Improving the Functional Outcomes in Older Adults with Schizophrenia

描述（由申请人提供）：精神分裂症患者的认知修复已被证明可以改善认知功能，并带来实质性的功能益处。然而，大多数精神分裂症患者，尤其是少数民族和老年人，从未接受过这些治疗。这些干预措施的后勤问题极大地限制了这些干预措施提供给这些患者的程度。目前，实施这些干预方案通常需要由训练有素的人员亲自出席，就像实施评估认知表现和功能能力（FC，执行日常生活技能的能力）的方案一样。用于评估这些干预措施以及认知和功能能力的评估方案也可能相当繁琐。此外，这些干预措施尚未对老年精神分裂症患者进行评估，这是一个关键且不断增长的亚群，其认知和功能缺陷更为严重。本发展项目考察了使用基于技术的方法的可行性和有效性，该方法结合了定制的认知增强干预、认知评估和FC测量。这项研究将包括一项随机临床试验。80名老年精神分裂症患者将被随机分为两组，一组接受定制的认知补救干预，另一组接受先前研究中使用的视频游戏控制条件。认知修复干预的重点是在以前的研究中显示出最大功效的认知成分，最容易在老年精神分裂症患者中下降，并且对日常生活任务的表现至关重要。基线和干预后评估将包括认知和功能能力的标准测量（MCCB， UPSA）和基于技术的认知能力评估（网络神经认知评估）和FC（对日常生活至关重要的一系列生态有效的基于技术的功能任务的表现）。我们还将研究与基于技术的评估相比，对认知和功能能力的标准亲自评估的治疗的收敛性和敏感性。拟议项目的总体目标是为老年精神分裂症患者开发基于技术的认知和功能评估和治疗方案的组成部分，该方案可以在各种社区和住宅环境中远程提供。然后将在一项更大的研究中对该方案进行测试，直接比较面对面与远程认知修复的有效性和可行性以及结果评估。

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.