Improving the Functional Outcomes in Older Adults with Schizophrenia

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DESCRIPTION (provided by applicant): Cognitive remediation for people with schizophrenia has been shown to lead to improved cognitive functioning and to result in substantial functional benefits. However, most people with schizophrenia especially minorities and older adults, never receive these treatments. Logistic problems with these interventions greatly limit the extent to which these interventions are delivered to these patients. Currently, implementation of these interventions protocols typically require in-person attendance by highly trained personnel as do the implementation of protocols for assessment of both cognitive performance and functional capacity (FC, the ability to perform everyday living skills). Assessment protocols used to evaluate these interventions and cognitive and functional capacities can be also quite cumbersome. Further, these interventions have not been evaluated with older adults with schizophrenia, a critical and growing subpopulation whose cognitive and functional deficits are more substantial. This developmental project examines the feasibility and efficacy of using a technology-based approach that combines a customized cognitive enhancement intervention, cognitive assessment, and measurement of FC. The study will involve a randomized clinical trial. Eighty older patients with schizophrenia will be randomized in equal numbers to a customized cognitive remediation intervention or to a video games control condition used in previous studies. The cognitive remediation intervention focuses on components of cognition which have shown the greatest efficacy in previous studies, are most susceptible to decline in older people with schizophrenia, and critical to performance of everyday living tasks. Baseline and post-intervention assessment will include standard measures of cognition and functional capacity (the MCCB, the UPSA) and technology-based assessment of cognitive abilities (Web Neuro Cognitive Assessment) and FC (performance on a battery of ecologically valid technology-based functional tasks critical to everyday living). We will also examine the convergence and sensitivity to treatment for standard in-person assessments of cognition and functional capacity as compared to technology-based, assessments. The overall goal of the proposed project is to develop the components of a technology-based cognitive and functional assessment and treatment package for older schizophrenia patients that can be delivered remotely in a variety of community and residential settings. This package will then be tested in a larger well-powered study directly comparing the efficacy and feasibility of in-person vs. remote cognitive remediation and outcomes assessment. PUBLIC HEALTH RELEVANCE: Persons with schizophrenia, especially older adults and minorities, have significant cognitive and functional deficits. This is a critical issue as the numer of older people with schizophrenia is increasing. It has been shown that cognitive remediation interventions can be delivered to patients with schizophrenia and result in improvements in cognitive performance and real-world functioning. These interventions have not been evaluated with older patients and most patients, regardless of their age, do not receive these treatments; this study will evaluate a technology-based approach that combines a customized cognitive enhancement intervention, cognitive assessment, and measurement of functional capacity in older patients with schizophrenia.