11. PERSONALIZING COGNITIVE REMEDIATION INTERVENTIONS: WHAT WORKS AND FOR WHOM?

Abstract

The link between cognition and functioning in schizophrenia is well established, and there is a large body of research supporting the efficacy of cognitive remediation (CR) for improving cognitive function in individuals with psychosis. In recent years, the focus of CR research has shifted to better understanding how these interventions work, and factors that influence whether or not an individual is likely to benefit from any such intervention. This line of research is particularly important given the considerable variability in response to this time and labor-intensive intervention, with upwards of 40% of individuals being non-responders. In the current symposium, we present new data exploring specific characteristics of CR interventions, individual participants, and disorder pathology that may influence CR's impact on outcomes of interest and inform the likelihood of positive response to this intervention. Mr. Best focuses his talk on the impact of differences in CR approaches. He presents data from a trial directly comparing an executive and perceptual skill-focused CR approach. Neurocognitive, symptom, self-report, functional competence and community function outcomes are evaluated, along with their trajectories after the active intervention phase. EEG data is also presented probing the neurophysiological mechanisms underlying specific effects of these two CR approaches. Dr. Choi focuses on how the efficacy of CR delivery methods may be augmented by using neurofeedback. He presents data from a trial examining the impact of augmenting standard performance-based CR with pupillometry, which indexes effort expenditure and task engagement, and may thereby offer a more sensitive measure of parameters relevant to optimizing learning. Effects of CR with and without pupillometric feedback are compared on measures of cognitive function and training motivation, and differences in neurofeedback learning algorithms between individuals with chronic schizophrenia versus first episode and clinical high risk are discussed. Dr. Kurtz focuses on person characteristics that may influence response to CR. He presents data on the influence of demographic factors, cognition, symptoms, and treatment duration/intensity on CR-associated improvements in working memory and functional capacity, and discusses his findings in relation to existing research on predictors of response to CR. Dr. Penades focuses on the genetic contributions to cognition and CR outcomes. He reviews recent literature on the impact of genetic variables on cognitive function and response to CR, presents new data on the impact of two gene polymorphisms (COMT and BDNF) on cognitive function, and discusses how genetic variability may be used to develop predictive models to optimize outcomes of different CR approaches.