Centre Emotion, CNRS USR 3246, Hôpital de La Salpêtrière, Paris, France.
Psychol Med. 2011 Jan;41(1):163-73. doi: 10.1017/S0033291710000607. Epub 2010 Apr 12.
Cognitive remediation is frequently based on computerized training methods that target different cognitive deficits. The aim of this article was to assess the efficacy of computer-assisted cognitive remediation (CACR) in schizophrenia and to determine whether CACR enables selective treatment of specific cognitive domains.
A meta-analysis was performed on 16 randomized controlled trials evaluating CACR. The effect sizes of differences between CACR and control groups were computed and classified according to the cognitive domain assessed. The possible influences of four potential moderator variables were examined: participants' age, treatment duration, weekly frequency, and control condition type. To test the domain-specific effect, the intended goal of each study was determined and the effect sizes were sorted accordingly. The effect sizes of the cognitive domains explicitly targeted by the interventions were then compared with those that were not.
CACR enhanced general cognition with a mean effect size of 0.38 [confidence interval (CI) 0.20-0.55]. A significant medium effect size of 0.64 (CI 0.29-0.99) was found for Social Cognition. Improvements were also significant in Verbal Memory, Working Memory, Attention/Vigilance and Speed of Processing with small effect sizes. Cognitive domains that were specifically targeted by the interventions did not yield higher effects than those that were not.
The results lend support to the efficacy of CACR with particular emphasis on Social Cognition. The difficulty in targeting specific domains suggests a 'non-specific' effect of CACR. These results are discussed in the light of the possible bias in remediation tasks due to computer interface design paradigms.
认知矫正通常基于针对不同认知缺陷的计算机训练方法。本文旨在评估计算机辅助认知矫正（CACR）在精神分裂症中的疗效，并确定 CACR 是否能够选择性地治疗特定的认知领域。
对 16 项评估 CACR 的随机对照试验进行了荟萃分析。计算了 CACR 组与对照组之间差异的效应大小，并根据评估的认知域进行分类。检查了四个潜在调节变量（参与者的年龄、治疗持续时间、每周频率和对照条件类型）的可能影响。为了测试特定领域的效果，确定了每项研究的预期目标，并相应地对效应大小进行了排序。然后将干预措施明确针对的认知域的效应大小与未明确针对的认知域的效应大小进行比较。
CACR 提高了一般认知，平均效应大小为 0.38 [置信区间（CI）0.20-0.55]。社会认知的效应大小为 0.64（CI 0.29-0.99），为显著的中等效应。言语记忆、工作记忆、注意力/警觉性和处理速度也有显著改善，效应大小较小。干预措施明确针对的认知域的效果并不高于未明确针对的认知域的效果。
结果支持 CACR 的疗效，特别是在社会认知方面。难以针对特定领域表明 CACR 具有“非特异性”效果。这些结果根据由于计算机接口设计范式而导致的矫正任务中的可能偏差进行了讨论。
