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Targeted cognitive training improves auditory, verbal outcomes in schizophrenia

Computerized targeted cognitive training improved auditory perception and verbal learning and reduced auditory hallucinations in patients with schizophrenia mandated to receive care at a rehabilitation center, study findings showed.

Prior study has shown that computerized targeted cognitive training (TCT) of auditory processing improves verbal learning in several clinical trials of schizophrenia outpatients, but its effectiveness in chronic, treatment-refractory patients remains largely unknown, according to the researchers.

"Chronic, treatment-refractory patients mandated to locked residential care facilities make up just a small subgroup of persons with schizophrenia, but they consume a disproportionately large share of mental health care resources," Gregory A. Light, PhD, professor of psychiatry at University of California, San Diego School of Medicine and director of the Mental Illness, Research, Education and Clinical Center at VA San Diego Healthcare System, said in a press release. "Finding an effective therapy for them is critical."

In their study, researchers examined whether TCT improved auditory processing, verbal learning and clinical symptoms in schizophrenia patients mandated to receive care at a locked residential rehabilitation center. They also assessed whether age, symptom severity, antipsychotic medication load and illness duration moderated the interventions effectiveness.

Patients were randomized to receive treatment as usual (n = 22) or treatment as usual plus TCT (n = 24). Those who received TCT also completed 1 hour of training per day 3 to 5 days each week for up to 40 hours. During TCT, patients used laptops to perform various learning and memory game exercises, which usually involved auditory cues. Researchers evaluated measures of cognition, auditory perception, verbal learning and clinical symptoms at baseline and at the end of treatment — about 12 weeks postrandomization.

TCT produced medium-sized, positive, and significant effects on verbal learning and auditory perception scores, according to the results. Participants who received TCT showed significant improvements in auditory perception (d = 0.67) and verbal learning (d = 0.65). In addition, results from exploratory analyses showed a statistically significant decrease in auditory hallucinations (d = –0.64) and voices conversing (d = –0.78).

Light and colleagues observed mostly small moderating effects, suggesting that the effectiveness of TCT was probably not negatively affected by age, clinical symptoms, medication and illness duration.

"Our results suggest that chronically ill, highly disabled patients can benefit from TCT. That contradicts current assumptions,” Light said in the release. “We're somewhere between the Wild West and golden age of cognitive training for schizophrenia patients. There is much still to be learned and done. We need to do a lot more research.” – by Savannah Demko

Disclosures: Light reports consulting for Astellas, Boehringer-Ingelheim, Dart Neuroscience, Heptares, Lundbeck, Merck, NeuroSig, Neuroverse and Takeda. Please see the study for all other authors’ relevant financial disclosures.