计算机化认知训练的训练参与度、基线认知功能及认知改善:一项跨诊断研究。
Training engagement, baseline cognitive functioning, and cognitive gains with computerized cognitive training: A cross-diagnostic study.
作者信息
Harvey Philip D, Balzer Alexandra M, Kotwicki Raymond J
机构信息
University of Miami Miller School of Medicine, USA.
Skyland Trail, USA.
出版信息
Schizophr Res Cogn. 2019 May 13;19:100150. doi: 10.1016/j.scog.2019.100150. eCollection 2020 Mar.
Computerized cognitive training (CCT) interventions are increasing in their use in outpatient mental health settings. These interventions have demonstrated efficacy for improving functional outcomes when combined with rehabilitation interventions. It has recently been suggested that patients with more cognitive impairment have a greater therapeutic response and that reduced engagement in training can identify cases who manifest low levels of benefit from treatment. Participants were psychiatric rehabilitation clients, with diagnoses of major depression, bipolar disorder and schizophrenia. Newly admitted cases received CCT, delivered via Brain HQ, with cognitive functioning divided into groups on the basis of a BACS t-score of 40 or less vs. more. Training engagement was indexed by the number of training levels achieved per day trained. Forty-nine cases trained on average for 17 days and completed a mean of 150 levels. Overall, patients improved by an average of 4.4 points (0.44 SD) in BACS t-scores ( < .001). Improvements were positively correlated with training engagement ( = 0.30, < .05), but not with days trained ( = 0.09) or levels earned ( = 0.03) alone. Patients with higher levels of baseline cognitive performance had reduced cognitive gains ( < .003), but did not have less training engagement ( = .97). Diagnoses did not predict cognitive gains ( = .93) or target engagement ( = .74). Poorer performance at baseline and higher levels of training engagement accounted for >10% in independent variance in cognitive gains. The mean level of cognitive improvement far exceeded practice effects. The index of engagement, levels achieved per training day, is easily extracted from the training records of patients, which would allow for early and continuous monitoring of treatment engagement in CCT activities and therapist intervention as needed to improve engagement.
计算机化认知训练(CCT)干预措施在门诊心理健康环境中的应用日益增加。这些干预措施与康复干预相结合时,已证明对改善功能结局有效。最近有人提出,认知障碍程度较高的患者有更大的治疗反应,而训练参与度降低可识别出从治疗中获益水平较低的病例。参与者为精神康复患者,诊断为重度抑郁症、双相情感障碍和精神分裂症。新入院病例接受通过Brain HQ提供的CCT,根据BACS t分数40或更低与更高将认知功能分为两组。训练参与度通过每天训练达到的训练水平数量来衡量。49例患者平均训练17天,平均完成150个水平。总体而言,患者的BACS t分数平均提高了4.4分(标准差0.44)(<0.001)。改善与训练参与度呈正相关(=0.30,<0.05),但与训练天数(=0.09)或单独获得的水平(=0.03)无关。基线认知表现水平较高的患者认知增益降低(<0.003),但训练参与度并不低(=0.97)。诊断不能预测认知增益(=0.93)或目标参与度(=0.74)。基线表现较差和训练参与度较高在认知增益的独立方差中占比超过10%。认知改善的平均水平远远超过练习效应。参与度指标,即每天训练达到的水平,可轻松从患者的训练记录中提取,这将允许对CCT活动中的治疗参与度进行早期和持续监测,并根据需要进行治疗师干预以提高参与度。
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