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Determining the most efficient referral process for cognitive remediation
144 DETERMINING THE MOST EFFICIENT REFERRAL PROCESS FOR COGNITIVE REMEDIATION R. W. Lira,* A. M e d a l i a
Neuropsychology, Montefiore Medical Center, Bronx, NY, USA Objective: Cognitive remediation has been an effective intervention to improve cognitive deficits in people who are diagnosed with schizophrenia. The referral process for this treatment would be facilitated if the most efficient way of determining cognitive impairment could be found. The purpose of this study was to investigate the validity of clinicians' perception of their clients' cognition and the clients' perception of their cognition by correlating each group's perception with objective measures. Method: One hundred and eighty-five psychiatric outpatients with a diagnosis of schizophrenia or schizoaffective disorder and their outpatient clinicians participated in this study. These participants were a part of a larger study which examined efficacy of cognitive remediation and explored validity of a newly developed neuropsychological screening test, Work Readiness Cognitive Screen (WCS). The WCS is a comprehensive web-based test that consists of self-report questionnaires about cognition, education history, and work history as well as neuropsychological tests that evaluate various aspects of cognition. The WCS was used to measure the participants' perception of their cognition, the clinicians' perception of the participants' cognition, and objective assessment of learning capacity, memory, and attention. Results: No significant correlation was found between the clinicians' overall perception of their patients' cognition and the patients' overall perception of their own cognition. Significant correlations were found between the clinicians' perception of their clients' cognitive functioning and objective measures of learning capacity, memory, and attention. Although significant correlations were found between the clients' perception of their cognition and the WCS subtest scores that measured learning capacity and memory, no significance was found between the clients' perception of their attention and the WCS measure of attention. Conclusions: The results indicate that the participants and their clinicians differ in their assessment of the participants' cognition. The clinicians appear to be more accurate in their evaluation of their clients' learning capacity, memory, and attention whereas the participants may not accurately perceive various aspects of their cognition. The results imply that clinicians' judgment may be useful in discerning which clients would most benefit from cognitive remediation.
THE CONTRIBUTION OF CONTROLLED ASPECTS OF SEMANTIC PROCESSING TO VERBAL MEMORY ENCODING AND SEMANTIC FLUENCY DEFICITS IN SCHIZOPHRENIA N. Lowery,* J. D. Ragland, T. Indersmitten, R. E. Gur, R. C. G u t
Schizophrenia Research Center, Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Individuals with schizophrenia have difficulty organizing words semantically to facilitate encoding on list learning tasks (e.g., the California Verbal Learning Test; CVLT). This is commonly attributed to organizational rather than semantic processing limitations. However, patients also have prominent semantic fluency deficits (i.e., animal naming; AN) that typically result from disrupted controlled
11. Psychology, Neuro(i.e., switching between semantic categories) rather than automatic (i.e., clustering words within a category) processes. The current study administered CVLT and AN tasks to 14 individuals with schizophrenia and 14 demographically balanced controls to examine the relationship between verbal learning and controlled and automatic processing on the fluency task. As expected, patients performed worse on both tasks, with fluency impairments due to reduced switching and unimpaired clustering. Correlational results differed between groups. In controls, serial clustering on the CVLT was positively correlated (r=.57) with clustering on the AN task. In patients, word list learning correlated positively with AN switching (r=.65), but did not bear any relation to AN clustering (r=.02). These results replicate previous findings and extend them to the realm of verbal learning. Previous studies have shown that impaired verbal learning in patients relates to their difficulty organizing words semantically to facilitate encoding. Current results suggest that this encoding deficit is strongly related to controlled aspects of semantic processing. This suggests that providing organizational strategies is likely to be beneficial since patients' ability to generate words within a category is intact once they have made a switch between categories. This work was supported by National Institutes of Health grant MH62103.
COGNITIVE DECLINE IS ASSOCIATED WITH REDUCTION IN GLOBAL WHITE MATTER VOLUME IN SCHIZOPHRENIA J. H. M a c C a b e , * S. L. Rossell, X. A. Chitnis, A. S. David, R. M. M u r l a y
Psychological Medicine, Institute of Psychiatry, Denmark Hill, London, United Kingdom Neurocognitive deficits are well documented in schizophrenia, the most consistent finding being a reduction in pre-morbid and current intelligence quotient (IQ). There is considerable controversy as to the existence of any absolute decline in IQ over time, partly because of uncelntain comparability between measures of pre-morbid and current IQ in schizophrenia. Nevertheless, the discrepancy between measures of pre-morbid and current IQ does vary in schizophrenic patients, and we speculated that this variance might represent a neurocognitive marker of underlying neurobiological changes. Recently developed techniques of voxel-based morphometry (VBM) of magnetic resonance images allow automated measurement of wholebrain tissue volumes, particularly grey and white matter and cerebrospinal fluid (CSF). VBM studies in patients with schizophrenia have shown deficits in global tissue volume, as well as regionally specific changes. However, few studies have examined associations between global tissue volumes and neurocognitive measures in schizophrenia. In this study, 72 patients with DSM-1V schizophrenia and 32 healthy controls, closely matched on age, gender, handedness and IQ, underwent neuropsychological testing (National Adult Reading Test (NART), 4 subtests of Weschler Adult Intelligence Scale, Revised (WAIS-R)) and VBM. IQ decline was estimated by subtracting NART IQ from WAIS-R full-scale IQ. Patients had significantly greater IQ decline than controls (18.7 vs. 6.0, p < 0.00005), smaller total brain volume (1235 vs 1300cc, p < 0.005) and smaller total white matter volume (506 vs. 544 cc, p < 0.05). There was no significant difference in grey matter or CSF volumes. In patients, there was a negative correlation between IQ decline and total white matter volume (r = -.26, p < 0.05) and a nonsignificant positive correlation between IQ decline and CFS volume (r = .23, NS). The equivalent correlations in controls were .00 and. 13 respectively, and were not significant. Further analyses demonstrated that these findings are not confounded by age at onset, length of illness, symptom
International Congress on Schizophrenia Research 2003
Neuropsychology, Montefiore Medical Center, Bronx, NY, USA Objective: Cognitive remediation has been an effective intervention to improve cognitive deficits in people who are diagnosed with schizophrenia. The referral process for this treatment would be facilitated if the most efficient way of determining cognitive impairment could be found. The purpose of this study was to investigate the validity of clinicians' perception of their clients' cognition and the clients' perception of their cognition by correlating each group's perception with objective measures. Method: One hundred and eighty-five psychiatric outpatients with a diagnosis of schizophrenia or schizoaffective disorder and their outpatient clinicians participated in this study. These participants were a part of a larger study which examined efficacy of cognitive remediation and explored validity of a newly developed neuropsychological screening test, Work Readiness Cognitive Screen (WCS). The WCS is a comprehensive web-based test that consists of self-report questionnaires about cognition, education history, and work history as well as neuropsychological tests that evaluate various aspects of cognition. The WCS was used to measure the participants' perception of their cognition, the clinicians' perception of the participants' cognition, and objective assessment of learning capacity, memory, and attention. Results: No significant correlation was found between the clinicians' overall perception of their patients' cognition and the patients' overall perception of their own cognition. Significant correlations were found between the clinicians' perception of their clients' cognitive functioning and objective measures of learning capacity, memory, and attention. Although significant correlations were found between the clients' perception of their cognition and the WCS subtest scores that measured learning capacity and memory, no significance was found between the clients' perception of their attention and the WCS measure of attention. Conclusions: The results indicate that the participants and their clinicians differ in their assessment of the participants' cognition. The clinicians appear to be more accurate in their evaluation of their clients' learning capacity, memory, and attention whereas the participants may not accurately perceive various aspects of their cognition. The results imply that clinicians' judgment may be useful in discerning which clients would most benefit from cognitive remediation.
THE CONTRIBUTION OF CONTROLLED ASPECTS OF SEMANTIC PROCESSING TO VERBAL MEMORY ENCODING AND SEMANTIC FLUENCY DEFICITS IN SCHIZOPHRENIA N. Lowery,* J. D. Ragland, T. Indersmitten, R. E. Gur, R. C. G u t
Schizophrenia Research Center, Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Individuals with schizophrenia have difficulty organizing words semantically to facilitate encoding on list learning tasks (e.g., the California Verbal Learning Test; CVLT). This is commonly attributed to organizational rather than semantic processing limitations. However, patients also have prominent semantic fluency deficits (i.e., animal naming; AN) that typically result from disrupted controlled
11. Psychology, Neuro(i.e., switching between semantic categories) rather than automatic (i.e., clustering words within a category) processes. The current study administered CVLT and AN tasks to 14 individuals with schizophrenia and 14 demographically balanced controls to examine the relationship between verbal learning and controlled and automatic processing on the fluency task. As expected, patients performed worse on both tasks, with fluency impairments due to reduced switching and unimpaired clustering. Correlational results differed between groups. In controls, serial clustering on the CVLT was positively correlated (r=.57) with clustering on the AN task. In patients, word list learning correlated positively with AN switching (r=.65), but did not bear any relation to AN clustering (r=.02). These results replicate previous findings and extend them to the realm of verbal learning. Previous studies have shown that impaired verbal learning in patients relates to their difficulty organizing words semantically to facilitate encoding. Current results suggest that this encoding deficit is strongly related to controlled aspects of semantic processing. This suggests that providing organizational strategies is likely to be beneficial since patients' ability to generate words within a category is intact once they have made a switch between categories. This work was supported by National Institutes of Health grant MH62103.
COGNITIVE DECLINE IS ASSOCIATED WITH REDUCTION IN GLOBAL WHITE MATTER VOLUME IN SCHIZOPHRENIA J. H. M a c C a b e , * S. L. Rossell, X. A. Chitnis, A. S. David, R. M. M u r l a y
Psychological Medicine, Institute of Psychiatry, Denmark Hill, London, United Kingdom Neurocognitive deficits are well documented in schizophrenia, the most consistent finding being a reduction in pre-morbid and current intelligence quotient (IQ). There is considerable controversy as to the existence of any absolute decline in IQ over time, partly because of uncelntain comparability between measures of pre-morbid and current IQ in schizophrenia. Nevertheless, the discrepancy between measures of pre-morbid and current IQ does vary in schizophrenic patients, and we speculated that this variance might represent a neurocognitive marker of underlying neurobiological changes. Recently developed techniques of voxel-based morphometry (VBM) of magnetic resonance images allow automated measurement of wholebrain tissue volumes, particularly grey and white matter and cerebrospinal fluid (CSF). VBM studies in patients with schizophrenia have shown deficits in global tissue volume, as well as regionally specific changes. However, few studies have examined associations between global tissue volumes and neurocognitive measures in schizophrenia. In this study, 72 patients with DSM-1V schizophrenia and 32 healthy controls, closely matched on age, gender, handedness and IQ, underwent neuropsychological testing (National Adult Reading Test (NART), 4 subtests of Weschler Adult Intelligence Scale, Revised (WAIS-R)) and VBM. IQ decline was estimated by subtracting NART IQ from WAIS-R full-scale IQ. Patients had significantly greater IQ decline than controls (18.7 vs. 6.0, p < 0.00005), smaller total brain volume (1235 vs 1300cc, p < 0.005) and smaller total white matter volume (506 vs. 544 cc, p < 0.05). There was no significant difference in grey matter or CSF volumes. In patients, there was a negative correlation between IQ decline and total white matter volume (r = -.26, p < 0.05) and a nonsignificant positive correlation between IQ decline and CFS volume (r = .23, NS). The equivalent correlations in controls were .00 and. 13 respectively, and were not significant. Further analyses demonstrated that these findings are not confounded by age at onset, length of illness, symptom
International Congress on Schizophrenia Research 2003