Cognitive Remediation for Outpatients With Recurrent Mood Disorders: A Feasibility Study

Early prediction of mastery of a computerized functional skills training program in participants with mild cognitive impairment

BACKGROUND

Cognition in MCI has responded poorly to pharmacological interventions, leading to use of computerized training. Combining computerized cognitive training (CCT) and functional skills training software (FUNSAT) produced improvements in 6 functional skills in MCI, with effect sizes >0.75. However, 4% of HC and 35% of MCI participants failed to master all 6 tasks. We address early identification of characteristics that identify participants who do not graduate, to improve later interventions.

METHODS

NC participants (n = 72) received FUNSAT and MCI (n = 92) participants received FUNSAT alone or combined FUNSAT and CCT on a fully remote basis. Participants trained twice a week for up to 12 weeks. Participants "graduated" each task when they made one or fewer errors on all 3-6 subtasks per task. Tasks were no longer trained after graduation.

RESULTS

Between-group comparisons of graduation status on baseline completion time and errors found that failure to graduate was associated with more baseline errors on all tasks but no longer completion times. A discriminant analysis found that errors on the first task (Ticket purchase) uniquely separated the groups, F = 41.40, p < .001, correctly classifying 94% of graduators. An ROC analysis found an AUC of .83. MOCA scores did not increase classification accuracy.

CONCLUSIONS

More baseline errors, but not completion times, predicted failure to master all FUNSAT tasks. Accuracy of identification of eventual mastery was exceptional. Detection of risk to fail to master training tasks is possible in the first 15 minutes of the baseline assessment. This information can guide future enhancements of computerized training.

Cognitive predictors of response to interpersonal and social rhythm therapy in mood disorders

BACKGROUND

There has been increasing interest in examining the potential moderating effects that cognitive functioning has on treatment outcome in bipolar disorder (BD) and major depressive disorder (MDD). Therefore, the aim of this exploratory study was to examine the relationship between baseline cognitive function and treatment outcome in individuals with mood disorders who completed 12 months of interpersonal and social rhythm therapy (IPSRT), and were randomised to receive adjunctive cognitive remediation (CR) or no additional intervention.

METHODS

Fifty-eight patients with mood disorders (BD, n = 36, MDD, n = 22), who were randomised to IPSRT-CR or IPSRT, underwent cognitive testing at baseline and completed follow-up mood measures after 12 months. General linear modelling was used to examine the relationship between baseline cognitive function (both objective and subjective) and change in mood symptom burden, and functioning, from baseline to treatment-end.

RESULTS

Poorer baseline attention/executive function was associated with less change in mood symptom burden, particularly depressive symptoms, at treatment-end. Additionally, slower psychomotor speed at baseline was associated with less improvement in mania symptom burden. Subjective cognitive function at baseline was not related to change in mood symptom burden at treatment-end, and neither objective nor subjective cognitive function was associated with functional outcome.

LIMITATIONS

Due to the exploratory nature of the study, there was no correction for multiple comparisons.

CONCLUSION

Aspects of objective cognitive function were associated with treatment outcomes following psychotherapy. Further large-scale research is required to examine the role that cognitive function may have in determining various aspects of mood disorder recovery.

A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders

OBJECTIVE

To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders.

METHODS

A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12-month course of IPSRT with CR (IPSRT-CR), or without CR (IPSRT). In IPSRT-CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12 months).

RESULTS

Sixty-eight individuals (BD n = 26, MDD n = 42; full/partial remission n = 39) were randomised to receive IPSRT-CR or IPSRT (both n = 34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment-end (12 months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT-CR arm over 12 months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41-0.60). At 18 months, small to moderate, non-significant benefits (0.26-0.47) of IPSRT vs IPSRT-CR were found on functioning and mood outcomes.

CONCLUSIONS

Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders.

Randomised controlled trial of Interpersonal and Social Rhythm Therapy and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy alone for mood disorders: study protocol

BACKGROUND

Individuals with mood disorders frequently experience cognitive impairment, which impacts on the long-term trajectory of the disorders, including being associated with persisting difficulties in occupational and psychosocial functioning, residual mood symptoms, and relapse. Current first-line treatments for mood disorders do little to improve cognitive function. Targeting cognition in clinical research is thus considered a priority. This protocol outlines a prospectively-registered randomised controlled trial (RCT) which examines the impact of adding group-based Cognitive Remediation (CR) to Interpersonal and Social Rhythm Therapy (IPSRT-CR) for individuals with mood disorders.

METHODS

This is a pragmatic, two-arm, single-blinded RCT comparing IPSRT-CR with IPSRT alone for adults (n = 100) with mood disorders (Major Depressive Disorder or Bipolar Disorder) with subjective cognitive difficulties, on discharge from Specialist Mental Health Services in Christchurch, New Zealand. Both treatment arms will receive a 12-month course of individual IPSRT (full dose = 24 sessions). At 6 months, randomisation to receive, or not, an 8-week group-based CR programme (Action-based Cognitive Remediation - New Zealand) will occur. The primary outcome will be change in Global Cognition between 6 and 12 months (treatment-end) in IPSRT-CR versus IPSRT alone. Secondary outcomes will be change in cognitive, functional, and mood outcomes at 6, 12, 18, and 24 months from baseline and exploratory outcomes include change in quality of life, medication adherence, rumination, and inflammatory markers between treatment arms. Outcome analyses will use an intention-to-treat approach. Sub-group analyses will assess the impact of baseline features on CR treatment response. Participants' experiences of their mood disorder, including treatment, will be examined using qualitative analysis.

DISCUSSION

This will be the first RCT to combine group-based CR with an evidence-based psychotherapy for adults with mood disorders. The trial may provide valuable information regarding how we can help promote long-term recovery from mood disorders. Many issues have been considered in developing this protocol, including: recruitment of the spectrum of mood disorders, screening for cognitive impairment, dose and timing of the CR intervention, choice of comparator treatment, and choice of outcome measures.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry, ACTRN12619001080112 . Registered on 6 August 2019.

Preliminary Support for a Cognitive Remediation Intervention for Women During the Menopausal Transition: A Pilot Study

Background: Menopause is associated with physical and emotional symptoms, and subjective cognitive concerns that are generally not borne out on objective cognitive measures. This discrepancy suggests that a psychological rather than biological mechanism likely mediates the cognitive concerns of women in menopause. The current study assessed the feasibility and effectiveness of a cognitive remediation intervention with the goal of reducing subjective perceptions of cognitive difficulty during the menopause. Methods: Twenty-seven menopausal women (M age = 53.74, SD = 4.14) completed a 5-week group-based intervention (with a post-group booster) consisting of 2-h weekly sessions. Participants completed pre- and post-intervention measures capturing subjective cognitive ability, mood, anxiety, stress, personality, and objective cognitive tests. The primary variable of interest was self-reported cognitive confidence measured by the Memory and Cognitive Confidence Scale (MACCS). Results: All but one MACCS subscale significantly decreased over the course of treatment (with lower scores associated with higher confidence) and effect sizes ranged from small to large (d = -0.39 to -0.91) with gains maintained at 1-month follow-up. Interestingly, no change in objective cognitive test performance was observed, indicating increases in subjective cognitive confidence in the absence of objective cognitive improvement. There was no change in mood, anxiety, or stress scores. Two-level HLM analyses revealed that those with higher baseline neuroticism, as measured by the NEO Personality Inventory, had smaller decreases in post-group MACCS High Standards subscale relative to those with lower baseline neuroticism (p = 0.027, d = -0.45). Those with higher baseline depression scores on the Depression Anxiety Stress Scale (DASS-21) had a smaller decrease in post-intervention MACCS Total Score relative to those with lower depression ratings. Conclusion: To our knowledge, this is the first feasibility study of its kind targeting perceptions of cognitive impairment during menopause. Although generally well-tolerated, recruitment and scheduling difficulties were flagged as challenges to engagement while a small sample size and lack of control group limit conclusions about efficacy. Providing current results could be replicated with enhanced methods, these results provide support that cognitive remediation is a feasible and credible treatment, and may improve quality of life for women in menopause. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03311880.