Subjective ratings of cognitive and emotional functioning in patients with mild cognitive impairment and patients with subjective memory complaints but normal cognitive functioning

In a retrospective chart review, 39 patients referred for a clinical neuropsychological examination were identified as showing either mild cognitive impairment of the amnestic type (MCI-A; N = 21) or subjective memory complaints but with normal memory function (SMC; N = 18). During the clinical interview, patients and informants were routinely asked to make subjective ratings regarding the patient’s cognitive and affective functioning in everyday life. The purpose of this study was to determine whether these two patient groups (and their informants) significantly differed in their subjective reports about level of cognitive and affective difficulties. It was predicted that SMC patients would report higher levels of cognitive and emotional dysfunction than MCI-A patients. It was further predicted that MCI-A patients would underreport cognitive difficulties (compared to informant reports); SMC patients would demonstrate the opposite pattern. Results supported these predictions and suggest that routine assessment of subjective experiences of patients in conjunction with informant ratings may aid clinical diagnosis, particularly when the primary complaint is a decline in memory.     

血管性认知功能障碍患者经颅多普勒超声血流动力学变化与认知功能的关系

目的探讨轻度血管性认知功能障碍(m VCI)患者TCD血流动力学变化与认知功能的关系。方法依据Erkinjuntti的MRI诊断标准入选的皮质下缺血性血管病(SIVD)患者115例,根据神经心理学评估分为血管性认知障碍(VCI)组和认知正常组。使用经颅多普勒超声(TCD)进行颅内血流动力学检查。最后分析患者的Mo CA评分与大脑中大动脉(MCA)和大脑前动脉(ACA)的搏动指数(PI)、平均血流(Vm)的相关性。结果对于两组患者的MCA-PI和ACA-PI进行比较,差异具有统计学意义(P0.05);而两组患者之间的MCA-Vm和ACA-Vm比较,差异无统计学意义(P0.05)。MCA-PI和SIVD患者的认知损害呈线性相关,回归方程Y=38.783-7.823 X_1,差异有统计学意义(P0.01)。结论 MCA-PI与SIVD患者Mo CA评分线性相关。SIVD患者的PI越高,相对应其认知障碍程度越严重。     

The Contribution of Prospective Memory Performance to the Neuropsychological Assessment of Mild Cognitive Impairment

Objective: Prospective memory difficulties are a feature of the amnestic form of mild cognitive impairment (aMCI). Although comprehensive test batteries of prospective memory are suitable for clinical practice, they are lengthy, which has detracted from their widespread clinical use. Our aim was to investigate the utility of a brief screening measure of prospective memory, which can be incorporated into a clinical neuropsychological assessment. Methods: Seventy-seven healthy older adults (HOA) and 77 participants with aMCI were administered a neuropsychological test battery, including a prospective memory screening measure (Envelope Task), a retrospective memory measure (CVLT-II), and a multi-item subjective memory questionnaire (Prospective and Retrospective Memory Questionnaire; PRMQ) and a single-item subjective memory scale. Results: Compared with HOA participants, participants with aMCI performed poorly on the Envelope Task (η² = .38), which provided good discrimination of the aMCI and HOA groups (AUC = .83). In the aMCI group, there was a small but significant relationship between the Envelope Task and the single-item subjective rating of memory, with the Envelope Task accounting for 5–6% of the variance in subjective memory after accounting for emotional status. This relationship of prospective memory and subjective memory was not significant for the multi-item questionnaire (PRMQ); and, retrospective memory was not a significant predictor of self-rated memory, single-item, or multi-item. Conclusion: A brief screening measure of prospective memory, the Envelope Task, provides useful support to traditional memory measures in detecting aMCI.     

Exploring the validity of mild cognitive impairment (MCI) subtypes: Multiple-domain amnestic MCI is the only identifiable subtype at longitudinal follow-up

Background: Epidemiological research exploring risk factors for Alzheimer’s dementia resulted in the identification of the mild cognitive impairment (MCI) profile. Subsequently, distinct subtypes of MCI have been proposed; however, the validity of these as diagnostic entities remains uncertain. Design and participants: The aim of the present study was to examine the longitudinal neuropsychological profiles of MCI subtypes. A total of 118 adults aged 60–90 years were classified at screening as amnestic (a-MCI), nonamnestic (na-MCI), and multiple-domain amnestic (a-MCI+) and were assessed at two time points across 20 months on a comprehensive neuropsychological assessment battery. Results: The a-MCI+ group displayed the poorest performance of all groups in terms of episodic memory, working memory, attention, and executive functioning. Conclusions: These findings suggest that the a-MCI+ subtype is the only variant that is recognizable via neuropsychological testing. In contrast, the differentiation between single-domain subtypes and healthy controls is difficult and may not be achievable through current neuropsychological assessment practices.     

Changes in theta activities in the left posterior temporal region,left occipital region and right frontal region related to mild cognitive impairment in Parkinson's disease patients

The aim of this study was to investigate changes in brain activity associated with mild cognitive impairment (MCI) in a large sample of nondemented Parkinson's disease (PD) patients and its relationship with specific neuropsychological deficits. Electroencephalography (EEG) and neuropsychological assessment were performed in a sample of 135 nondemented PD patients and 44 healthy controls. All patients underwent a neuropsychological battery to assess global cognitive function. Patients were classified according to their cognitive status as PD patients with MCI (n = 61) and without MCI (n = 74). EEG data were used to analyze the relative band power parameters for the following frequency bands: delta (0.5–4 Hz), theta (4–8 Hz), alpha (8–13 Hz) and beta (13–30 Hz). In addition, relative band power parameters were compared between groups and examined for correlations with neuropsychological performance. The relative theta band powers in three regions (O1, T5 and F4) exhibited statistically significant increases in PD patients with MCI. Beta band powers also exhibited obvious decreases in five regions (T5, T6, P3, P4 and C3) in the PD-MCI group compared with the normal control group. Furthermore, correlation analyses revealed that attention, visuospatial and executive functions were associated with theta power in local regions, mainly in the frontal region (F4). The present study demonstrated that changes in brain activities limited to distinct cognitive domains, especially the theta power in the frontal region, could serve as an electrophysiological marker of cognitive impairment in nondemented PD patients.     

Self-awareness of cognitive efficiency: Differences between healthy elderly and patients with mild cognitive impairment (MCI)

Introduction: Self-estimation of performance implies the ability to understand one’s own performance with relatively objective terms. Up to date, few studies have addressed this topic in mild cognitive impairment (MCI) patients. The aim of the present study was to compare objective measures of performance with subjective perception of specific performance on cognitive tests and investigate differences in assessment between MCI patients and healthy elderly. Method: Thirty-five participants diagnosed with MCI (women = 16, men = 19, mean age = 65.09 years ±SD = 7.81, mean education = 12.83 years ±SD = 4.32) and 35 control subjects similar in terms of age and education (women = 20, men = 15, mean age = 62.46 years ± SD = 9.35, mean education = 14.26 ± SD = 2.84) were examined with an extended battery of neuropsychological tests. After every test they were asked to self-evaluate their performance by comparing it to what they considered as average for people of their age and educational level. This self-evaluation was reported on a scale ranging from –100 to +100. Results: Significant differences were found in the self-assessment patterns of the two groups in memory measures of verbal and visual delayed recall, visuospatial perception, and tests of attention. MCI patients overestimated their performance on every cognitive domain while control participants underestimated their performance on measures of verbal memory. Conclusions: The present results indicate that accuracy of self-report is not uniform across groups and functional areas. The discrepancies in the MCI patients indicate unawareness of their memory deficits, which is contradictory to subjective memory complaints as being an important component for clinical diagnosis.     

The diagnostic accuracy of the Montreal Cognitive Assessment in inpatient stroke rehabilitation

The Montreal Cognitive Assessment (MoCA) is a commonly used screening measure for cognitive impairment; however, the diagnostic accuracy and optimal cutoff points in inpatients with mild stroke severity is unknown. We examined the diagnostic accuracy of the MoCA in an acute inpatient stroke rehabilitation unit (N?=?95). The criterion neuropsychological assessment was the 30-minute National Institute of Neurological Disorders and Stroke-Canadian Stroke Network battery, modified to include the Symbol-Digit Modalities Test and Trail Making Test A & B. The MoCA had moderately strong diagnostic accuracy in receiver operating curve analyses, with areas under the curve ranging from .80 to .89 depending on the threshold for defining cognitive impairment. Sensitivity ranged from .72 to .87, and was generally greater than specificity, which ranged from .60 to .81. The optimal cutoff on the MoCA for detecting mild or greater cognitive impairment was <25/30. The optimal cutoff using more conservative definitions of cognitive impairment ranged from <23–24/30. Exploratory analyses of MoCA subgroups (“normal,” “mildly impaired,” and “functionally impaired”) differed in the frequency and magnitude of impairment on the criterion neuropsychological assessment. These findings inform the clinical use of the MoCA in individuals with mild stroke in an inpatient rehabilitation setting.     

Clock Drawing Test and the diagnosis of amnestic mild cognitive impairment: Can more detailed scoring systems do the work?

Introduction: The Clock Drawing Test is a frequently used cognitive screening test with several scoring systems in elderly populations. We compare simple and complex scoring systems and evaluate the usefulness of the combination of the Clock Drawing Test with the Mini-Mental State Examination to detect patients with mild cognitive impairment. Method: Patients with amnestic mild cognitive impairment (n = 48) and age- and education-matched controls (n = 48) underwent neuropsychological examinations, including the Clock Drawing Test and the Mini-Mental State Examination. Clock drawings were scored by three blinded raters using one simple (6-point scale) and two complex (17- and 18-point scales) systems. The sensitivity and specificity of these scoring systems used alone and in combination with the Mini-Mental State Examination were determined. Results: Complex scoring systems, but not the simple scoring system, were significant predictors of the amnestic mild cognitive impairment diagnosis in logistic regression analysis. At equal levels of sensitivity (87.5%), the Mini-Mental State Examination showed higher specificity (31.3%, compared with 12.5% for the 17-point Clock Drawing Test scoring scale). The combination of Clock Drawing Test and Mini-Mental State Examination scores increased the area under the curve (0.72; p < .001) and increased specificity (43.8%), but did not increase sensitivity, which remained high (85.4%). Conclusions: A simple 6-point scoring system for the Clock Drawing Test did not differentiate between healthy elderly and patients with amnestic mild cognitive impairment in our sample. Complex scoring systems were slightly more efficient, yet still were characterized by high rates of false-positive results. We found psychometric improvement using combined scores from the Mini-Mental State Examination and the Clock Drawing Test when complex scoring systems were used. The results of this study support the benefit of using combined scores from simple methods.     

Cognitive impairment is associated with Hoehn and Yahr stages in early,de novo Parkinson disease patients

IntroductionThe relationship between motor impairment and cognitive deterioration has long been described in Parkinson's disease (PD). The aim of the study was to compare cognitive performance of de novo PD patients in relation to the motor impairment severity according to Hoehn and Yahr (HY) stages.MethodsForty de novo PD patients at HY stage I and 40 patients at HY stage II completed a standardized neuropsychological battery. A multivariate analysis of covariance was used to compare cognitive performance between HY groups. Odds ratios (ORs) were employed to explore the risk of cognitive impairment between HY stages. Finally, the prevalence of mild cognitive impairment (MCI) was estimated for patients in HY stage I and II.ResultsPatients at HY stage I obtained better scores on neuropsychological tests than patients at HY stage II (p = 0.001). Univariate analysis of covariance revealed significant differences between HY stages on Rey's auditory verbal learning test -immediate recall (p < 0.0001), 10 points Clock Drawing Test (p = 0.002), and Rey-Osterrieth Complex Figure Test -copy (p < 0.0001). ORs of having cognitive impairment were greater for HY stage II than stage I group. MCI occurred in 7.5% of patients in HY stage I, and in 42.5% of patients in HY stage II.ConclusionIn de novo PD patients, the severity of motor impairment at the diagnosis is associated to cognitive deficits and higher risk of MCI.     

Domain-specific accuracy of the Montreal Cognitive Assessment subsections in Parkinson's disease

ObjectiveThe Montreal Cognitive Assessment (MoCA) is among the most widely adopted screening tools for cognitive impairment because it includes tests in multiple domains and is available in 55 languages. The MoCA is often the only formal cognitive assessment available when comprehensive neuropsychological testing is not practical, such as rural clinical settings or large retrospective and multi-lingual research settings. However, the MoCA domain-specific subsections have never been formally assessed for sensitivity or specificity. Therefore, in Parkinson's disease, we examined whether the subsections of the MoCA could identify cognitive impairment within specific cognitive domains.MethodsWe administered a comprehensive neuropsychological battery to 85 Parkinson's disease participants, who were then categorized as with or without cognitive impairment, with respect to global cognition and in five cognitive domains. We then assessed the domain-specific categorization of the MoCA subsections compared to the full neuropsychology battery.ResultsAll MoCA subsections predicted impairment in their respective cognitive domain. However, the executive subsection showed the highest sensitivity and specificity (89.3% and 82.5%, respectively), followed by visuospatial (93.3% and 45.7%, respectively) and memory (84.6% and 56.5%, respectively).ConclusionThe MoCA is a useful screening tool for PD global cognitive and executive functions. The MoCA is also highly sensitive to visuospatial and memory impairment, but with limited specificity and accuracy these subsections should be interpreted with caution.     

Depression Predicts Delirium After Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the Neuropsychiatric Outcomes After Heart Surgery Study

Objective

Although depression is a known risk factor for delirium after coronary artery bypass graft (CABG) surgery, it is unclear whether this risk is independent of delirium risk attributable to cognitive impairment or cerebrovascular disease. This study examines depression, mild cognitive impairment (MCI), and cerebrovascular disease as post-CABG delirium risk factors.

Neuropsychological subtypes of incident mild cognitive impairment in the Mayo Clinic Study of Aging

IntroductionWe evaluated whether incident mild cognitive impairment (MCI) subtypes could be empirically derived in the Mayo Clinic Study of Aging.MethodsWe performed cluster analysis on neuropsychological data from 506 participants with incident MCI.ResultsThe 3-cluster solution resulted in (1) amnestic, (2) dysexecutive, (3) dysnomic subtypes. The 4-cluster solution produced these same three groups and a fourth group with subtle cognitive impairment (SCI). The SCI cluster was a subset of the amnestic cluster and distinct from well-matched cognitively unimpaired participants based on memory and global z-score area under the receiver operating characteristic curve analyses and probability of progression to MCI/dementia.DiscussionWe empirically identified three neuropsychological subtypes of MCI that share some features with MCI subtypes identified in the Alzheimer's Disease Neuroimaging Initiative. The fourth subtype with SCI in the Mayo Clinic Study of Aging differed from the fourth cluster-derived normal group in Alzheimer's Disease Neuroimaging Initiative and could represent a group to target with early interventions.     

Validity of the Mindstreams™ computerized cognitive battery for mild cognitive impairment

The NeuroTrax Mindstreams™ computerized cognitive assessment system was designed for widespread clinical and research use in detecting mild cognitive impairment (MCI). However, the capability of Mindstreams tests to discriminate the elderly with MCI from those who are cognitively healthy has yet to be evaluated. Moreover, the comparability between these tests and traditional neuropsychological tests in detecting MCI has not been examined. A two-center study was designed to assess the discriminant validity of tests in the Mindstreams Mild Impairment Battery. Participants were 30 individuals diagnosed with MCI, 29 with mild Alzheimer’s disease (AD), and 39 healthy elderly. Testing was with the Mindstreams battery and traditional neuropsychological tests. Receiver operating characteristic (ROC) analysis was used to examine the ability of Mindstreams and traditional measures to discriminate those with MCI from cognitively healthy elderly. Between-group comparisons were made (Mann-Whitney U test) between MCI and healthy elderly and between MCI and mild AD groups. Mindstreams outcome parameters across multiple cognitive domains significantly discriminated between MCI and healthy elders with considerable effect sizes (p<0.05). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best, and discriminability was at least comparable to that of traditional neuropsychological tests in these domains. Mindstreams tests are effective in detecting MCI, providing a comprehensive profile of cognitive function. Further, the enhanced precision and ease of use of these computerized tests make the NeuroTrax system a valuable clinical tool in the identification of elders at high risk for dementia. An erratum to this article is available at .     

Pulsion severity showed a good correlation with cognitive function in Parkinson’s disease

Abstract

Objectives:

To examine the correlation between cognitive impairment and postural instability in Parkinson’s disease (PD) patients by using posturography.

Methods:

We investigated 88 PD patients comparing clinical scorings of cognitive functions and pulsion severity, and quantitative measurement of postural instability by posturography with the length of the center of gravity (LNG) and envelope area (ENV).

Results:

The number of patients with severe pulsion increased in PD with disease progression assessed by Hoehn and Yahr (H & Y) scale regardless of age, and a significant correlation was observed between the pulsion severity and both LNG (R = 0·4242) and ENV (R = 0·4335). Both LNG and ENV showed a good correlation with all cognitive assessments such as mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and frontal assessment battery (FAB), suggesting that cognitive impairment became worse with the longer LNG and the larger ENV. Among the cognitive assessments, MoCA showed the highest correlation (R = 0·56–0·62) with both LNG and ENV, reflecting that MoCA is the most sensitive and reliable screening for dementia in PD.

Discussion:

The present study showed that posturography is useful to quantify the pulsion severity in PD patients, that pulsion severity and cognitive function showed a good correlation especially assessed by MoCA, and that posturography thus provides a more detailed quantitative correlation of postural instability to cognitive impairment.     

MDS task force on mild cognitive impairment in Parkinson's disease: Critical review of PD‐MCI

There is controversy regarding the definition and characteristics of mild cognitive impairment in Parkinson's disease. The Movement Disorder Society commissioned a Task Force to critically evaluate the literature and determine the frequency and characteristics of Parkinson's disease–mild cognitive impairment and its association with dementia. A comprehensive PubMed literature review was conducted using systematic inclusion and exclusion criteria. A mean of 26.7% (range, 18.9%–38.2%) of nondemented patients with Parkinson's disease have mild cognitive impairment. The frequency of Parkinson's disease–mild cognitive impairment increases with age, disease duration, and disease severity. Impairments occur in a range of cognitive domains, but single domain impairment is more common than multiple domain impairment, and within single domain impairment, nonamnestic is more common than amnestic impairment. A high proportion of patients with Parkinson's disease–mild cognitive impairment progress to dementia in a relatively short period of time. The primary conclusions of the Task Force are that: (1) Parkinson's disease–mild cognitive impairment is common, (2) there is significant heterogeneity within Parkinson's disease–mild cognitive impairment in the number and types of cognitive domain impairments, (3) Parkinson's disease–mild cognitive impairment appears to place patients at risk of progressing to dementia, and (4) formal diagnostic criteria for Parkinson's disease–mild cognitive impairment are needed. © 2011 Movement Disorder Society     

Subjective cognitive complaints, neuropsychological performance, affective and behavioural symptoms in non-demented patients

OBJECTIVE: Subjective cognitive complaints (SCC) have been previously investigated to establish whether they are risk factors for dementia, but no clear-cut conclusions have emerged. In this study non-demented patients with SCC were studied and the neuropsychological findings, affective and behavioural aspects and parameters with the highest correct classifications in discriminating patients who had only SCC but no objective clinical and neuropsychological impairment, i.e. no cognitive impairment (NCI) patients and those with objective neuropsychological deficits, namely patients with mild cognitive (MCI) were analyzed. METHODS: Consecutive non-demented outpatients with SCC were enrolled of over 9 months and examined using neuropsychological tests and scales for depression, anxiety and behaviour. Clinical criteria and neuropsychological test results were used to classify patients into groups of NCI, MCI and subtypes of MCI. RESULTS: Ninety-two patients with SCC were included; 49 of them had objective deficits (MCI patients), whereas 43 were without any clinical and cognitive impairment (NCI patients). These patients had lower age, higher education and better general cognitive indices than MCI patients who had higher caregiver distress, depression and irritability. The combination of a battery for mental deterioration and for behavioural memory assessment were the most discriminative in differentiating the two groups. CONCLUSIONS: An objective cognitive impairment, reaching the criteria for a MCI diagnosis, was present in almost half of patients having SCC. MCI patients have more behavioural disturbances than NCI subjects. SCC should not be underestimated and appropriate neuropsychological assessment is required to reassure subjects with normal results and to identify patients with MCI.     

Predictors of independence in instrumental activities of daily living: Amnestic versus nonamnestic MCI

Introduction: Individuals with mild cognitive impairment (MCI) demonstrate deficits in instrumental activities of daily living (IADL) that place them at high risk for progression to dementia. The cognitive profiles, IADL deficits, and risk of progression differ between MCI subgroups of amnestic (aMCI) and nonamnestic MCI (naMCI), though many studies of functional impairment have not examined these subgroups separately. This study aims to determine whether common neuropsychological measures, as well as the related concept of patient anosognosia, are associated with IADL functioning differently in aMCI compared to naMCI. Method: Seventy-one individuals were identified as naMCI, and 99 individuals were identified as aMCI based on neuropsychological evaluation. Controlling for age, gender, and education, we examined whether performance on neuropsychological tests predicted informant-rated IADL dysfunction. We also investigated the ability of patient awareness, as rated by clinicians and informants, to predict informant-rated IADL dysfunction within MCI subgroups. Results: Better performance in cognitive domains of attention/processing speed and executive functioning predicted IADL independence in aMCI, but not in naMCI. Exploratory analysis with a subset of these individuals revealed that after accounting for an estimate of cerebrovascular burden, better performance in Delayed Memory predicted IADL independence in the naMCI group, but not in the aMCI group. Lastly, informant, but not clinician, ratings of patient awareness predicted IADL independence within the aMCI group only. Conclusion: Neuropsychological performance on tests of attention/processing speed and executive functioning may be better able to predict cognitive contributions to IADL dysfunction specifically in aMCI. After controlling for vascular burden, memory deficits may be the earliest cognitive indication of IADL dysfunction in naMCI. These results suggest that executive functions and memory, in addition to patient’s awareness of deficits, differentially predict early IADL dysfunction in subgroups of MCI and can be used to formulate patient prognosis and recommendations on a more individualized basis.     

Memory for unfamiliar faces differentiates mild cognitive impairment from normal aging

Memory for unfamiliar faces has received little attention in the effort to identify neuropsychological measures that could differentiate mild cognitive impairment (MCI) from normal aging and/or predict conversion from MCI to dementia. We used the Wechsler Memory Scale–III Faces test to investigate facial memory in normal aging (n = 58), MCI (n = 74), and mild Alzheimer’s disease (n = 22). After adjustment for age, gender, and years of education, MCI patients demonstrated significantly poorer memory for unfamiliar faces than their healthy peers. Lower scores were also associated with worsening cognition and functional abilities but not an increased risk of dementia.     

Baseline Clinical and Biomarker Characteristics of Biobank Innovations for Chronic Cerebrovascular Disease With Alzheimer’s Disease Study: BICWALZS

ObjectiveWe aimed to present the study design and baseline cross-sectional participant characteristics of biobank innovations for chronic cerebrovascular disease with Alzheimer’s disease study (BICWALZS) participants. MethodsA total of 1,013 participants were enrolled in BICWALZS from October 2016 to December 2020. All participants underwent clinical assessments, basic blood tests, and standardized neuropsychological tests (n=1,013). We performed brain magnetic resonance imaging (MRI, n=817), brain amyloid positron emission tomography (PET, n=713), single nucleotide polymorphism microarray chip (K-Chip, n=949), locomotor activity assessment (actigraphy, n=200), and patient-derived dermal fibroblast sampling (n=175) on a subset of participants. ResultsThe mean age was 72.8 years, and 658 (65.0%) were females. Based on clinical assessments, total of 168, 534, 211, 80, and 20 had subjective cognitive decline, mild cognitive impairment (MCI), Alzheimer’s dementia, vascular dementia, and other types of dementia or not otherwise specified, respectively. Based on neuroimaging biomarkers and cognition, 199, 159, 78, and 204 were cognitively normal (CN), Alzheimer’s disease (AD)-related cognitive impairment, vascular cognitive impairment, and not otherwise specified due to mixed pathology (NOS). Each group exhibited many differences in various clinical, neuropsychological, and neuroimaging results at baseline. Baseline characteristics of BICWALZS participants in the MCI, AD, and vascular dementia groups were generally acceptable and consistent with 26 worldwide dementia cohorts and another independent AD cohort in Korea. ConclusionThe BICWALZS is a prospective and longitudinal study assessing various clinical and biomarker characteristics in older adults with cognitive complaints. Details of the recruitment process, methodology, and baseline assessment results are described in this paper.     

Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia

Cognitive Behavioral Social Skills Training (CBSST) is a 24-session weekly group therapy intervention to improve functioning in people with schizophrenia. In our prior randomized clinical trial comparing treatment as usual (TAU) with TAU plus group CBSST (Granholm, E., McQuaid, J.R., McClure, F.S., Auslander, L., Perivoliotis, D., Pedrelli, P., Patterson, T., Jeste, D.V., 2005. A randomized controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. Am. J. Psychiatry 162, 520–529.), participants with schizophrenia in CBSST showed significantly better functional outcome than participants in TAU. The present study was a secondary analysis of neuropsychological predictors of functional outcome in our prior CBSST trial. We examined (1) whether neuropsychological impairment at baseline moderated functional outcome in CBSST relative to TAU, and (2) whether improvement in neuropsychological abilities mediated improvement in functional outcome in CBSST. Attention, verbal learning/memory, speed of processing, and executive functions were assessed at baseline, end of treatment, and 12-month follow-up. Greater severity of neuropsychological impairment at baseline predicted poorer functional outcome for both treatment groups (nonspecific predictor), but the interaction between severity of neuropsychological impairment and treatment group was not significant (no moderation). Effect sizes for the difference between treatment groups on functional outcome measures at 12-month follow-up were similar for participants with relatively mild (d = .44–.64) and severe (d = .29–.60) neuropsychological impairment. Results also did not support the hypothesis that improvement in neuropsychological abilities mediated improvement in functioning in CBSST. Adding CBSST to standard pharmacologic care, therefore, improved functioning relative to standard care alone, even for participants with severe neuropsychological impairment, and this improvement in functioning was not related to improvement in neuropsychological abilities in CBSST.