| Article |
The Effectiveness of Computerized Cognitive Rehabilitation Training Program in Improving Cognitive Abilities of Schizophrenia Clients |
Cognitive remediation in schizophrenia: efficacy and effectiveness in patients with early versus long-term course of illness |
Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets |
| Author, year, country |
Mohammadi, M; Keshavarzi, Z. & Talepasand, S. (2014)(1111 Mohammadi M, Keshavarzi Z, Talepasand S. The Effectiveness of Computerized Cognitive Rehabilitation Training Program in Improving Cognitive Abilities of Schizophrenia Clients. Iran J Psychiatry [Internet]. 2014 [cited 2018 Mar 09];9(4):209-15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361823/
https://www.ncbi.nlm.nih.gov/pmc/article...
).
Iran. |
Bowie, C.; Grossman, M.; Gupta, M.; Oyewumi, L. & Harvey, P. (2014)(1212 Bowie C, Grossman M, Gupta M, Oyewumi LK, Harney P. Cognitive remediation in schizophrenia: efficacy and effectiveness in patients with early versus long-term course of illness. Early Interv Psychiatry. 2014;8(1):32-8. doi: 10.1111/eip.12029
https://doi.org/10.1111/eip.12029...
).
USA and Canada. |
Biagianti, B., Fisher, M., Howard, L., Rowlands, A., Vinogradov, S. & Woolley, J. (2017)(1313 Biagianti B, Fisher M, Howard L, Rowlands A, Vinogradov S, Woolley J. Feasibility and preliminar efficacy of remotely delivering cognitive training to people with schizophrenia using tablets. Schizophr Res Cogn. 2017;10:7-14. doi: 10.1016/j.scog.2017.07.003
https://doi.org/10.1016/j.scog.2017.07.0...
).
USA. |
| Context and sample |
15 clinically-stable people diagnosed with schizophrenia, followed up in an outpatient setting. |
39 people were diagnosed with schizophrenia or schizoaffective disorder, followed up in outpatient psychiatric treatment, of whom 12 had early-course psychosis and 27 had a long-term course. |
79 people diagnosed with schizophrenia, followed at community mental health centers. |
| Objective(s) of the study |
To assess the computer program effectiveness of cognitive rehabilitation in improving the cognitive abilities of people with schizophrenia. |
To distinguish the cognitive remediation effectiveness among people with illness under 5 years (early-course of illness) and people over 15 (long-term) with schizophrenia. |
To investigate if there are differences in the cognitive gains between the people with schizophrenia that realized cognitive training in the computer and those that realized in the iPads, and if it is feasible the training realized from these apparatuses. |
| Moments and assessment tools (scales) |
Assessment took place in four moments: before the program, immediately after, one month and three months later (follow-up).
»Symptom assessment: Positive and Negative Syndrome Scale (PANSS);
»Neuropsychological assessment: Continuous Performance Test Identical Pair Version (CPTIP) ;
»Cognitive function: Revised Wechsler Adult Intelligence Scale (WAIS) and Prospective and Retrospective MemoryQuestionnaire (PRMQ) . |
Assessment performance in two moments: before the program and one (1) week after its end.
»Cognition: Brief Assessment of Cognition in Schizophrenia ;
»Clinical Symptoms: Positive and Negative Syndrome Scale (PANSS) ;
»Skills assessment: Social Skills Performance Assessment, roleplays and Specific Levels of Functioning (SLOF) . |
Assessment performance in two moments: before the program and after its end.
»Diagnosticassessment: initial interview;
»Cognition: MATRICS Consensus Cognitive Battery (MCCB), Hopkins Verbal Learning Test-R (HVLT-R) and Brief Visuospatial Memory Test-R (BVMT-R) ;
»Symptomatology and Functional Results: Positive and Negative Syndrome Scale (PANSS), Quality of Life Scale (QLS), Social Functioning Scale (SFS) and UCSD Performance Based Skill Assessment (UPSA) . |
| Intervention (CS technique used and training frequency) |
Therapy consists of 20 individual sessions, two per week (for about 18 weeks), with 60 minute-duration.
The intervention came from the Rehacome ® software, which trains attention, concentration, working memory and executive functions. |
Program that uses exercises in computers.
It describes that the detailed program is described in an article by Bowie, McGurk, Mausbach, Patterson and Harvey (2012). |
40-hour exercise program in BrainHQ software, 21 people on a fixed computer (supervised) and 26 people on an iPad (unsupervised). Each person was asked to train 60 minutes a day, 5 days a week. |
| Nurse as intervener |
No.
The program was conducted by a psychologist. |
No.
Psychologists conduct the program. |
It does not define professionals, but refers that there was little intervention. |
| Caregiver as intervener |
No. |
No. |
No. |
| Results |
The software improved attention, working memory, and prospective and retrospective memory.
Regarding reaction time, there were no long-term improvements.
In the working memory, results demonstrated that improvements remain long-term.
The software did not produce any improvement over the positive and negative effects of the disease. |
There are greater improvements in cognitive abilities in people with early-onset disease than with more years of illness.
This difference was visible in psychomotor speed, complex information processing speed, working memory and planning capacity areas.
If cognitive remediation is used in early stages of the disease, it will have more robust and relevant clinical, cognitive and functional effects.
There were no improvements in verbal memory, verbal fluency and social competence. |
Cognitive remediation through iPads is feasible, since people who used these portable devices had the same earnings as those who completed the program on a computer.
Both groups showed significant cognitive improvements in verbal learning, and problem-solving skills and working memory, regardless of the device they used.
People from the sample showed improvements in quality of life and social functioning, and they not have computers/iPads that influenced the magnitude of this improvement. |
| Limitations reported in the article |
- There was no randomness in the sample choice;
- The group consisted of only 15 people;
- Further follow-up assessments are needed to prove the effects of training. |
- Selected sample for convenience (from a study already done);
- No follow-up assessment. |
- Each person in the sample could choose the device they preferred to use, and the iPads group included younger people with less symptomatology than the other.
- Small sample;
- No follow-up assessment. |
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| Article |
Personalized cognitive training in unipolar and bipolar disorder: a study of cognitive functioning |
Effects of Short-Term Cognitive Remediation on Cognitive Dysfunction in Partially or Fully Remitted Individuals with Bipolar Disorder: Results of a Randomised Controlled Trial |
Efficacy of Cognitive Rehabilitation Using Computer Software With Individuals Living With Schizophrenia: A Randomized Controlled Trial in Japan |
| Author, year, country |
Preiss, M., Shatil, E., Cermákova, R., Cimermanová, D. & Ram, I. (2013)(1414 Preiss M, Shatil E, Cermákova R, Cimermanová D, Ram I. Personalized cognitive training in unipolar and bipolar disorder: a study of cognitive functioning. Front Hum Neurosci. 2013;7:108. doi: 10.3389/fnhum.2013.00108
https://doi.org/10.3389/fnhum.2013.00108...
).
Czech Republic. |
Demant, K., Vinberg, M., Kessing, L. & Miskowiak, K. (2015)(1515 Demant K, Vinberg M, Kessing L, Miskowiak K. Effects of short-term cognitive remediation on cognitive dysfunction in partially or fully remitted individuals with bipolar disorder: results of a randomised controlled trial. PLoS One. 2015;10(6):e0127955. doi: 10.1371/journal.pone.0127955
https://doi.org/10.1371/journal.pone.012...
).
Denmark. |
Iwata, K. et al. (2017)(1616 Iwata K, Matsuda Y, Sato S, Furukawa S, Watanabe Y, Hatsuse N, et al. Efficacy of cognitive rehabilitation using computer software with individuals living with schizophrenia: A randomized controlled trial in Japan. Psychiatr Rehabil J. 2017;40(1):4-11. doi: 10.1037/prj0000232
https://doi.org/10.1037/prj0000232...
).
Japan. |
| Context and sample |
45 people were diagnosed with unipolar depression or in the depressive phase of bipolar disorder, followed-up in a psychiatry outpatient setting, and who had a computer at home |
46 people were diagnosed with bipolar disorder, followed-up in psychiatric community centers |
60 people were diagnosed with schizophrenia, followed-up in a psychiatric treatment outpatient, where they already performed psychiatric rehabilitation activities |
| Objective(s) of the study |
To examine the impact of cognitive training on the functioning of people with unipolar or bipolar depression and the level of attention and executive control. |
To assess whether cognitive remediation improves cognitive function and psychosocial functioning compared to the control group of people with bipolar disorder. |
To assess whether cognitive remediation is effective in promoting cognitive functioning and social functioning in people with schizophrenia. |
| Moments and assessment tools (scales) |
Assessment performance in two moments: before the program and after its completion.
»Cognitive Function: Cognitive Failures Questionnaire (CFQ)
»Executive functions: TheDyexecutive Questionnaire (DEX)
»Memory: The Everyday Memory Questionnaire (EMQ)
»Psychological functioning and well-being: The Schwartz Outcomes Scale-10
»Quality of life: Subjective Quality of Life Questionnaire (SQUALA)
»Depression: Beck Depression inventory-II |
Assessment performance in two moments: before the program and after its completion.
»Primary Outcome (verbal memory): Rey Auditory Verbal Learning Test (RAVLT)
• Secondary Outcome: Rapid Visual Information Processing (RVP), Trail Making Test - Part B (TMT-B) and Functional Assessment Short Test (FAST)
"Tertiary Outcomes: Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Cognitive Failures Questionnaire (CFQ), WHO Quality of Life BREF (WHOQOL-Bref), Cohen's Perceived Stress Scale (PSS), European Quality of Life, Beck Depression Inventory (BDI) and Work and Social Adjustment Scale (WSAS). |
Assessment performance in two moments: before the program and after its end.
»Cognitive Function: Brief Assessment of Cognition in Schizophrenia (BACS)
»Social functioning: Life Assessment Scale for Mentally III (LAS III) |
| Intervention (CS technique used and training frequency) |
The use of the CogniFit software could be adjusted to customize the training to each person. Each person performed cognitive training exercises (15 people) or only received standard care (16 people) in their own home. The program comprises 3 sessions per week, sessions of 20 to 30 minutes duration, for 8 weeks. |
Group sessions, once a week, sessions lasting 2 hours for 12 weeks (short-term group-based cognitive remediation).
Four weeks after the end of the program, a booster session was held. |
Intervention takes place through the CogPack software and run twice a week for 12 weeks. 29 people performed cognitive remediation program, and the other 31 people performed Treatment Usual (TAU). |
| Nurse as intervener |
Not defined. |
Not defined. |
Not defined. |
| Caregiver as intervener |
Intervenes in the filling of the DEX questionnaire in order to assess executive functions of participants and their relatives. |
No. |
No. |
| Results |
The cognitive training group showed significant improvements compared to the control group, depression (lower levels of depression), cognitive functioning, executive functions, attention and working memory.
Caregivers/family members noticed improvements in their family members. |
Primary Outcomes: There were no improvements in verbal memory.
Secondary Outcomes: There were no improvements in psychosocial functioning or sustained attention and executive functions compared to the control group.
Tertiary Outcomes: There have been long-term improvements in mental acuity, verbal fluency, and quality of life - a psychological component.
It is unlikely that an increase in the sample would change the results presented at the verbal memory level. |
The group that performed cognitive remediation program presented better results than the control group, namely in terms of processing speed, attention, verbal fluency and executive functions, as well as improvements in interpersonal relationships and work skills (work skills). |
| Limitations reported in the article |
- The control group did not take active care (suggest that an upcoming study also include for the control group exercises in the computer that do not directly stimulate cognitive functioning);
- Humor was not assessed in a quantitative and objective way;
- Limited information to compare the data collected in this study. |
- Small sample;
- Inclusion of people in total remission together with people in partial remission of their disease. |
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