Cognitive Remediation in Schizophrenia

描述(由申请人提供)：综合神经科学的最新进展使人们对感知和认知技能学习背后的大脑可塑性机制有了更多的了解。本研究的目的是将这些原则应用于神经科学指导的以训练为基础的精神分裂症特定认知缺陷的补救。基于精神分裂症患者皮质神经网络处理效率受损和注意缺陷的后果的工作模型，我们将采用一套新颖的、强化的、基于计算机的认知训练练习，专门针对神经认知处理效率(感知和准确性中的速度和准确性)。 对目标的反应)，使用自适应训练程序。我们将检验这种神经科学指导的训练策略对精神分裂症受试者的认知表现、症状特征、生活质量和社会线索识别的影响，并与接受控制干预(基于图形的电脑游戏)的受试者进行比较。我们还将检查这种干预的效果在最初培训后的六个月内持续到什么程度。这项研究设计将是一项对照临床试验，80名精神分裂症受试者随机配对分配到100小时的积极训练或对照电脑游戏干预中，每组40名完成实验的受试者。根据Merzenich等人最初开发的自我调节神经适应心理物理训练工具的原理，将使用三套不同的语言和视觉空间认知训练练习。语言障碍(1998年)。练习将直接针对精神分裂症患者神经认知障碍的一个核心领域--语言和视觉空间处理效率--这是已知与临床和心理社会结果相关的，同时其次是训练注意力和执行控制。具体目标是：1.采用基于神经科学的认知训练策略来补救精神分裂症患者受损的神经认知加工效率，并将这种训练的效果与对照干预进行比较。2.评估对这一特定认知障碍的补救在多大程度上促进了精神分裂症患者其他更高级别的认知障碍的改善。3.评估这种有针对性的训练是否降低了受试者的症状严重程度，并改善了复杂的心理社会功能，包括社会线索识别和生活质量。4.确定训练效果是否在训练期结束后持续6个月。5.检查影响训练反应的因素：--研究开始时的个体受试者差异(认知和临床状态)--药物状态(血清抗胆碱能和血浆抗神经镇静剂水平)。

DESCRIPTION (provided by applicant): Recent advances in the integrative neurosciences have led to an increased understanding of brain plasticity mechanisms underlying perceptual and cognitive skill learning. The purpose of this study is to apply these principles to the neuroscience-guided training-based remediation of specific cognitive deficits in schizophrenia. Based on a working model of the consequences of impaired cortical neuronal network processing efficiency and attentional deficits in schizophrenia, we will employ a set of novel, intensive, computer-based cognitive training exercises that specifically target neurocognitive processing efficiency (speed and accuracy in the perception and response to targets), using an adaptive training procedure. We will examine the effects of this neuroscience-guided training strategy on cognitive performance, symptom profile, quality of life, and social cue recognition in subjects with schizophrenia as compared to schizophrenic subjects who undergo a control intervention (graphics-based computer games). We will also examine to what degree the effects of this intervention endure six months beyond the initial training. The study design will be a controlled clinical trial with 80 schizophrenic subjects randomly assigned in matched pairs to 100 hours of either active training or a control computer-games intervention, for 40 completed subjects per matched group. Three different sets of both verbal and visuo-spatial cognitive training exercises will be used based on the principles of the self-adjusted neuroadaptive psychophysical training tools initially developed by Merzenich et al. for language disabilities (1998). Exercises will directly target a core domain of neurocognitive impairment in schizophrenia--verbal and visuo-spatial processing efficiency-- which is known to be relevant to clinical and psychosocial outcome, while secondarily training attention and executive control. The specific aims are: 1. To employ a neuroscience-based cognitive training strategy for the remediation of impaired neurocognitive processing efficiency in schizophrenia and to compare the effects of this training to a control intervention. 2. To evaluate the degree to which remediation of this specific cognitive impairment generalizes to improvements in other, higher-order cognitive deficits in schizophrenia. 3. To evaluate whether this targeted training reduces subjects' symptom severity and improves complex psychosocial functions, including social cue recognition and quality of life. 4. To determine whether the effects of training persist 6 months beyond the training period. 5. To examine factors that influence the response to training: -- Individual subject differences at study entry (cognitive and clinical status)-- Pharmacologic status (serum anticholinergicity and plasma neuroleptic levels).