Evaluating Two Types of Cognitive Training in Veterans with Schizophrenia

描述(由申请人提供)： 精神分裂症是一种影响高级神经认知操作(如言语记忆、执行功能)和低级知觉过程(如听觉处理)的障碍。这些缺陷导致了社区结果不佳和患者严重的功能残疾。有效地治疗与这种疾病相关的认知功能障碍对于改善日常功能是很重要的。最近的荟萃分析研究报告称，精神分裂症患者的认知训练对认知功能的影响程度适中，对日常功能的影响较小。然而，大多数针对精神分裂症的训练干预只针对更高阶的认知过程。最近的一些干预措施针对的是基本的知觉处理，并表明精神分裂症患者的听觉和视觉知觉能力可以得到训练和提高。这些发现表明，基本的知觉处理可能是干预的理想目标。在这一点上，仍然不清楚基于神经可塑性的自下而上的干预是否比针对注意力、工作记忆和执行功能等自上而下的功能的干预更有效。目前的CDA提案将对比针对基本听觉过程的自下而上干预和针对高阶认知功能的自上而下干预，与对照条件相比，退伍军人患有精神分裂症。这些干预措施将根据它们对三个结果领域的代表性指标的影响进行评估：1)神经认知，2)脑电(EEG)，3)功能能力。参与者将被随机分配到自下而上的听觉训练、自上而下的认知训练或控制治疗(商业电脑游戏)。所有治疗将每周进行三次(每次1小时)，为期12周。在基线和治疗结束时，将进行一系列全面的认知、电生理和功能测量。在四年的研究中，我们将招募120名患有精神分裂症或分裂情感障碍的退伍军人。这项建议将确定哪种训练方法在EEG测量的神经认知、功能能力和神经功能方面的改善幅度最大。此外，它还将阐明训练反应背后的神经机制。通过确定治疗较低水平的感知过程或较高水平的认知功能是否更有益，拟议的研究结果将为未来对患有精神分裂症的退伍军人进行基于康复的认知补救干预提供信息。

DESCRIPTION (provided by applicant): Schizophrenia is a disorder that affects both higher-level neurocognitive operations (e.g., verbal memory, executive functioning) and lower-level perceptual processes (e.g., auditory processing). These deficits contribute to the poor community outcome and severe functional disability seen in patients. Effectively treating the cognitive dysfunction associated with this illness is important to achieve improvements in daily functioning. Recent meta-analytic studies report that cognitive training in schizophrenia has a moderate effect-size impact on cognitive functioning and a lower impact on daily functioning. However, most training interventions for schizophrenia have only targeted higher- order cognitive processes. A few recent interventions have targeted basic perceptual processing and shown that auditory and visual perceptual abilities can be trained and improved in patients with schizophrenia. These findings suggest that basic perceptual processing may be an ideal target for intervention. At this point, it is still unclear whether a neuroplasticity-based, bottom-up intervention is more effective than an intervention that targets top-down functions like attention, working memory, and executive functioning. The current CDA proposal will contrast a bottom-up intervention targeting basic auditory processes and a top-down intervention targeting higher-order cognitive functions, compared with a control condition, in Veterans with schizophrenia. These interventions will be assessed by their effects on representative measures from three outcome domains: 1) neurocognition, 2) electroencephalography (EEG), and 3) functional capacity. Participants will be randomly assigned to the bottom-up auditory training, top-down cognitive training, or control treatment (commercial computer games). All treatments will be administered three times a week (1 hour each) for 12 weeks. A comprehensive battery of cognitive, electrophysiological, and functional measures will be administered at baseline and at completion of treatment. We will enroll 120 Veterans with schizophrenia or schizoaffective disorder across the 4 years of the study. This proposal will determine which training approach leads to the largest magnitude of improvement in neurocognition, functional capacity, and neural functioning measured with EEG. Moreover, it will shed light on the neural mechanisms underlying the response to training. By determining whether it is more beneficial to treat lower-level perceptual processes or higher-level cognitive functions, the results of the proposed research will inform future recovery-based cognitive remediation interventions for Veterans with schizophrenia.