Durability of Effects of Cognitive Remediation on Cognition and Psychosocial Functioning in Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Journal: The American journal of psychiatry

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Affiliated Institutions:  Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Vita, Barlati, Nibbio, Facchi, Deste); Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy (Vita, Barlati, Ceraso, Durante, Deste); Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London (Wykes).

Abstract summary 

Cognitive remediation provides substantial improvements in cognitive performance and real-world functioning for people living with schizophrenia, but the durability of these benefits needs to be reassessed and better defined. The aims of this study were to provide a comprehensive assessment of the durability of the benefits of cognitive remediation for cognition and functioning in people living with schizophrenia and evaluating potential moderators of effects.A systematic search was conducted in PubMed, Scopus, and PsycINFO, and reference lists of included articles and Google Scholar were inspected. Eligible studies were randomized clinical trials of cognitive remediation in patients diagnosed with schizophrenia spectrum disorders in which follow-up assessments were included. Screening and data extraction were performed by at least two independent reviewers. Cohen's d was used to measure outcomes. Primary outcomes were changes in cognition and functioning from baseline to conclusion of follow-up. Moderators of the durability of effects were assessed.Of 2,840 identified reports, 281 full texts were assessed and 130 reports on 67 studies with 5,334 participants were included. Cognitive remediation produced statistically significant positive effects that persisted at the end of follow-up in global cognition (d=0.23) and in global functioning (d=0.26). Smaller study samples and single-center studies were associated with better cognitive outcomes; longer treatment and follow-up duration, techniques for transferring cognitive gains to the real world, integration with psychiatric rehabilitation, group format of delivery, and more female participants in the sample were associated with better functional outcomes.Cognitive remediation provides durable improvements in cognition and functioning in schizophrenia. This finding corroborates the notion that cognitive remediation should be implemented more widely in clinical and rehabilitation practice.

Authors & Co-authors:  Vita Barlati Ceraso Nibbio Durante Facchi Deste Wykes

Study Outcome 

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Citations : 
Authors :  8
Identifiers
Doi : 10.1176/appi.ajp.20230396
SSN : 1535-7228
Study Population
Female
Mesh Terms
Other Terms
Cognition/Learning/Memory;Cognitive Remediation;Meta-Analysis;Rehabilitation;Schizophrenia Spectrum and Other Psychotic Disorders
Study Design
Study Approach
Country of Study
Publication Country
United States