Neuroplasticity-based computerized cognitive training, depressive symptoms, and functional outcome in schizophrenia

Cognitive deficits and depressive symptomatology are both prevalent and disabling in the schizophrenia population. Research efforts are underway to remediate cognitive deficits and improve functional disability, though it is unknown to what extent depressive symptomatology also plays a role in functional changes. This dissertation examined the relationship between a computerized cognitive remediation program, depressive symptoms, and long-term functional outcome at the Cognitive Remediation in Schizophrenia (CRIS) research program. An interim study of the first 22 participants from the cohort revealed an association between long-term improvements in cognition and functional outcome. This current analysis aimed to replicate those findings with the complete cohort of 32 participants. Additionally, within this cohort, effects of baseline depressive symptoms on functional outcome were analyzed. The CRIS program targeted improvement of schizophrenia-specific cognitive deficits using a novel neuroplasticity-based computerized cognitive remediation program. Participants were assessed at baseline and six months post-treatment. Cognitive functioning, functional outcome, and depressive symptomatology were assessed at each time point. For the primary analysis, findings of the previous interim study were replicated. A significant positive correlation was found between improvements in measurement of cognition and functional outcome for changes occurring between baseline and six months post-treatment. For the secondary investigation of the effects of depressive symptomatology, post-treatment cognitive changes were controlled for, but baseline severity of depressive symptomatology failed to account for decreased improvement in functional outcome post-treatment. Moreover, this analysis revealed that rather, long-term improvements in cognition predicted improvements in functional outcome. In the CRIS program, long-term cognitive improvements appear strongly related to life functioning improvements. This suggests that continued efforts to research and clinically implement cognitive remediation may indeed generalize to gains in functioning. Evidence was not found to implicate depressive symptomatology as interfering with functional gains from computerized remediation. Nonetheless, as depressive symptomatology is prevalent and disabling in schizophrenia, further research in this area is warranted.