Cognitive enhancement and Schizophrenia

 Computer Remediation therapy indicated for Schizophrenia

Computer Remediation therapy indicated for Schizophrenia

Schizophrenia is estimated to cost £13.1 billion per year in total in the UK.  This is a significant sum  even without considering the impact on wellbeing and health of the persons affected.   There are  no licensed pharmaceutical treatments to improve cognitive functions for people with schizophrenia.  However, there is increasing evidence that computer-assisted training and rehabilitation can help people with schizophrenia overcome some of their symptoms, with better outcomes in daily functioning and their lives.

Researchers at the University of Cambridge, referenced below have developed and tested their own game to help improve the memory of patients with schizophrenia.  This gives further weight to the use of RehaCom  which has been a popular tool in Germany for a number of years.

Cognitive deficits are a central facet of the condition and are known to be an important determinant of the level of self care.   Even small improvements in cognitive functions could help patients secure independent living and working, thereby reducing direct and indirect costs significantly.  Cognitive deficits are typically found in memory, cognitive flexibility and visuospatial learning.

Cognitive remediation therapies for schizophrenia can result in improvements in cognition, symptoms and psychosocial functioning, particularly when combined with neuropsychiatric rehabilitation.  Of particular interest, recent computer-assisted cognitive rehabilitation and training studies have successfully shown improvements, not only in cognitive functioning, but also in negative symptoms, reality monitoring, social cognition and employment and functional outcomes in schizophrenia.

As apathy and negative symptoms are typical of chronic neuropsychiatric disorders, the computer training has the added advantage of increasing motivation. This latter feature of computer based cognitive training is particularly important as patients actively enjoy participating, in contrast to the traditional cognitive training, which may seem tedious or boring.

Computer-based cognitive training taking the form of a neurotechnology (i.e. ‘brain training’ software), for example, has already been shown to improve verbal learning/memory and cognitive control in individuals with schizophrenia. Importantly, improved cognition was associated with better functioning 6 months after completing the training intervention.

Use of a computer game as a means of cognitive remediation has also been shown to improve negative symptoms and executive function in a small number of individuals with first episode psychosis. Furthermore, video game playing has been associated with structural neural changes, including a significant grey matter increase in the hippocampal formation in healthy individuals. Computer games that are custom-made to be enjoyable, attention-grabbing and easily accessible may thus comprise an appealing treatment option for patients and a cost effective option for health services.

RehaCom has been widely used across Europe since it's introduction in Germany where it is used by approaching 200 centres treating neurological diseases.

Reference:

"The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy people".  Sahakian, Barbara J et al
Phil. Trans. R. Soc. B 370: 20140214.
http://dx.doi.org/10.1098/rstb.2014.0214