Cognitive Impairment in Schizophrenia: Understanding and Treatment
Examining the impact of cognitive impairment on daily functioning and exploring treatment options
Introduction
- Good afternoon and welcome to the brain and behavior Research Foundations meet the scientist monthly webinar series
- Dr. Jeff Bo, President and CEO of the Foundation, will be your host for today's webinar
- Dr. Amanda McMacquarie will present on cognitive impairment in psychosis: what it is and how it's treated
- The brain behavior research foundation funds innovative ideas in neuroscience and psychiatry to better understand and treat brain and behavior disorders
Overview of Schizophrenia
- Schizophrenia is a complex psychiatric disorder characterized by psychotic symptoms
- While effective treatments for psychosis symptoms exist, functional outcomes remain a challenge
- Cognitive impairment is a core feature of schizophrenia, with approximately 80% of individuals experiencing cognitive deficits
- Despite its advances, schizophrenia remains a leading cause of disability for young adults
Assessment of Cognitive Impairment
- Cognitive impairment in schizophrenia can be objectively assessed through neuro evaluations conducted by clinical psychologists
- The Matrix Consensus Cognitive Battery (MCCB) is a recommended cognitive assessment battery for research studies
- The MCCB assesses various cognitive domains including speed of processing, attention, working memory, verbal and visual learning, reasoning, and social cognition
- Cognitive performance in schizophrenia is consistently found to be below expectations even when falling within normal limits
Profile of Cognitive Impairment
- Cognitive impairment in schizophrenia is characterized by a diffuse pattern of deficits across cognitive domains
- It affects both lower order perception processing and higher order executive functions
- Studies show consistent and large effects of cognitive impairment in individuals with schizophrenia
- Cognitive performance is not significantly impacted by clinical factors or medications
Neurodevelopmental Nature of Cognitive Impairment
- Schizophrenia is now recognized as a neurodevelopmental disorder with cognitive impairments starting early in life
- Cognitive impairments are present before the onset of psychosis and remain relatively stable over time
- Studies with clinical high-risk individuals provide insights into the trajectory of cognitive impairment preceding the onset of psychosis
- The timing of the onset of cognitive impairment is still an open question
Cognition and Community Functioning
- The link between cognition and community functioning is well-established in the literature
- Cognitive impairment is associated with reduced community functioning, including social relationships, work/school success, independent living, and engagement in fulfilling activities
- The relationship between cognition and functioning holds early in the illness course and among clinical high-risk individuals
- Cognitive impairment predicts later community functioning over time
Intervening Factors: Social Cognition
- Social cognition refers to the mental operations underlying social interactions
- People with schizophrenia often exhibit social cognitive impairment across domains such as emotion processing, theory of mind, and social cue perception
- Social cognition is associated with community functioning, and improvements in social cognition can lead to improved functioning
- Targeting social cognition is a potential treatment approach
Intervening Factors: Defeatist Beliefs
- Defeatist beliefs refer to negative attitudes and beliefs about one's ability to perform tasks
- Defeatist beliefs are associated with reduced motivation to engage in activities and poor functioning
- Targeting defeatist beliefs can improve functioning and increase motivation
- Cognitive interventions and psychotherapy can address defeatist beliefs as part of treatment
Intervening Factors: Negative Symptoms
- Negative symptoms in schizophrenia include reduced motivation and drive to engage in activities
- Negative symptoms are associated with cognitive impairment and poor functioning
- Psychotherapy and targeted interventions can address negative symptoms and improve cognitive functioning
- Addressing negative symptoms can lead to improved community functioning
Treatment Approaches: Pharmacological Interventions
- Pharmacological interventions can directly target cognitive impairment in schizophrenia
- Some neurotransmitter systems and medications show promising effects on cognitive performance
- However, the effects of medication on cognition can vary and may have side effects
- Combining medications with other forms of treatment, such as cognitive training, may be more effective
Treatment Approaches: Cognitive Training
- Cognitive training involves structured activities to improve cognitive performance
- Both restorative and compensatory approaches can be used in cognitive training
- Cognitive training can lead to improvements in cognitive performance but transfer to untrained tasks and community functioning is challenging
- Personalized cognitive training and strategies for near and far transfer of skills are avenues for further research
Treatment Approaches: Physical Exercise
- Physical exercise has shown promise in improving cognitive performance in schizophrenia
- Aerobic exercise has been associated with improvements in overall cognition, working memory, attention, and social cognition
- Combining cognitive training and exercise can yield greater improvements in cognition and functioning
- Further research is needed to explore optimal exercise approaches and long-term effects
Treatment Approaches: Non-Invasive Neurostimulation
- Non-invasive neurostimulation techniques involve applying electrical or magnetic stimulation to modulate brain activity
- Repetitive transcranial magnetic stimulation (rTMS) has shown promise in improving working memory performance
- Further research is needed to determine the reliability of these effects and the optimal stimulation parameters
- Non-invasive neurostimulation may be a complementary treatment approach for cognitive impairment
Treatment Approaches: Targeting Social Cognition
- Social skills training and social cognition training can improve social cognition in schizophrenia
- Improved social cognition can lead to enhanced community functioning
- These interventions involve instruction, role-play exercises, and cognitive strategies
- Bridging components can facilitate the generalization of skills to real-world settings
Treatment Approaches: Addressing Defeatist Beliefs
- Psychotherapy and cognitive interventions can address defeatist beliefs
- Targeting defeatist beliefs can improve motivation and functioning
- Treatment approaches can involve cognitive restructuring, goal-setting, and support
- Addressing defeatist beliefs is an important part of a comprehensive treatment plan
Treatment Approaches: Psychotherapy for Negative Symptoms
- Psychotherapy can address negative symptoms and improve cognitive functioning
- Targeted interventions, such as cognitive-behavioral therapy (CBT), can be effective
- Cognitive-behavioral therapy for negative symptoms focuses on identifying and challenging negative beliefs and increasing activity levels
- Preliminary evidence suggests that psychotherapy can lead to improvements in functioning
Conclusion
- Cognitive impairment is a core feature of schizophrenia and impacts daily functioning
- The link between cognition and functioning is well-established
- Understanding the factors along the pathway between cognition and functioning can inform treatment approaches
- Pharmacological interventions, cognitive training, physical exercise, neurostimulation, and psychotherapy can all play a role in improving cognitive impairment and functioning