Do specific neurocognitive deficits predict specific domains of community function in schizophrenia?

We examined whether specific neurocognitive deficits predicted specific domains of community outcome in 40 schizophrenic patients. Neuropsychological assessments were conducted before hospital discharge, and measures of functional outcome were obtained 1 to 3.5 years later. A priori hypotheses were generated based upon a recent review by Green (Green MF [1996] What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153(3):321-330). As hypothesized, verbal memory predicted all measures of community outcome, vigilance predicted social outcomes, and executive functioning predicted work and activities of daily living (ADLs). However, in addition to the predicted relationships, many other associations were found between neuropsychological test scores and adaptive function. Furthermore, both cognitive and functional measures were intercorrelated. If deficits in adaptive functioning are neurocognitively multi-determined, utilizing compensatory strategies to bypass multiple areas of cognitive impairment may be more efficient than cognitive remediation in improving community outcomes.

Randomized controlled trial of the use of compensatory strategies to enhance adaptive functioning in outpatients with schizophrenia.

OBJECTIVE: Cognitive adaptation training is a novel psychosocial treatment approach designed to improve adaptive functioning by using compensatory strategies in the home or work environment to bypass the cognitive deficits associated with schizophrenia. The authors tested the effect of cognitive adaptation training on level of adaptive functioning in outpatients with schizophrenia. METHOD: Forty-five patients with DSM-IV schizophrenia or schizoaffective disorder were randomly assigned for 9 months to one of three treatment conditions: 1) standard medication follow-up, 2) standard medication follow-up plus cognitive adaptation training, and 3) standard medication follow-up plus a condition designed to control for therapist time and provide environmental changes unrelated to cognitive deficits. Comprehensive assessments were conducted every 3 months by raters who were blind to treatment condition. RESULTS: Significant differences were found between the three treatment groups in levels of psychotic symptoms, motivation, and global functioning at the end of the 9-month study period. Patients in the cognitive adaptation training group overall had higher levels of improvement, compared with those in the remaining treatment conditions. In addition, the three groups had significantly different relapse rates over the 9-month study: 13% for the cognitive adaptation training group, 69% for the group in which therapist time and environmental changes were controlled, and 33% for the group who received standard follow-up only. CONCLUSIONS: Compensatory strategies may improve outcomes for patients with schizophrenia.

Predicting quality of life from symptomatology in schizophrenia at exacerbation and stabilization.

There has been little research investigating how symptoms of schizophrenia and changes in symptomatology across the course of the illness relate to measures of quality of life in patients. We examined this issue in 45 patients assessed at hospital admission for illness exacerbation, at stabilization (prior to discharge) and at follow-up (5-9 months post-discharge). Symptom ratings at each time period consisted of the Brief Psychiatric Rating Scale (BPRS) and the Negative Symptom Assessment (NSA). The Heinrichs-Carpenter Quality of Life Scale (QLS) was administered upon admission to the hospital (assessing the 3 months prior to admission) and again at follow-up. Correlational analyses revealed relationships of both positive and negative symptoms with quality of life. These relationships are particularly strong at stabilization. Stepwise regression analyses revealed changes in the NSA motivation component to be most important in predicting quality of life for the patients at follow-up. BPRS psychosis and paranoia components are important predictors of quality of life at stabilization (but not during acute exacerbation). These results are important in terms of understanding the impact of changes in symptomatology on the quality of life for patients with schizophrenia as well as in targeting specific symptom clusters for treatment to maximize quality of life post-hospitalization.

Executive function in schizophrenia.

Many domains of executive function are impaired in patients with schizophrenia including forward planning, concept formation, initiation, self-monitoring, and the ability to direct attention and memory. These impairments are noticeable against a background of generalized cognitive deficits, and many affect 40% to 95% of individuals with this disorder. Specific executive deficits appear to be related to specific symptom clusters and are linked to structural and functional brain abnormalities. Executive impairment predicts multiple domains of functional outcome in schizophrenia patients. Atypical antipsychotic agents and cognitive rehabilitation may be promising new approaches for the treatment of cognitive and functional impairment in schizophrenia.

Concurrent and predictive validity of the Allen Cognitive Levels Assessment.

The present study examined the concurrent and predictive validity of the Allen Cognitive Levels (ACL) Assessment in a sample of 110 medicated patients with schizophrenia who received the ACL at discharge from a state psychiatric facility. Subsamples within this group of patients had received an Activities of Daily Living assessment (n = 64) and a comprehensive neuropsychological test battery (n = 48) at discharge, or a battery of community follow-up measures (n = 30) 1-3.5 years following discharge as part of other investigations. Positive correlations were found between the ACL and concurrent measures of adaptive and cognitive function. With respect to cognitive variables, stepwise multiple regression analysis revealed that the majority of the variance in ACL scores was predicted by neuropsychological test scores assessing higher level cognitive processes, such as visual organization, manipulation of information in working memory, and ability to inhibit a response to a prepotent stimulus. Finally, results revealed positive relationships between the ACL obtained at discharge and community functioning at follow-up. The results of this study provide some evidence for the concurrent and predictive validity of the ACL for patients with schizophrenia and suggest that further study of this assessment tool would be important to pursue in future investigations.

Development of arithmetical competencies in Chinese and American children: influence of age, language, and schooling.

The arithmetical competencies of more than 200 Chinese or American kindergarten, first-, second-, or third-grade children were assessed toward the beginning and toward the end of the U.S. school year. All children were administered a paper-and-pencil test of addition skills, a digit span measure, and an addition strategy assessment. The addition strategy assessment provided information on the types of strategies the children used to solve simple addition problems as well as information on the speed and accuracy of their strategy use. Information on the number of math instruction periods across times of measurement was also obtained for each of the first-, second-, and third-grade children. The pattern of arithmetical development across the academic year and across the Chinese and American children suggests that a mix of cultural and maturational factors influence the emergence of early arithmetical competencies and that the Chinese advantage in early mathematical development is related to a combination of language- and school-related factors.

Counting knowledge and skill in cognitive addition: a comparison of normal and mathematically disabled children.

The relationship between counting knowledge and computational skills (i.e., skill at counting to solve addition problems) was assessed for groups of first-grade normal and mathematically disabled (MD) children. Twenty-four normal and 13 MD children were administered a series of counting tasks and solved 40 computer-administered addition problems. For the addition task, problem-solving strategies were recorded on a trial-by-trial basis. Performance on the counting tasks suggested that the MD children were developmentally delayed in the understanding of essential and unessential features of counting and were relatively unskilled in the detection of certain forms of counting error. On the addition task, the MD children committed many more computational errors and tended to use developmentally immature counting procedures. The immature counting knowledge of the MD children, combined with their relatively poor skills at detecting counting errors, appeared to underlie their poor computational skills on the addition task. Suggestions for future research are presented.