Divergence of subjective and performance-based cognitive gains following cognitive training in schizophrenia.

Treichler EBH, Thomas ML, Bismark AW, Hochberger WC, Tarasenko M, Nungaray J, Cardoso L, Joshi YB, Zhang W, Sprock J, Swerdlow N, Cohen AN, Light GA. Divergence of subjective and performance-based cognitive gains following cognitive training in schizophrenia. Schizophrenia Research. 2019 Aug 1; 210:215-220.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

BACKGROUND: Cognitive training is effective for improving cognitive performance among people with schizophrenia. An individual's perception of their own cognition is dissociable from performance on objective cognitive tests. Since subjective cognitive benefit may impact engagement, motivation, and satisfaction with time-intensive cognitive interventions, this study aimed to determine whether subjective cognitive difficulties improve in conjunction with cognitive gains following 30?h of cognitive training. METHODS: Patients with schizophrenia or schizoaffective disorder (N? = 46) were randomized to treatment as usual (TAU) or TAU augmented with auditory-targeted cognitive training (TCT). All participants completed assessment batteries at baseline and follow-up. As previously reported, the TCT group showed significant improvements in verbal learning and memory and reductions in auditory hallucinations relative to the TAU group. RESULTS: Subjective cognitive difficulties did not significantly improve following TCT, even among TCT participants who showed improvements in cognitive performance (all ps? > 0.05). Subjective cognitive difficulties were significantly associated with severity of depressive symptoms and hallucinations (r? = 0.48 and r? = 0.28, p? < 0.001), but not global or specific domains of cognition (all rs? < 0.1) at baseline. There were no significant relationships between change in subjective cognitive difficulties and change in cognitive or clinical variables (all ps? > 0.05). DISCUSSION: Patients with schizophrenia do not detect change in their cognition following cognitive training, even among those who showed robust gains in cognitive performance. Failure to detect improvement may undermine treatment engagement, motivation, and satisfaction. Translating score improvements on the cognitive exercises into tangible metrics, and providing ongoing, clinician-delivered feedback on performance may facilitate patient ability to detect improvements and improve motivation to engage with cognitive training interventions.