Cognitive Remediation 2012 Alice Medalia, PhD Professor of Psychology (in Psychiatry), College of Physicians and Surgeons Director of Psychiatric Rehabilitation, Columbia University Medical Center New York, New York
Disclosure: Alice Medalia, PhD Type Company Grant/Research Support Eli Lilly and Company; SunovionPharmaceuticals Inc.• This presentation will not include discussion of off-label, experimental, and/or investigational uses of drugs or devices
Cognitive Remediation“is a behavioral training based intervention that aims to improve cognitive processes (attention, memory, executive function, socialcognition, or metacognition) with the goal of durability and generalization. …where social cognition is defined as “the mental operations that underlie social interactions, includingperceiving, interpreting, and generating responses to the intentions, dispositions, and behaviors of others.” Cognitive Remediation Experts Workshop 2010
Cognitive Remediation Is a Learning Activity• Learning relies on neuroplasticity Neurons in the brain adjust their activity and organization in response to new situations or to changes in the environment• Schizophrenia and neuroplasticity Patients receiving CR demonstrated a decelerated loss of and, in some cases, increase in gray matter volumeEack SM, et al. Arch Gen Psychiatry. 2010;67(7):674-682.
Cognitive Remediation and Computers• Many different software companies make exercises to improve cognition• There have been no head-to-head studies comparing software within and between companies• Some CR programs use one software and others use a combination of software• Engaging software has better outcomes
Who Participates in Cognitive Remediation Research? 36 years old Mild-moderate symptoms 12 years of education In- and outpatients N >2700 17 weeks of treatment 2-3 times a week 32 hours Drill and strategyWykes T, et al. Am J Psychiatry. 2011. Kurtz & Richardson Schz Bull 2011
Impact of Cognitive Remediation: Effect Sizes from Meta-Analyses Daily Functioning N-Cog:0.45 N-Cog:0.36 N-Cog:0.28 S-Cog:0.46 - S-Cog:0.78 S-Cog: 0.68 1.01WykesT, et al. Am J Psychiatry. 2011; McGurk SR, et al. Am J Psychiatry. 2007; Kurtz & Richardson Schiz Bull 2011
Variables That Significantly Moderate Impact of Cognitive Remediation Cognitive Functional Outcome Outcome Treatment Intensity Context Strategy + Motivation practiceMedalia &Choi . Neuropsych Review. 2009 Wykes T, et al. Am J Psychiatry. 2011
Impact of Treatment Intensity on Cognitive Enhancement in Schizophrenia Medalia & Richardson Schiz Bull 2005
Effect Size of Motivational Enhancements on Learning & Motivation Outcomes0.80.70.60.22.214.171.124.1 0 Attention Math Skill Intrinsic Perceived Motivation Competency Choi and Medalia; ScizResch2009
Promote Intrinsic Motivation • Use engaging activities • Contextualize • Personalize • Offer Learner Control
Personalizing Treatment• Link cognitive remediation to personally relevant goals• Different training exercises for different people• Find the sweet spot of challenge• Combine with therapies that are relevant to recovery goals
Cognitive Remediation ProgramsTypical Components Where They Are Found• Assessment of • Outpatient clinics that offer baseline cognition psychosocial rehabilitation programming• Set cognitive goals as they relate to recovery goals • Long-term residential/ inpatient care settings• Groups 2+/week; 3-4 months; drill practice strategy• Include bridging activities• Track progressMedalia A, et al. Cognitive Remediation in Psychological Disorders. Oxford University Press: New York; 2009.
Alice Medalia, PhD E-mail: email@example.com