Cognitive remediation therapy for outpatients with chronic schizophrenia: a controlled and randomized study

[Schizophrenia, cognition and psychoeducation]

Cognitive impairment among patients suffering from schizophrenia is closely linked to psychoeducation and therapeutic education. First, this cognitive impairment requires specific communication strategy and special cognitive and behavioral techniques, which make possible for the patients to improve their trainability. Some of these tools are detailed, such as solving problems, communication skills, role plays, repetition, rewarding, and motivational support. Second, functional and social impairment, and outcome, are partly consequences of these cognitive problems. Cognitive remediation targets elementary cognitive impairment, mostly with repetitive cognitive tasks, and studies show an improvement in these specific tasks, but without positive effect on functional and social aspects of the illness. Overall approaches, such as psychoeducation or therapeutic education, obtain real gains in quality of life for the patients, autonomy and clinical improvement. It's not yet possible to know if these positive results underlie improvement in elementary cognitive impairment. The combination between remediation and psychoeducation seems to be promising.

Is there any impact of cognitive remediation on an ecological test in schizophrenia?

INTRODUCTION

Cognitive deficits are commonly reported in schizophrenia and have a significant impact on the daily life of patients and on their social and work inclusion. Cognitive remediation therapies (CRT) may enhance the capabilities of schizophrenia patients. Although social and work integration is the ultimate goal of CRT, previous studies have failed to carry out a detailed assessment of the effects on everyday life.

METHODS

Fifty-nine schizophrenia patients were randomised into two groups (remediation or usual treatment) to test the effects of a new remediation programme, which included both rehearsal and strategy learning, on cognitive functions. An ecological test was used to evaluate its transfer to daily living skills.

RESULTS

Cognitive improvements are revealed in CRT patients, mainly in memory and executive functions. Patients showing some deficiencies to perform the ecological test had better scores after the CRT. Moreover, they significantly improve their social activity scores.

CONCLUSIONS

CRT would facilitate mental load monitoring by enhancing or reallocating cognitive resources, facilitating the patient's organisation and autonomy. The rehearsal learning approach improves the ability to carry out automatic operations that are less demanding in terms of cognitive resources, thereby increasing the resources available for acquisition and efficient use of strategies provided during the strategy learning approach.

Potential therapeutic avenues to tackle social cognition problems in schizophrenia

Therapeutic strategies for improving social cognition in patients with schizophrenia have shown much promise in improving social functioning, as well as remediating core psychotic symptoms. However, the efficacy of previous interventions has often been limited by the ambiguity and inconsistency of the categorized subdomains of social cognition, including theory of mind, emotion processing, social perception and attributional bias. Recent research in social and cognitive neuroscience has revealed many new issues that could contribute to the development of more integrated approaches for improving social functioning. The application of such neuroscientific work to a therapeutic and diagnostic context is likely to encourage more effective transference of learned skills to real-world social functioning. This article seeks to provide a comprehensive review of previous social cognitive interventions for schizophrenia, highlight some crucial limitations of these and present the relevance of recent advances in neuroscientific research in possible future treatment strategies. It is emphasized that a more integrated and naturalistic approach for improving social functioning with greater sensitivity for neuroscientific findings related to the psychopathology of schizophrenia is warranted.

Mindfulness training alters emotional memory recall compared to active controls: support for an emotional information processing model of mindfulness

Objectives: While mindfulness-based interventions have received widespread application in both clinical and non-clinical populations, the mechanism by which mindfulness meditation improves well-being remains elusive. One possibility is that mindfulness training alters the processing of emotional information, similar to prevailing cognitive models of depression and anxiety. The aim of this study was to investigate the effects of mindfulness training on emotional information processing (i.e., memory) biases in relation to both clinical symptomatology and well-being in comparison to active control conditions. Methods: Fifty-eight university students (28 female, age = 20.1 ± 2.7 years) participated in either a 12-week course containing a “meditation laboratory” or an active control course with similar content or experiential practice laboratory format (music). Participants completed an emotional word recall task and self-report questionnaires of well-being and clinical symptoms before and after the 12-week course. Results: Meditators showed greater increases in positive word recall compared to controls [F(1, 56) = 6.6, p = 0.02]. The meditation group increased significantly more on measures of well-being [F(1, 56) = 6.6, p = 0.01], with a marginal decrease in depression and anxiety [F(1, 56) = 3.0, p = 0.09] compared to controls. Increased positive word recall was associated with increased psychological well-being (r = 0.31, p = 0.02) and decreased clinical symptoms (r = −0.29, p = 0.03). Conclusion: Mindfulness training was associated with greater improvements in processing efficiency for positively valenced stimuli than active control conditions. This change in emotional information processing was associated with improvements in psychological well-being and less depression and anxiety. These data suggest that mindfulness training may improve well-being via changes in emotional information processing. Future research with a fully randomized design will be needed to clarify the possible influence of self-selection.

Cognitive training for impaired neural systems in neuropsychiatric illness

Neuropsychiatric illnesses are associated with dysfunction in distributed prefrontal neural systems that underlie perception, cognition, social interactions, emotion regulation, and motivation. The high degree of learning-dependent plasticity in these networks-combined with the availability of advanced computerized technology-suggests that we should be able to engineer very specific training programs that drive meaningful and enduring improvements in impaired neural systems relevant to neuropsychiatric illness. However, cognitive training approaches for mental and addictive disorders must take into account possible inherent limitations in the underlying brain 'learning machinery' due to pathophysiology, must grapple with the presence of complex overlearned maladaptive patterns of neural functioning, and must find a way to ally with developmental and psychosocial factors that influence response to illness and to treatment. In this review, we briefly examine the current state of knowledge from studies of cognitive remediation in psychiatry and we highlight open questions. We then present a systems neuroscience rationale for successful cognitive training for neuropsychiatric illnesses, one that emphasizes the distributed nature of neural assemblies that support cognitive and affective processing, as well as their plasticity. It is based on the notion that, during successful learning, the brain represents the relevant perceptual and cognitive/affective inputs and action outputs with disproportionately larger and more coordinated populations of neurons that are distributed (and that are interacting) across multiple levels of processing and throughout multiple brain regions. This approach allows us to address limitations found in earlier research and to introduce important principles for the design and evaluation of the next generation of cognitive training for impaired neural systems. We summarize work to date using such neuroscience-informed methods and indicate some of the exciting future directions of this field.

HT1001, a proprietary North American ginseng extract, improves working memory in schizophrenia: a double-blind, placebo-controlled study

Evidence suggests that HT1001™, a proprietary North American ginseng extract containing known levels of active ginsenosides, may improve cognitive function. Importantly, individuals with schizophrenia show marked deficits in working memory, which are believed to be predictive of functional outcome in this population. The present study aimed to characterize the effect of HT1001 on working memory in a group of stable individuals with schizophrenia. In a double-blind, placebo-controlled study design, a total of 64 individuals satisfying DSM-IV criteria for schizophrenia were randomly assigned to receive either HT100 or placebo for 4 weeks. Verbal working memory and visual working memory were assessed at baseline and again at the end of the treatment phase using the Letter-Number Span Test and Visual Pattern Test, respectively. Symptoms and medication side effects were also measured at baseline and post-treatment. Visual working memory was significantly improved in the HT1001 group, but not in the placebo group. Furthermore, extrapyramidal symptoms were significantly reduced after 4 weeks treatment with HT1001, whereas no difference in extrapyramidal effects was observed in the placebo group. These results provide a solid foundation for the further investigation of HT1001 as an adjunct therapy in schizophrenia, as an improvement in working memory and a reduction in medication-related side effects has considerable potential to improve functional outcome in this population.

Effectiveness of the cognitive differentiation program of the integrated psychological therapy: group versus individual treatment

The aim of the current pilot study was to compare two strategies in the application of the cognitive differentiation program of Integrated Psychological Therapy for people with schizophrenia. Twenty-six outpatients were randomly assigned to the application of the program in group sessions (CDg), or to its application in individualized sessions (CDi). The program provides cognitive exercises to promote better performance in cognition, and both groups of participants completed the same number of exercises following the same number of sessions per week. Outcomes were assessed on neuropsychological measures of attention, executive functioning and everyday memory, and everyday functioning. Effect sizes showed the absence of effects in everyday memory and social functioning, higher improvements in the CDi group in attention, and a higher improvement in the CDg condition in executive functioning. The results suggest that the program application model could be individualized, depending on patient-specific cognitive deficits.

Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy: results of the randomized clinical TONES study

Clinical studies on cognitive behavioral therapy (CBT) that include schizophrenia patients primarily on the basis of negative symptoms are uncommon. However, those studies are necessary to assess the efficacy of CBT on negative symptoms. This article first gives an overview of CBT on negative symptoms and discusses the methodological problems of selecting an adequate control group. Furthermore, the article describes a clinical study (the TONES-Study, ISRCTN 25455020), which aims to investigate whether CBT is specifically efficacious for the reduction of negative symptoms. This multicenter randomized clinical trial comparing CBT with cognitive remediation (CR) for control of nonspecific effects is depicted in detail. In our trial, schizophrenia patients (n = 198) participated in manualized individual outpatient treatments. Primary outcome is the negative syndrome assessed with the positive and negative syndrome scale, analyzed with multilevel linear mixed models. Patients in both groups moderately improved regarding the primary endpoint. However, against expectation, there was no difference between the groups after treatment in the intention to treat as well as in the per-protocol analysis. In conclusion, psychotherapeutic intervention may be useful for the reduction of negative symptoms. However, there is no indication for specific effects of CBT compared with CR.

No association between the Catechol-O-Methyltransferase (COMT) val158met polymorphism and cognitive improvement following cognitive remediation therapy (CRT) in schizophrenia

Cognitive deficits are rate limiters on recovery in schizophrenia that respond poorly to pharmacotherapy. Cognitive remediation therapy (CRT), a novel psychological therapy, has produced promising outcomes for cognition. However, little is known about the biological mechanisms that might underlie individual differences in CRT response. Catechol-O-Methyltransferase (COMT) is associated specifically with prefrontal cognition. The COMT Val158Met polymorphism is known to have a functional effect on the rate of dopamine degradation, which may be related to cognitive treatment response. This study aimed to determine whether COMT genotype influences cognitive improvement following CRT in schizophrenia. Participants with schizophrenia were recruited from three randomised controlled trials of CRT compared to treatment as usual, and one CRT treatment only trial, each providing 40 CRT sessions. Eighty-seven participants (40%) agreed to participate in the genetic study, and provided DNA for COMT genotyping. Cognitive function and psychopathology were assessed at baseline, post-treatment and 3-6-month follow-up. People with the COMT Val/Met genotype performed more poorly on categories achieved at baseline on the Wisconsin Card Sorting Test (WCST) than those homozygous for the Val or Met allele. Cognitive function improved with CRT but there was no association between this cognitive improvement and COMT genotype, either in the CRT group or in the total sample. The COMT val158Met polymorphism does not appear to be a clinically useful biomarker of cognitive improvement following CRT in schizophrenia. A complex set of factors may influence cognitive change, however, such that the COMT genotype might still have a subtle effect on response to CRT or similar interventions.

The relationships between schizophrenia symptom dimensions and executive functioning components

Research investigating the relationships between executive functioning impairments and the positive, negative, and cognitive schizophrenia symptoms has produced inconsistent results. This inconsistency may be due to the tendency to view executive functioning as a unified process as opposed to multiple fractionated processes. A fractionated model of executive functioning has been supported in several studies of various populations, but few schizophrenia studies have used the factor analytic methods of these studies to empirically determine separate executive functioning components, causing conclusions regarding the relationships between these components and schizophrenia symptoms to be unreliable. The purposes of the present study were to (1) identify separate components of executive functioning by conducting a factor analysis of the performance of individuals with schizophrenia on the Delis Kaplan Executive Function System (D-KEFS) and (2) investigate the relationships between executive functioning components and the three schizophrenia symptom dimensions by correlating the derived factor scores with the scale scores of the Positive and Negative Symptom Scale (PANSS). An exploratory factor analysis revealed two separate components: inhibition/set shifting and mental flexibility. The results showed that the symptom dimensions were differentially related to impairments in executive functioning, with both negative and cognitive symptoms associated with the inhibition/set shifting component, cognitive symptoms alone associated with the mental flexibility component, and positive symptoms unrelated to either component.

An evidence map of interventions across premorbid, ultra-high risk and first episode phases of psychosis

The onset of psychotic disorders peaks in adolescence and young adulthood. Early interventions during the ultra-high risk and first episode stages of illness are increasingly emphasised given the greater opportunities for clinical and functional recovery during these early phases. As a large volume of such research now exists, there is a need to summarise the extent and distribution of research to ascertain what is, and is not yet known about the evidence-base for preventing and treating early psychotic disorders.

METHODS

An 'evidence mapping' methodology was used to systematically search for intervention studies published post-1980 in English (participant mean age: 6-30 years). Studies were restricted to systematic reviews, meta-analyses and controlled trials. The Cochrane Central Register of Controlled Trials, PSYCHINFO, MEDLINE and EMBASE were searched. Studies were screened according to these criteria and mapped on pre-defined study characteristics, including intervention types, stage of illness and type of study.

RESULTS

Fifty-eight controlled trials and 8 systematic reviews were identified. The majority pertained to the first episode stage of illness (n=37), indicated prevention (n=9) and relapse prevention (n=9). Most studies involved biological (n=32) or psychological (n=17) interventions. Antipsychotic medication (n=27) and cognitive behavioural therapy (CBT; n=10) were the most common intervention modalities.

CONCLUSIONS

The extant research is dominated by trials examining intervention for first episode psychosis with antipsychotic medication. Biological interventions other than antipsychotics are sparse for patients with established psychotic disorders. For at-risk populations, there is a need for high-quality prevention studies of pharmaceutical treatments (e.g. neuroprotective agents) and a broad range of psychosocial interventions, including, but not limited to, CBT.

Neuroplasticity-based cognitive training in schizophrenia: an interim report on the effects 6 months later

BACKGROUND

New cognitive treatments for schizophrenia are needed that drive persistent gains in cognition and functioning. Using an innovative neuroplasticity-based cognitive training approach, we report our interim findings on the effects on cognition and functional outcome at 6 months after treatment.

METHODS

Thirty-two clinically stable schizophrenia subjects were randomly assigned to either targeted cognitive training (TCT, N = 22) or a computer games (CGs) control condition (N = 10). Twelve TCT subjects completed 50 hours of auditory based training; 10 TCT subjects completed an additional 50 hours of training targeting visual and cognitive control processes. Subjects were assessed on neurocognition and functional outcome after training and at 6-month follow-up.

RESULTS

Both TCT subject groups showed significant durable gains at 6 months on measures of verbal learning/memory and cognitive control. Only TCT subjects who completed 100 hours of training showed durable gains on processing speed and global cognition, with nonsignificant improvement in functional outcome. Improved cognition was significantly associated with improved functional outcome at 6 months for TCT subjects.

CONCLUSIONS

A total of 50 hours of neuroplasticity-based computerized cognitive training appears sufficient to drive improvements in verbal learning/memory and cognitive control that endure 6 months beyond the intervention, but a higher "dose" and more "broad-spectrum" training may be necessary to drive enduring gains in processing speed and global cognition. Training-induced cognitive improvement is related to enhanced functioning at 6 months. These data suggest that (1) higher and "broader" doses of cognitive training may confer the most benefits for schizophrenia patients; (2) the posttraining period opens a critical window for aggressive adjunctive psychosocial rehabilitation.

Executive function needs to be targeted to improve social functioning with Cognitive Remediation Therapy (CRT) in schizophrenia

While the role of impaired cognition in accounting for functional outcome in schizophrenia is generally established, the relationship between cognitive and functional change in the context of treatments is far from clear. The current paper tries to identify which cognitive changes lead to improvements in daily functioning among persons with chronic schizophrenia who had current negative symptoms and evidenced neuropsychological impairments. In a previous work, Cognitive Remediation Therapy (CRT) was compared with a control therapy, involving similar length of therapist contact but different targets. At the end of treatment, CRT conferred a benefit to people with schizophrenia in cognition and functioning [Schizophrenia Research, 87 (2006) 323-331]. Subsequently, analyses of covariance (ANCOVA) were conducted with baseline and cognitive change scores as covariates to test whether cognitive change predicted change in functioning. Additionally, statistical tests to establish the mediation path with significant variables were performed. Although verbal memory, but not executive functioning, was associated with functioning at baseline, it was the improvement in executive functioning that predicted improved daily functioning. Verbal memory played a mediator role in the change process. Consequently, in order to improve daily functioning with CRT, executive function still needs to be targeted in despite of multiple cognitive impairments being present.

Effects of cognitive remediation therapies on psychotic symptoms and cognitive complaints in patients with schizophrenia and related disorders: a randomized study

BACKGROUND

Cognitive remediation therapy (CRT) has proven to be effective in treating cognitive deficits in schizophrenia. The current study aimed to assess the efficacy of CRT on psychotic symptoms and cognitive complaints.

METHODS

We contrasted the changes in symptoms and cognitive complaints in patients with schizophrenia and related disorders who received 2 novel CRTs, one targeting mental state attribution, and the other, mental flexibility, compared with a control group given treatment as usual. Twenty-four patients with schizophrenia and related disorders were pseudo-randomly assigned to 1 of 3 groups. Psychotic symptoms and subjective complaints about their cognitive deficits were evaluated twice in each group, before and after therapy. Scores obtained pre- and post-therapy were compared between the groups.

RESULTS

The therapies were well-tolerated by the participants, and no one dropped out of the study. Symptoms decreased after therapy, but not in the control group. The mental flexibility group showed the most improvement. Moreover, patients in this group described a subjective diminution of their cognitive deficits.

CONCLUSIONS

Our results demonstrate that CRT can be useful to reduce clinical symptoms while they suggest an impact of CRT on cognitive complaints in patients with schizophrenia.

Identifying and treating cognitive impairment in bipolar disorder

OBJECTIVES

The presence of cognitive deficits has become increasingly appreciated across all phases of bipolar disorder. The present review sought to identify domains of cognitive dysfunction, methods of assessment, discrimination of iatrogenic from illness-specific etiologies, and pharmacologic strategies to manage cognitive problems in patients with bipolar disorder.

METHODS

A selective literature review was performed focusing on studies of descriptive phenomenology and pharmacologic intervention (favoring randomized comparisons when existent but open trials or case reports when not) involving cognition in bipolar disorder populations, healthy volunteers, or other clinical populations. Identification was made of (i) practical strategies for clinical assessment and management of cognitive complaints, (ii) limitations of existing intervention studies, and (iii) recommendations for the design and direction of future research.

RESULTS

Cognitive deficits involving attention, executive function, and verbal memory are evident across all phases of bipolar disorder. Most existing treatment studies involve nonbipolar populations, prompting caution when extrapolating outcomes to individuals with bipolar disorder. Differentiating medication- from illness-induced cognitive dysfunction requires comprehensive assessment with an appreciation for the cognitive domains most affected by specific medications. No current pharmacotherapies substantially improve cognition in bipolar disorder, although preliminary findings suggest some potential value for adjunctive stimulants such as modafinil and novel experimental agents.

CONCLUSIONS

Circumscribed cognitive deficits may be both iatrogenic and intrinsic to bipolar disorder. Optimal management hinges on a knowledge of illness-specific cognitive domains as well as of the beneficial or adverse cognitive profiles of common psychotropic medications.

Cognitive remediation for schizophrenia: it is even more complicated

PURPOSE OF REVIEW

Attempts to remediate the cognitive difficulties of people with a diagnosis of schizophrenia have shown efficacy; however, existing treatment studies display huge variation, frustrating efforts to determine how best to apply this treatment tool. This review summarizes findings of induced cognitive change in schizophrenia, with reference to the remediation method, the presence of accompanying treatment(s), how cognitive change generalizes and its value.

RECENT FINDINGS

Although there is strong evidence that cognitive change can be induced in schizophrenia, there is little evidence for the superiority of any treatment approach. Furthermore, remediation is most effective when in combination with other treatments, such as vocational training. Cognitive rehabilitation can be cost-effective and is valued by patients. A number of studies show generalization of positive outcomes beyond cognitive variables, with more focused treatment associated with less generalization.

SUMMARY

Induced cognitive change does not necessarily need to be large to facilitate functional outcomes. Instead, opportunities to apply newly acquired cognitive skills and strategies in the real world are vital. The next generation of studies need to compare different treatments using specific and more general measures of cognitive outcome. These may then throw light on their mechanisms of action. The results of these more sophisticated studies will allow therapists to tailor treatments to individuals to maximize gain for patients.

Summary of the 1st Schizophrenia International Research Society Conference oral sessions, Venice, Italy, June 21-25, 2008: the rapporteur reports

The Schizophrenia International Research Society held its first scientific conference in Venice, Italy, June 21 to 25th, 2008. A wide range of controversial topics were presented in overlapping and plenary oral sessions. These included new genetic studies, controversies about early detection of schizophrenia and the prodrome, treatment issues, clinical characteristics, cognition, neuropathology and neurophysiology, other etiological considerations, substance abuse co-morbidity, and animal models for investigating disease etiology and for use as targets in drug studies. Young investigators in the field were awarded travel grants to participate in the congress and one of their roles was to summarize the oral sessions and subsequent discussions. The reports that follow are the culmination of this work produced by 30 young investigators who attended the congress. It is hoped that these summaries will be useful synopses of what actually occurred at the congress for those who did not attend each session or were unable to be present. The abstracts of all presentations, as submitted by the authors a few months prior, were previously published as supplement 2 to volume 102/1-3, June 2008.

Predictors of medication competence in schizophrenia patients

Competence in self-administration of a drug regimen is related to both treatment adherence and functional outcome. Previous research with middle-aged and older schizophrenia patients suggests a central role for cognitive performance in predicting this competence. We examined the relative and joint contributions of demographic, clinical and cognitive predictors of medication management ability in an age-representative group of patients. The study participants comprised 147 patients with schizophrenia or schizoaffective disorder ranging from 21 to 65 years of age. Measures included demographic variables, current symptoms, subjective treatment response and a battery of cognitive tests. Competence in medication management was indexed with the Medication Management Ability Assessment (MMAA). Multiple regression analyses revealed that cognitive variables accounted for a significant proportion of the variance in MMAA scores over and above the contribution of all other variables. Measures of word recognition and pronunciation, auditory working memory and verbal learning yielded unique contributions to prediction. Positive and negative symptoms and subject treatment evaluations did not independently predict medication competency. This study documents a considerable range in MMAA scores across a demographically broad schizophrenia sample and supports the unique contribution of specific cognitive factors in predicting medication competence.

A meta-analysis of cognitive remediation in schizophrenia

OBJECTIVE

This study evaluated the effects of cognitive remediation for improving cognitive performance, symptoms, and psychosocial functioning in schizophrenia.

METHOD

A meta-analysis was conducted of 26 randomized, controlled trials of cognitive remediation in schizophrenia including 1,151 patients.

RESULTS

Cognitive remediation was associated with significant improvements across all three outcomes, with a medium effect size for cognitive performance (0.41), a slightly lower effect size for psychosocial functioning (0.36), and a small effect size for symptoms (0.28). The effects of cognitive remediation on psychosocial functioning were significantly stronger in studies that provided adjunctive psychiatric rehabilitation than in those that provided cognitive remediation alone.

CONCLUSIONS

Cognitive remediation produces moderate improvements in cognitive performance and, when combined with psychiatric rehabilitation, also improves functional outcomes.

Relationship between financial competence and cognitive function in patients with schizophrenia

The present study examined financial competence in patients with schizophrenia and the relationship between their financial competence and cognitive function. The subjects consisted of 25 patients with schizophrenia (10 inpatients and 15 outpatients) and 22 normal controls who were community-dwelling people with no psychiatric disorders or cognitive deficit. To assess the subjects' cognitive function and financial competence, they completed the Japanese version of the Neurobehavioral Cognitive Status Examination (COGNISTAT), which has 10 subtests, and the Financial Competency Assessment Tool (FCAT), which has six subordinate domains of financial competence. Patients with schizophrenia performed significantly worse than the controls in all scores on the FCAT. The financial scores that were significantly different between the patients and the normal controls were significantly positively correlated with the scores on several COGNISTAT subtests (e.g. comprehension). These results suggest that patients with schizophrenia have problems with financial competence and that these problems may be accounted for by deficits in several cognitive functions.

Neurocognitive deficits in adolescents with schizophrenia: longitudinal stability and predictive utility for short-term functional outcome

OBJECTIVE

Previous cross-sectional studies in adolescents with early-onset schizophrenia (EOS; onset of psychotic symptoms by 18 years of age) have reported patterns of generalized neurocognitive deficits as compared to healthy comparison subjects (HCSs). Here, the authors examined the longitudinal stability of neuropsychological deficits in adolescents with EOS relative to HCS and the associations of these deficits with short-term functional outcome in patients.

METHOD

Fifty-two subjects (26 EOS, 26 HCS) were evaluated using a comprehensive neuropsychological test battery a median of 13 months after baseline examination. The stability of scores and the relationship between baseline test performance and functional outcome in patients was explored.

RESULTS

Adolescents with EOS were impaired across neurocognitive domains at baseline and follow-up compared to HCSs; these deficits remained relatively stable over time. Follow-up social/communication, personal living, and community living skills were significantly related to attention/vigilance, working memory and verbal memory at baseline; individual cognitive domains were more strongly related to functional outcome than a global measure of intelligence.

CONCLUSIONS

Neuropsychological impairment in patients with EOS appears to remain relatively stable over time regardless of changes in clinical state. In addition, this report offers preliminary support for a longitudinal relationship between neurocognitive performance in specific domains and functional outcome.