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Training effects of computer-based cognitive training in patients with schizophrenia
124 TRAINING COGNITIVE
11. Psychology, NeuroEFFECTS OF COMPUTER-BASED TRAINING
IN PATIENTS WITH
SCHIZOPHRENIA S. Bender,* R. Thienel, A. Dittmann-Balcar, A. Tackenberg, M. Gastpar
Clinic fiTr Psychiatry and Psychotherapy, University of Essen, Essen, Germany Cognitive training is an important focus of treatment for patients with schizophrenia. COGPACK is the only computer-based cognitive training especially designed for patients with schizophrenia and is widely used in Germany. The training ranks high in patients' judgement: Besides improvement of cognitive function (primary effect), they report increased self-esteem and progress in using computers (secondary effects). In an ongoing multi-center study we investigate the progress in cognitive skills of medicated patients with schizophrenia while training with the computerbased program COGPACK (Janssen-Cilag version). We reassigned the tasks of the program to their main neuropsychological focus (attention, memory, executive function, visuo-motor function and calculation). On the basis ot" these different neuropsychological functions patients' performance at the end of the treatment is compared with their initial abilities. Here we report results ot" the first 80 patients investigated. At the beginning of the training patients exhibit most difficulties in the areas ot" memory and visuo-motor function. During the training their performance significantly improves across all neuropsychological functions. At the end of the training the strongest deficits remain in the memory associated tasks. Computer-based cognitive training using COGPACK is an efficacious treatment for cognitive dysfunction in patients with schizophrenia covering different neuropsychological deficits. Future comparisons will assess the impact of different atypical antipsychotics. (Supported by Janssen-Cilag, Germany)
PRISM ADAPTATION
IN SCHIZOPHRENIA
N. O. Bigelow,* B. M. Turner, J. S. Paulsen, N. C. Andreasen, D. S. O ' L e a r y
Schizophrenia Research Center, Department of Psychiatr3~. University of Iowa School of Medicine, Iowa City, IA, USA Prism adaptation is a type of procedural learning (PL) in which performance facilitation occurs with practice on tasks without the need for conscious awareness. Neural structures that are involved in PL of prism adaptation include the basal ganglia and cerebellum. Both the basal ganglia and cerebellum are implicated in schizophrenia; however, PL has been shown to be normal in schizophrenia for most other types of PL tasks. This study addressed the possibility that impaired neural structures that are involved in PL disrupt prism adaptation in schizophrenia. Patients with schizophrenia (n=103) and normal control subjects (n = 68) were compared on a prism adaptation task involving laterally displaced vision. Of the 103 in the schizophrenia sample, 32 were first-episode patients who were neuroleptic naive, and 71 were chronically treated. All subjects were required to point to a target while wearing distorting prisms that shifted the target 20 degrees to the right. Quantitative indices of performance scores with and without distortion and feedback were obtained with mean scores adjusted for baseline performance. Significant group differences were found between patients and controls on all four
learning trials in which subjects received feedback while wearing the distortion prisms. Also, a significant group difference was found on 1 out of 4 stability adaptation trials when visual feedback was no longer provided. When given feedback 'after removing the prisms, patients had significantly more difficulty reorienting than did controls. The performance of the first-episode group did not differ from that of the chronic group, indicating that neuroleptic treatment did not affect the abnormalities of prism adaptation. These results indicate that schizophrenia patients demonstrate slow learning and difficulty reorienting to this type of PL task. Moreover, these results suggest that limitations may exist for normal PL in schizophrenia in tasks that are subserved by neural structures that include the basal ganglia and cerebellum.
COMPUTERIZED ASSESSMENT:
NEUROCOGNITIVE CLINICAL TRIALS AND FMRI
APPLICATIONS R. M. Bilder,* J. A. Bates, E. Turkel, T. Lencz, J. M. Gold, D. Javitt, M. E Green, S. Park, R. S. Goldman, T. Sharma, J. Spicer, M. J. Hoptman, M. Ashtari, S. R. Marder, J. A. Lieberman, J. M. Kane
Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA, USA Efficiency of neurncognitive assessment is both a clinical and research priority, given pressures o1"cost containment, logistics and patient burden. Most neurocognitive assessment continues to rely on paper-and-pencil methods with historical roots in the mid-20th century when the priority was detection of brain damage. Cognitive neuroscience research has generated novel paradigms with greater sensitivity and specificity to systems-level function, but instrumentation inertia has prevented widespread adoption of these methods. To bridge traditional neuropsychological tests and cognitive neuroscience methods, we developed computerized methods to examine executive functions, attention, working memory and declarative memory functions. Reliability and validity data will be presented lot a series of measures, including: Set Shifting, Competing Programs, Go/No-Go, Variable Interval Delayed Alternation, Facial Memory, Word List Memory, Spatial Working Memory, Delayed Match to Sample (working memory for visual patterns), and Tone Matching (working memory for tones). Innovative features of the tasks will be highlighted, including adaptive titration algorithms to optimize efficiency in psychometric construct definition, touch-screen response collection, and automated transmission to central databases. Findings from multiple validation streams involving more than 300 subjects will be surmnarized, including: cross-sectional mid longitudinal studies of first episode and chronic schizophrenia and healthy volunteers, where test-retest stability and concurrent validity with respect to traditional tests is considered; and FMRI studies where the neural systems engaged by task subcomponents can be specified. The results show internal consistency and stability is comparable and concurrent validity is moderate with respect to paper-pencil counterparts, suggesting measurement of both shared and unique constructs. FMRI data in healthy subjects and patients with schizophrenia participating in clinical trials provide unique validation with respect to the neural architectures engaged by the tasks, generally consistent with inferences drawn from lesion studies, but offering novel insights into systems-level pathology and treatment mechanisms. The findings suggest that increased use of computerized assessment protocols will facilitate both clinical practice and patient oriented research, including clinical trials applications.
International Congress on Schizophrenia Research 2003
11. Psychology, NeuroEFFECTS OF COMPUTER-BASED TRAINING
IN PATIENTS WITH
SCHIZOPHRENIA S. Bender,* R. Thienel, A. Dittmann-Balcar, A. Tackenberg, M. Gastpar
Clinic fiTr Psychiatry and Psychotherapy, University of Essen, Essen, Germany Cognitive training is an important focus of treatment for patients with schizophrenia. COGPACK is the only computer-based cognitive training especially designed for patients with schizophrenia and is widely used in Germany. The training ranks high in patients' judgement: Besides improvement of cognitive function (primary effect), they report increased self-esteem and progress in using computers (secondary effects). In an ongoing multi-center study we investigate the progress in cognitive skills of medicated patients with schizophrenia while training with the computerbased program COGPACK (Janssen-Cilag version). We reassigned the tasks of the program to their main neuropsychological focus (attention, memory, executive function, visuo-motor function and calculation). On the basis ot" these different neuropsychological functions patients' performance at the end of the treatment is compared with their initial abilities. Here we report results ot" the first 80 patients investigated. At the beginning of the training patients exhibit most difficulties in the areas ot" memory and visuo-motor function. During the training their performance significantly improves across all neuropsychological functions. At the end of the training the strongest deficits remain in the memory associated tasks. Computer-based cognitive training using COGPACK is an efficacious treatment for cognitive dysfunction in patients with schizophrenia covering different neuropsychological deficits. Future comparisons will assess the impact of different atypical antipsychotics. (Supported by Janssen-Cilag, Germany)
PRISM ADAPTATION
IN SCHIZOPHRENIA
N. O. Bigelow,* B. M. Turner, J. S. Paulsen, N. C. Andreasen, D. S. O ' L e a r y
Schizophrenia Research Center, Department of Psychiatr3~. University of Iowa School of Medicine, Iowa City, IA, USA Prism adaptation is a type of procedural learning (PL) in which performance facilitation occurs with practice on tasks without the need for conscious awareness. Neural structures that are involved in PL of prism adaptation include the basal ganglia and cerebellum. Both the basal ganglia and cerebellum are implicated in schizophrenia; however, PL has been shown to be normal in schizophrenia for most other types of PL tasks. This study addressed the possibility that impaired neural structures that are involved in PL disrupt prism adaptation in schizophrenia. Patients with schizophrenia (n=103) and normal control subjects (n = 68) were compared on a prism adaptation task involving laterally displaced vision. Of the 103 in the schizophrenia sample, 32 were first-episode patients who were neuroleptic naive, and 71 were chronically treated. All subjects were required to point to a target while wearing distorting prisms that shifted the target 20 degrees to the right. Quantitative indices of performance scores with and without distortion and feedback were obtained with mean scores adjusted for baseline performance. Significant group differences were found between patients and controls on all four
learning trials in which subjects received feedback while wearing the distortion prisms. Also, a significant group difference was found on 1 out of 4 stability adaptation trials when visual feedback was no longer provided. When given feedback 'after removing the prisms, patients had significantly more difficulty reorienting than did controls. The performance of the first-episode group did not differ from that of the chronic group, indicating that neuroleptic treatment did not affect the abnormalities of prism adaptation. These results indicate that schizophrenia patients demonstrate slow learning and difficulty reorienting to this type of PL task. Moreover, these results suggest that limitations may exist for normal PL in schizophrenia in tasks that are subserved by neural structures that include the basal ganglia and cerebellum.
COMPUTERIZED ASSESSMENT:
NEUROCOGNITIVE CLINICAL TRIALS AND FMRI
APPLICATIONS R. M. Bilder,* J. A. Bates, E. Turkel, T. Lencz, J. M. Gold, D. Javitt, M. E Green, S. Park, R. S. Goldman, T. Sharma, J. Spicer, M. J. Hoptman, M. Ashtari, S. R. Marder, J. A. Lieberman, J. M. Kane
Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA, USA Efficiency of neurncognitive assessment is both a clinical and research priority, given pressures o1"cost containment, logistics and patient burden. Most neurocognitive assessment continues to rely on paper-and-pencil methods with historical roots in the mid-20th century when the priority was detection of brain damage. Cognitive neuroscience research has generated novel paradigms with greater sensitivity and specificity to systems-level function, but instrumentation inertia has prevented widespread adoption of these methods. To bridge traditional neuropsychological tests and cognitive neuroscience methods, we developed computerized methods to examine executive functions, attention, working memory and declarative memory functions. Reliability and validity data will be presented lot a series of measures, including: Set Shifting, Competing Programs, Go/No-Go, Variable Interval Delayed Alternation, Facial Memory, Word List Memory, Spatial Working Memory, Delayed Match to Sample (working memory for visual patterns), and Tone Matching (working memory for tones). Innovative features of the tasks will be highlighted, including adaptive titration algorithms to optimize efficiency in psychometric construct definition, touch-screen response collection, and automated transmission to central databases. Findings from multiple validation streams involving more than 300 subjects will be surmnarized, including: cross-sectional mid longitudinal studies of first episode and chronic schizophrenia and healthy volunteers, where test-retest stability and concurrent validity with respect to traditional tests is considered; and FMRI studies where the neural systems engaged by task subcomponents can be specified. The results show internal consistency and stability is comparable and concurrent validity is moderate with respect to paper-pencil counterparts, suggesting measurement of both shared and unique constructs. FMRI data in healthy subjects and patients with schizophrenia participating in clinical trials provide unique validation with respect to the neural architectures engaged by the tasks, generally consistent with inferences drawn from lesion studies, but offering novel insights into systems-level pathology and treatment mechanisms. The findings suggest that increased use of computerized assessment protocols will facilitate both clinical practice and patient oriented research, including clinical trials applications.
International Congress on Schizophrenia Research 2003