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Cognitive remediation therapy for participants with late‐life schizophrenia
Author(s) -
Golas Angela C,
Elgallab Bishoy,
Abdool Petal S,
Bowie Christopher R,
Rajji Tarek K
Publication year - 2021
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.052696
Subject(s) - cognition , schizophrenia (object oriented programming) , cognitive remediation therapy , tolerability , dementia , montreal cognitive assessment , population , psychology , medicine , psychiatry , clinical psychology , physical therapy , adverse effect , cognitive impairment , disease , environmental health
Background Older patients with schizophrenia have an elevated risk of dementia; enhancing their cognitive function holds promise for delaying dementia in this population. Cognitive deficits strongly predict function in schizophrenia. Anticholinergic medication burden (ACB) compounds age‐related cognitive declines in late‐life schizophrenia (LLS). Cognitive remediation (CR) improves cognition in schizophrenia, however literature in LLS is sparse. This study examined the effect of CR on cognitive performance in participants with LLS. We also assessed CR tolerability, the interaction between ACB and the effect of CR on cognition. Method We adapted CR from our pilot study to a larger group. CR was provided over 12, twice‐weekly, therapist‐guided group sessions. Computerized drill‐and‐practice exercise difficulty levels were adjusted automatically based on performance. Participants were assessed at baseline and at study completion using clinical and cognitive measures. Result Thirty‐four participants were enrolled, 20 (mean (SD) age: 66.0 [5.8]) completed 92.3% (22.14 [1.98]) CR sessions; the ITT group (N=34) attended 72.9% (17.50 [7.23]) sessions. Global cognition did not improve (completers: p=0.80, ITT: p=0.86) with negligible effect size (completers: d=0.08; ITT d=0.04). There was no significant improvement in executive function (completers: p=0.16; ITT: p=0.33). Medication ACB was inversely associated with total MoCA score, accounting for 8.9% of the variance in final MoCA score (p=0.02). Conclusion Overall, CR was well tolerated but did not improve global cognition or executive functioning in this outpatient sample with LLS. A higher ACB was associated with greater cognitive impairment and a poorer response to CR. Future studies need to better characterize potential variables serving to limit the response to CR, including the number and frequency of CR sessions and the role of ACB.