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Conveying information cohesively is an essential element of communication that is disrupted in schizophrenia. These disruptions are typically expressed through disorganized symptoms, which have been linked to neurocognitive, social cognitive, and metacognitive deficits. Automated analysis can objectively assess disorganization within sentences, between sentences, and across paragraphs by comparing explicit communication to a large text corpus.
Little work in schizophrenia has tested: (1) links between disorganized symptoms measured via automated analysis and neurocognition, social cognition, or metacognition; and (2) if automated analysis explains incremental variance in cognitive processes beyond clinician-rated scales. Disorganization was measured in schizophrenia (n = 81) with Coh-Metrix 3.0, an automated program that calculates basic and complex language indices. Trained staff also assessed neurocognition, social cognition, metacognition, and clinician-rated disorganization.
Findings showed that all three cognitive processes were significantly associated with at least one automated index of disorganization. When automated analysis was compared with a clinician-rated scale, it accounted for significant variance in neurocognition and metacognition beyond the clinician-rated measure. When combined, these two methods explained 28–31% of the variance in neurocognition, social cognition, and metacognition.
This study illustrated how automated analysis can highlight the specific role of disorganization in neurocognition, social cognition, and metacognition. Generally, those with poor cognition also displayed more disorganization in their speech—making it difficult for listeners to process essential information needed to tie the speaker's ideas together. Our findings showcase how implementing a mixed-methods approach in schizophrenia can explain substantial variance in cognitive processes.
Patients with schizophrenia have shown cognitive improvements following
cognitive remediation, but the neuroplastic changes that support these
processes are not fully understood.
To use a triple-blind, placebo-controlled trial to examine neural
activation before and after cognitive remediation or a computer skills
training (CST) placebo (trial registration: NCT00995553)).
Twenty-seven participants underwent functional magnetic resonance imaging
before and after being randomised to either cognitive remediation
intervention or CST. Participants completed two variants of the N-back
task during scanning and were assessed on measures of cognition,
functional capacity, community functioning and symptoms.
We observed a group × time interaction in the left prefrontal cortex,
wherein the cognitive remediation group showed increased activation.
These changes correlated with improved task accuracy within the cognitive
remediation group, whereas there was no relationship between changes in
activation in untrained cognitive measures. Significant changes were not
observed in other hypothesised areas for the cognitive remediation
We replicated the finding that cognitive remediation increases left
lateral prefrontal activation during a working memory task in patients
with schizophrenia, suggesting this may be an important neural target for
these types of interventions.
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