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

  • Shuping Tan (a1), Xiaolin Zhu (a1), Hongzhen Fan (a1), Yunlong Tan (a1), Fude Yang (a1), Zhiren Wang (a1), Yanli Zhao (a1), Fengmei Fan (a1), Junhua Guo (a2), Zhanjiang Li (a2), Wenxiang Quan (a3), Xiangqun Wang (a3), Clare Reeder (a4), Dongfeng Zhou (a3), Yizhuang Zou (a1) and Til Wykes (a4) (a5)...

Abstract

Background

Computerized 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.

Method

In 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.

Results

There 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.

Conclusions

CCRT 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.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Shuping Tan, E-mail: shupingtan@126.com and Yizhuang Zou, E-mail: yzouy@263.net

Footnotes

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These authors contributed equally to this work.

Footnotes

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