Cassetta Briana D, Goghari Vina M
Clinical Neuroscience of Schizophrenia Laboratory, Administration Building, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
Trials. 2016 Jan 26;17:49. doi: 10.1186/s13063-016-1188-5.
In most domains of cognition, individuals with schizophrenia are generally found to be one standard deviation below the mean of the controls. As a result, examining the impact of cognitive remediation in individuals with schizophrenia has been a burgeoning area of research. However, the state of the literature remains unclear as to which domains of cognition should be targeted to produce the most widespread and durable benefits for individuals with schizophrenia. One suggestion is that targeting lower-level cognitive processes that are important for higher-level and more complex aspects of cognition may produce the most widespread benefits in cognition and everyday functioning. Relatively few studies have examined the effects of working memory or processing speed training in schizophrenia, as most studies examine broad-based remediation programs. Thus, a need exists for targeted working memory and processing speed training studies to better understand the mechanisms of cognitive enhancement in patients. This study aims to 1) investigate near-transfer gains (that is, the transfer of learning to related contexts) associated with working memory and processing speed training in schizophrenia patients; 2) investigate far-transfer gains (that is, the transfer of learning to new contexts) associated with working memory and processing speed training (that is, gains in other neurocognitive domains and social cognition); and 3) investigate real-world gains associated with training (that is, gains in daily functioning).
METHODS/DESIGN: A double-blind randomized controlled trial with a three parallel group design will be conducted. A random sample of 81 patients with schizophrenia or schizoaffective disorder will be recruited through outpatient clinics at Foothills Hospital and community support programs in Calgary, Alberta. Participants will be randomly assigned using a computer-generated program in a 1:1:1 ratio to a working memory-training group, a processing speed-training group, or a no-training control group. Training will be completed at home for 30 minutes per day, 5 days per week, for a total of 10 weeks. Neurocognitive, social cognitive, and daily functioning measures will be administered both pre- and post-training to detect training-related gains. The primary outcome measures will include working memory and processing speed (near-transfer measures), as well as fluid intelligence (far-transfer measure).
Current controlled trials NCT02478827 (ClinicalTrials.gov, registered on 15 June 2015).
在大多数认知领域，精神分裂症患者的表现通常比对照组均值低一个标准差。因此，研究认知康复对精神分裂症患者的影响已成为一个新兴的研究领域。然而，关于应针对哪些认知领域进行干预，才能为精神分裂症患者带来最广泛、最持久的益处，目前的文献尚无定论。一种观点认为，针对对高级和更复杂认知方面至关重要的低级认知过程进行干预，可能会在认知和日常功能方面产生最广泛的益处。相对较少的研究考察了工作记忆或处理速度训练对精神分裂症的影响，因为大多数研究考察的是基础广泛的康复计划。因此，需要开展有针对性的工作记忆和处理速度训练研究，以更好地理解患者认知增强的机制。本研究旨在：1）调查精神分裂症患者工作记忆和处理速度训练的近迁移收益（即学习迁移到相关情境）；2）调查工作记忆和处理速度训练的远迁移收益（即学习迁移到新情境，也就是其他神经认知领域和社会认知的收益）；3）调查训练的现实世界收益（即日常功能的收益）。
方法/设计：将进行一项采用三组平行设计的双盲随机对照试验。通过山麓医院的门诊和艾伯塔省卡尔加里的社区支持项目，随机抽取81例精神分裂症或分裂情感性障碍患者。使用计算机生成程序，按照1:1:1的比例将参与者随机分配到工作记忆训练组、处理速度训练组或无训练对照组。训练将在家中完成，每天30分钟，每周5天，共10周。在训练前后进行神经认知、社会认知和日常功能测量，以检测与训练相关的收益。主要结局指标将包括工作记忆和处理速度（近迁移指标）以及流体智力（远迁移指标）。
当前受控试验NCT02478827（ClinicalTrials.gov，2015年6月15日注册）。
