Cognitive Impairment in Schizophrenia: Understanding and Treatment

Examining the impact of cognitive impairment on daily functioning and exploring treatment options

Slide1: 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

Slide2: 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

Slide3: 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

Slide4: 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

Slide5: 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

Slide6: 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

Slide7: 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

Slide8: 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

Slide9: 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

Slide10: 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

Slide11: 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

Slide12: 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

Slide13: 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

Slide14: 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

Slide15: 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

Slide16: 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

Slide17: 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

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