Comparison of focused cognitive training and portable "brain-games" on functional outcomes for vocational rehabilitation participants

Morris D Bell, Holly Laws, Brian Pittman, Jason K Johannesen, Morris D Bell, Holly Laws, Brian Pittman, Jason K Johannesen

Abstract

Cognitive remediation performed in a cognitive laboratory was compared with a sham control using portable brain games to study effects on vocational, neurocognitive, and functional outcomes for participants with psychotic disorders in vocational rehabilitation (VR). Seventy-seven participants (61% schizophrenia, 39% other psychosis) in transitional (45.5%) or supported employment (54.5%) were randomly assigned to 6 months of portable cognitive-games (CG) or cognitive remediation (CR) plus a weekly goal-setting group, and evaluated during training, post-training and at 12 months. Overall rates of employment did not differ significantly at 12-month follow-up; however, VR + CG attained employment more rapidly during training. A significant time by condition interaction favored VR + CR on Quality of Life Total Score and Instrumental Functioning over 12 months. Neurocognitive outcomes favored VR + CR, particularly on attention. Training hours related significantly to neurocognitive improvement regardless of condition. No differences were found in training adherence despite portability for VR + CG. Results indicate that VR + CR had significantly greater effect than VR + CG on neurocognition and community functioning, but not on employment outcome. Job attainment rates during the training period revealed a potential advantage for portable training raising new questions concerning how cognitive remediation can be most effectively integrated with VR.

Trial registration: ClinicalTrials.gov NCT00829400.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Employment rates over time by condition.

References

    1. McGurk SR, Mueser KT, Feldman K, Wolfe R, Pascaris A. Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial. Am J Psychiat. 2007;164(3):437–441. doi: 10.1176/ajp.2007.164.3.437.
    1. Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A Meta-Analysis of Cognitive Remediation for Schizophrenia: Methodology and Effect Sizes. Am J Psychiat. 2011;168(5):472–485. doi: 10.1176/appi.ajp.2010.10060855.
    1. Katsumi A, Hoshino H, Fujimoto S, Niwa S. Efficacy of Cognitive Remediation in Schizophrenia: A Short Review of Its Variable Effects According to Cognitive Domain. Open Journal of Psychiatry. 2015;5:170–176. doi: 10.4236/ojpsych.2015.52019.
    1. Wexler BE, Bell MD. Cognitive Remediation and Vocational Rehabilitation for Schizophrenia. Schizophr Bull. 2005;31(4):931–41. doi: 10.1093/schbul/sbi038.
    1. Bell MD, Zito W, Greig T, Wexler BE. Neurocognitive Enhancement Therapy with Vocational Services in Schizophrenia: Work Outcomes at Two Year Follow-Up. Schizophr Res. 2008;105(1–3):18–29. doi: 10.1016/j.schres.2008.06.026.
    1. McGurk SR, Mueser KT, Pascaris A. Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Schizophr Bull. 2005;31:898–909. doi: 10.1093/schbul/sbi037.
    1. Nuechterlein KH, et al. Individual placement and support for individuals with recent-onset schizophrenia: integrating supported education and supported employment. Psych Rehab J. 2008;31(4):340. doi: 10.2975/31.4.2008.340.349.
    1. Chan JY, Hirai HW, Tsoi KK. Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials. J Psychiatric Res. 2015;68:293–300. doi: 10.1016/j.jpsychires.2015.05.010.
    1. Lystad JU, et al. Neurocognition and occupational functioning in schizophrenia spectrum disorders: The MATRICS Consensus Cognitive Battery (MCCB) and workplace assessments. Schizophr Res. 2016;31:143–9. doi: 10.1016/j.schres.2015.12.002.
    1. Wykes. T., Spaulding, W.D. Thinking about the future cognitive remediation therapy—what works and could we do better? Schizophr Bull. Sep1(37) (suppl 2):S80–90 (2011).
    1. Shah TM, Weinborn M, Verdile G, Sohrabi HR, Martins RN. Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline. Neuropsychol Rev. 2017;27:62–80. doi: 10.1007/s11065-016-9338-9.
    1. Nouchi R, et al. Brain Training Game Improves Executive Functions and Processing Speed in the Elderly: A Randomized Controlled Trial. PLoS ONE. 2012;7(1):e29676. doi: 10.1371/journal.pone.0029676.
    1. Nouchi R, et al. Brain Training Game Boosts Executive Functions, Working Memory and Processing Speed in the Young Adults: A Randomized Controlled Trial. PLoS ONE. 2013;8(2):e55518. doi: 10.1371/journal.pone.0055518.
    1. Bell MD, Choi KH, Dyer C, Wexler BE. Benefits of Cognitive Remediation and Supported Employment for Schizophrenia Patients with Poor Community Functioning. Psychiatr Serv. 2014;65(4):469–475. doi: 10.1176/appi.ps.201200505.
    1. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-I/P) New York: New York State Psychiatric Institute. Biometrics Research; 1996.
    1. Kay SR, Fiszbein A, Opler L. The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophr Bull. 1987;13:261–276. doi: 10.1093/schbul/13.2.261.
    1. Heinrichs D, Hanlon E, Carpenter W. The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull. 1984;10:388–398. doi: 10.1093/schbul/10.3.388.
    1. Bell MD, Milstein RM, Goulet JL, Lysaker PH, Cicchetti D. The positive and negative syndrome scale and the brief psychiatric rating scale: Reliability, comparability and predictive validity. Journal of Nervous and Mental Disorders. 1992;180:723–728. doi: 10.1097/00005053-199211000-00007.
    1. Bryson G, Greig T, Lysaker P, Bell MD. Quality of life benefits of paid work activity in schizophrenia: a longitudinal analysis. Schizophr Bull. 2002;28(2):249–257. doi: 10.1093/oxfordjournals.schbul.a006935.
    1. The Psychological Corporation . Wechsler test of adult reading. San Antonio, TX: Harcourt Assessment; 2001.
    1. Nuechterlein KH, Green MF. MATRICS Consensus Cognitive Battery Manual. Los Angeles, CA: MATRICS Assessment Inc; 2006.
    1. Bond G, et al. Implementing supported employment as an evidence-based practice. Psychiatr Serv. 2001;52(3):313–22. doi: 10.1176/appi.ps.52.3.313.
    1. Petry NM, Martin B, Cooney JL, Kranzler HR. Contingency Management to Reduce Substance Use in Individuals Who are Homeless with Co-Occurring Psychiatric Disorders. J Consulting and Clinical Psychol. 2000;68(2):250–257. doi: 10.1037/0022-006X.68.2.250.
    1. Brunner E, Domhof S, Langer F. Nonparametric analysis of longitudinal data in factorial experiments. New York, NY: John Wiley and Sons; 2002.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit