Occurrence and Influencing Factors of Cognitive Impairment in Elderly Patients With Schizophrenia and

Occurrence and Influencing Factors of Cognitive Impairment in Elderly Patients With Schizophrenia and the Application Effect of Acceptance and Commitment Therapy Nursing Model

ACT combined with stratified intervention improved cognitive function and quality of life in elderly schizophrenia patients by enhancing psychological flexibility and family support.

Study Overview

• Status: Terminated
• Conditions: Cognitive Impairment; Acceptance and Commitment Therapy; Schizophrenia Disorders
• Intervention / Treatment: Other: the conventional treatment group; Other: the ACT group

Detailed Description

This study analyzes factors influencing cognitive impairment and evaluates the efficacy of a stratified intervention combining Acceptance and Commitment Therapy (ACT) with these factors to improve cognitive function and quality of life. A total of 149 elderly patients with schizophrenia were enrolled, split into cognitive impairment (n = 86) and non-cognitive impairment (n = 63) groups. A combined case-control and randomized controlled trial design was employed. Logistic regression was used to identify independent risk factors. Cognitive impairment patients were randomly assigned to either the conventional treatment group (n = 39) or the ACT group (n = 39) for a 6-week intervention. Evaluation instruments included the AAQ-II (psychological flexibility), GSES (self-efficacy), FACES II-CV (family functioning), SSMI-C (internalized stigma), and SQLS (quality of life).

• Study Type: Interventional
• Enrollment (Actual): 78
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Huzhou, China, 313000
    • Huzhou third people's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• (1)Meets the diagnostic criteria for schizophrenia as defined in the International Classification of Diseases, Tenth Revision (ICD-10);
• (2) age > 60 years;
• (3)possesses at least a primary school education, enabling independent completion of all questionnaires;
• (4) has been taking antipsychotic medication continuously and regularly for at least one year during the enrollment period, with current symptoms and disease status stabilized in the maintenance phase;
• (5)informed consent obtained from the patient or their family/guardian.

Exclusion Criteria:

• (1) Coexisting organic mental disorders, affective disorders, or similar conditions;
• (2) coexisting physical illnesses that may affect cognitive function, such as hepatic or renal dysfunction;
• (3) alcohol dependence or dependence on psychoactive substances;
• (4) receipt of electroconvulsive therapy within the past three months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: the conventional treatment group; Patients received conventional mental health education once weekly for 6 weeks, covering schizophrenia symptoms, treatment, and prognosis. Standard nursing care and antipsychotic medications (e.g., olanzapine, quetiapine) were maintained without additional psychological interventions.	Other: the conventional treatment group; Patients received conventional mental health education once weekly for 6 weeks, covering schizophrenia symptoms, treatment, and prognosis. Standard nursing care and antipsychotic medications (e.g., olanzapine, quetiapine) were maintained without additional psychological interventions.
Other: the ACT group; Patients received ACT-based nursing interventions tailored to risk factors (e.g., age ≥70, long disease duration), including: ACT modules: Acceptance, cognitive defusion, mindfulness, values clarification, and committed action. Adjunct strategies: Family therapy, Tai Chi, and crisis planning. Frequency: Daily practice + 1-2 group sessions/week for 6 weeks. Goal: Enhance psychological flexibility, reduce stigma, and improve cognitive function.	Other: the ACT group; Patients received ACT-based nursing interventions tailored to risk factors (e.g., age ≥70, long disease duration), including: ACT modules: Acceptance, cognitive defusion, mindfulness, values clarification, and committed action. Adjunct strategies: Family therapy, Tai Chi, and crisis planning. Frequency: Daily practice + 1-2 group sessions/week for 6 weeks. Goal: Enhance psychological flexibility, reduce stigma, and improve cognitive function.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Cognitive Function	Improvement in global cognitive function assessed via the Montreal Cognitive Assessment (MoCA), focusing on memory, attention, and executive function. Higher scores indicate better cognition (range: 0-30).	Baseline to 6 weeks post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Psychological Flexibility (AAQ-II)	Scores on the Acceptance and Action Questionnaire-II (7 items, Likert scale 1-7). Lower scores indicate greater flexibility.	Baseline to 6 weeks.
Self-Efficacy (GSES)	General Self-Efficacy Scale (10 items, scores 10-40). Higher scores reflect stronger self-efficacy.	Baseline to 6 weeks.
Family Functioning (FACES II-CV)	Family Adaptability and Cohesion Evaluation Scale (cohesion + adaptability subscales). Higher scores indicate healthier family dynamics.	Baseline to 6 weeks.
Stigma Reduction (SSMI-C)	Stigma Scale for Mental Illness (28 items). Lower scores on Discrimination/Illness Concealment subscales indicate reduced stigma.	Baseline to 6 weeks.
Quality of Life (SQLS)	Schizophrenia Quality of Life Scale (30 items). Lower scores indicate better QoL in psychosocial, motivation, and symptom domains.	Baseline to 6 weeks.

Collaborators and Investigators

• Sponsor: Third People's Hospital, Huzhou City, Zhejiang Province, China
• Investigators: Principal Investigator: Ying Xu, Huzhou third people's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): October 13, 2023
• Primary Completion (Actual): January 5, 2024
• Study Completion (Actual): September 19, 2024

Study Registration Dates

• First Submitted: April 22, 2025
• First Submitted That Met QC Criteria: April 22, 2025
• First Posted (Actual): April 29, 2025

Study Record Updates

• Last Update Posted (Actual): June 24, 2025
• Last Update Submitted That Met QC Criteria: June 18, 2025
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Schizophrenia; Cognitive Dysfunction
• Other Study ID Numbers: No. 2025-130

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No