Brain Activation Patterns in Schizophrenia After Computerized Cognitive Skills Training (fMRI)

Manhattan Psychiatric Center

Status

Completed

Conditions

Schizophrenia

Treatments

Behavioral: Cognitive remediation therapy

Study type

Interventional

Funder types

Other

Identifiers

NCT00431223

05I/C52

Details and patient eligibility

About

This project is a novel exploratory research project to investigate changes in activation patterns of the dorsolateral prefrontal cortex (DLPFC) in inpatients with schizophrenia who received a 12-week computerized cognitive remediation (CRT) program. The hypothesis is that patients receiving CRT will show greater increase in activation patterns in the brain as compared to controls, and the degree of brain activation will correlate with improvements in working memory.

Full description

Abnormalities in the domains of attention, working memory (WM) and information processing are important features of schizophrenia. There is growing literature that cognitive remediation therapy (CRT) can produce modest improvements in cognitive functioning in schizophrenia, suggesting that systematic efforts at improving cognitive functioning are feasible. Cognitive improvement after CRT may correlate with changes in brain activation patterns in specific areas.

After screening, patients are randomized to a 12 week trial of CRT using COGPACK (Marker Software), or to a 12-week control condition. All patients attend 3 weekly 1-hour laboratory sessions, with 1 discussion session per week.

Patients continue their antipsychotic treatment with a typical or atypical antipsychotic during the CRT and 4 weeks prior to enrollment in the study (Phase A). Following Phase A they receive baseline evaluations, including an cognitive activation task (N-back visual-letter task) while being scanned for fMRI , MATRICS neuropsychological test battery, and psychiatric, social functioning, and symptoms assessment.

Patients then enter Phase B with randomization to control or CRT for 12 weeks (36 laboratory sessions). Upon successful completion of 36 sessions, endpoint evaluations include an N-back task while fMRI scan, MATRICS, psychiatric, and social functional assessments.

All baseline and endpoint fMRI scans are conducted at the Center for Advanced Brain Imaging (CABI) at Nathan Kline Institute for Psychiatric Research.

Enrollment

11 patients

Sex

Male

Ages

18 to 55 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Inpatient status
Age 18 - 55
Male gender (females are enrolled but will not be scanned)
DSM-IV diagnosis of schizophrenia (all subtypes) and schizoaffective disorder
illness duration > 5 years
MMSE score > 24 (inclusive) at screening
Stable dose of oral atypical antipsychotic for at least 4 weeks prior to study entry
Total PANSS score > 60 at screening
Capacity and willingness to give written informed consent
Patients deemed not ready to be discharged within the next 12 weeks

Exclusion criteria

Inability to read or speak English
Documented disease of the central nervous system
History of intellectual impairment pre-dating onset of symptoms of psychosis (e.g. mental retardation)
Clinically significant or unstable cardiovascular, renal, hepatic, gastrointestinal, pulmonary, or hematological conditions; HIV positive
Any medical condition rendering the subject unable to receive an fMRI scan