Card Sort Test improvement mediated a positive effect on functional capacity and Digit Span benefit mediated decreases in positive symptoms. In exploratory analyses younger and older participants showed cognitive improvements but on different tests (younger on Symbol Coding Test, while older on the Spatial Span Test). Only the older age group showed MSCEIT benefits at post-treatment. In addition, cognition at baseline negatively correlated with cognitive improvement and those whose MCCB baseline total score was around 31 seem to derive the most benefit.ConclusionsCCRT can improve the cognitive function of patients with schizophrenia. Changes in cognitive outcomes also contributed to improvements in functional outcomes either directly or solely in the context of CCRT. Age and the basic cognitive level of the participants seem to affect the cognitive benefits from CCRT.

Bilingual Experience and Executive Control over the Adult Lifespan: The Role of Biological Sex

We investigated whether bilingual language experience over the lifespan impacts women and men in a manner that differentially buffers against age-related declines in executive control. To this end, we investigated whether executive control performance in a lifespan sample of adult women and men were differentially impacted by individual differences in bilingual language experience, assessed using an unspeeded measure of executive control, the Wisconsin Card Sort Test. The results suggested that women showed both the greatest degree of age-related decline across WCST measures, and a greater likelihood than men to express improved performance as a function of increased bilingual experience. We consider implications of this finding for advancing our understanding of the relation between bilingualism and cognition, and also the effects of biological sex on cognitive aging.

Bilingual experience and executive control over the adult lifespan: The role of biological sex

We investigated whether bilingual language experience over the lifespan impacts women and men in a manner that differentially buffers against age-related declines in executive control. To this end, we investigated whether executive control performance in a lifespan sample of adult women and men were differentially impacted by individual differences in bilingual language experience, assessed using an unspeeded measure of executive control: the Wisconsin Card Sort Test. The results suggested that women showed both the greatest degree of age-related decline across WCST measures, and a greater likelihood than men to express improved performance as a function of increased bilingual experience. We consider implications of this finding for advancing our understanding of the relation between bilingualism and cognition, and also the effects of biological sex on cognitive aging.

The relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia

ObjectivesThe present study aimed to (i) evaluate the association between insight and measures of executive functions and working memory in a sample of 132 patients with schizophrenia and (ii) to explore to what proportion neurocognitive dysfunction contributed to the variance in insight after controlling for symptomatology.MethodsSubjects were evaluated with a standardized neurocognitive test battery and a semi-structured interview, the Psychosis Evaluation tool for Common use by Caregivers (PECC). PECC, apart from evaluating symptoms and side-effects, measures insight on a 4-point scale by two of its dimensions: awareness of having a mental illness (AMI) and awareness of having symptoms attributed to a mental illness (ASAMI). Executive functioning was measured by the Wisconsin Card Sort Test (WCST) and the Trail Making B (TMB). Working memory was measured by the Letter Number Sequencing (LNS) test from the Wechsler Adult Intelligence Scale (WAIS).ResultsOnly one significant association was found after correction for multiple testing, between WCST categories completed and AMI (r = −0.29, p = 0.0006). WCST categories completed explained only 7.9% of the variance in AMI, while symptomatology explained 20% of variance in AMI and 16.5% of variance in ASAMI.ConclusionsThe current results show a significant but subtle association with the WCST, which is in agreement with earlier literature. No other associations between cognitive functioning and insight were found. In general, these findings seem to suggest that factors other than cognition have a greater impact on insight in patients with schizophrenia.

A systematic review and meta-analysis of set-shifting ability in eating disorders

ABSTRACTBackgroundThe aim was to critically appraise and synthesize the literature relating to set-shifting ability in eating disorders. PsycINFO, Medline, and Web of Science databases were searched to December 2005. Hand searching of eating-disorder journals and relevant reference sections was also undertaken.MethodThe 15 selected studies contained both eating disorder and healthy control groups, and employed at least one of the following six neuropsychological measures of set-shifting ability; Trail Making Test (TMT), Wisconsin Card Sort Test (WCST), Brixton task, Haptic Illusion, CatBat task, or the set-shifting subset of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The outcome variable was performance on the set-shifting aspect of the task. Pooled standardized mean differences (effect sizes) were calculated.ResultsTMT, WCST, CatBat and Haptic tasks had sufficient sample sizes for meta-analysis. These four tasks yielded acceptable pooled standardized effect sizes (0·36; TMT −1·05; Haptic) with moderate variation within studies (as measured by confidence intervals). The Brixton task showed a small pooled mean difference, and displayed more variation between sample results. The effect size for CANTAB set shifting was 0·17.ConclusionProblems in set shifting as measured by a variety of neuropsychological tasks are present in people with eating disorders.