Optimizing Cognitive Remediation Outcomes in Schizophrenia

描述（由申请人提供）：本研究的目的是明确和积极地推动对精神分裂症中基于神经可塑性的认知补救的最佳反应，以最大限度地提高治疗反应。我们将调查在基于计算机的认知补救计划中通常被忽视的因素--那些与社会认知相关的因素--并将描述它们与动机、功能结果以及奖励预期和情绪处理的神经基质的关系。目前的研究表明，除非我们充分理解和利用这些因素，否则我们将无法为精神分裂症患者获得有意义的治疗收益。我们的具体目标是：1.进行一项随机对照试验，其中100名精神分裂症受试者被分配接受60小时的基于神经可塑性的计算机化定向认知训练（TCT），该训练专门关注“冷认知”（一个训练听觉和视觉领域的早期感觉处理、注意力、工作记忆和认知控制的项目），或60小时的训练，将TCT计划与每天20分钟的自适应计算机化社会认知训练（SCT）练习相结合。2.比较两组受试者在神经认知、社会认知、动机和功能结果方面的结果。3.在干预后6个月对受试者进行评估，以确定培训效果的持久性。4.确定单独TCT与TCT+SCT在关键神经区域的大脑激活模式变化：在奖励预期期间和情绪识别期间。这种方法的及时性得到了最近的证据的支持，这些证据表明，传统的认知补救方法和精神分裂症的功能结果之间只有微弱的关联，但社会认知和功能结果之间有着强烈的直接关系。因此，我们现在必须检查一个精心设计的最先进的认知训练计划的临床，功能和神经效果，该计划将神经认知与社会认知训练相结合。公共卫生相关性声明（叙述）这项研究与公共卫生有关，因为它将：1）确定在基于听觉和视觉处理的神经可塑性认知训练中加入社会认知训练练习是否会改善精神分裂症患者的结果; 2）有助于识别神经可塑性-基于认知补救策略的精神分裂症治疗策略，在帮助患者在动力以及社会和职业功能方面实现有意义的改善方面提供最大益处。

DESCRIPTION (provided by applicant): The purpose of this study is to explicitly and aggressively drive an optimal response to neuroplasticity- based cognitive remediation in schizophrenia in order to maximize treatment response. We will investigate factors that have generally been ignored in computer-based cognitive remediation programs-those related to social cognition-- and will delineate their relationship to motivation, functional outcome, and the neural substrates of reward anticipation and emotion processing. Current research indicates that, unless we fully understand and harness these factors, we will not achieve meaningful treatment gains for individuals with schizophrenia. Our specific aims are: 1. To perform an RCT in which 100 schizophrenia subjects are assigned to either 60 hours of neuroplasticity- based computerized targeted cognitive training (TCT) that focuses exclusively on "cold cognition" (a program which trains early sensory processing, attention, working memory and cognitive control in auditory and visual domains), or to 60 hours of training that combines the TCT program with 20 minutes per day of adaptive computerized social cognition training (SCT) exercises. 2. To compare the outcomes of these two groups of subjects on measures of neurocognition, social cognition, motivation, and functional outcome. 3. To assess subjects six months after the intervention to determine the durability of training effects. 4. To identify changes in brain activation patterns in key neural regions as a result of TCT alone vs. TCT+SCT: during reward anticipation, and during emotion recognition. The timeliness of this approach is supported by recent evidence demonstrating only weak associations between traditional cognitive remediation approaches and functional outcome in schizophrenia, but a strong, direct relationship between social cognition and functional outcome. Thus we must now examine the clinical, functional, and neural effects of a well-designed state-of-the-art cognitive training program that combines neurocognition with social cognition training. Public Health Relevance Statement (Narrative) This research is relevant to public health in that it will: 1) determine whether the addition of social cognition training exercises to neuroplasticity-based cognitive training of auditory and visual processing improves outcome for people with schizophrenia; 2) help to identify neuroplasticity-based cognitive remediation strategies for schizophrenia that provide the maximal benefit in terms of helping patients to achieve meaningful improvements in motivation and social and occupational functioning.