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Effects on Neuropsychological Test Performance

Morris Bell, PhD; Gary Bryson, PhD; Tamasine Greig, PhD; Cheryl Corcoran, MD; Bruce E. Wexler, MD

Arch Gen Psychiatry. 2001;58:763-768.

Background  Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia. In this study, we determined whether neurocognitive enhancement therapy (NET) in combination with work therapy (WT) would improve performance on neuropsychological tests related to but different from the training tasks.

Methods  Sixty-five patients with schizophrenia or schizoaffective disorder were randomly assigned to NET plus WT or WT alone. Neurocognitive enhancement therapy included computer-based training on attention, memory, and executive function tasks; an information processing group; and feedback on cognitive performance in the workplace. Work therapy included paid work activity in job placements at the medical center (eg, mail room, grounds, library) with accompanying supports. Neuropsychological testing was performed at intake and 5 months later.

Results  Prior to enrollment, both groups did poorly on neuropsychological testing. Patients receiving NET + WT showed greater improvements on pretest-posttest variables of executive function, working memory, and affect recognition. As many as 60% in the NET + WT group improved on some measures and were 4 to 5 times more likely to show large effect-size improvements. The number of patients with normal working memory performance increased significantly with NET + WT, from 45% to 77%, compared with a decrease from 56% to 45% for those receiving WT.

Conclusions  Computer training for cognitive dysfunction in patients with schizophrenia can have benefits that generalize to independent outcome measures. Efficacy may result from a synergy between NET, which encourages mental activity, and WT, which allows a natural context for mental activity to be exercised, generalized, and reinforced.

From the Veterans Affairs Connecticut Healthcare System, West Haven, Conn; and Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.

Corresponding author and reprints: Morris Bell, PhD, Psychology Service 116B, 950 Campbell Ave, VA Connecticut Healthcare System, West Haven, CT (e-mail: Bell.Morris_D+{at}West-Haven.va.gov).

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