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Keefe RS, Vinogradov S, Medalia A, Buckley PF, Caroff SN, D’Souza DC, Harvey PD, Graham KA, Hamer RM, Marder SM, Miller DD, Olson SJ, Patel JK, Velligan D, Walker TM, Haim AJ, Stroup TS. Feasibility and pilot efficacy results from the multisite Cognitive Remediation in the Schizophrenia Trials Network (CRSTN) randomized controlled trial. J Clin Psychiatry 2012; 73:1016-22. [PMID: 22687548 PMCID: PMC3746329 DOI: 10.4088/jcp.11m07100] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 12/15/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND The true benefit of pharmacologic intervention to improve cognition in schizophrenia may not be evident without regular cognitive enrichment. Clinical trials assessing the neurocognitive effects of new medications may require engagement in cognitive remediation exercises to stimulate the benefit potential. However, the feasibility of large-scale multisite studies using cognitive remediation at clinical trials sites has not been established. METHOD 53 adult patients with DSM-IV schizophrenia from 9 university-affiliated sites were randomized to a cognitive remediation condition that included the Posit Science Brain Fitness auditory training program with weekly Neuropsychological and Educational Approach to Remediation (NEAR) "bridging groups" or a control condition of computer games and weekly healthy lifestyles groups. Patients were expected to complete 3 to 5 one-hour sessions weekly for 40 sessions or 12 weeks, whichever came first. The primary outcomes were feasibility results as measured by rate of enrollment, retention, and completion rate of primary outcome measures. The study was conducted from July 2009 through January 2010. RESULTS During a 3-month enrollment period, 53 (of a projected 54) patients were enrolled, and 41 (77%) met criteria for study completion. Thirty-one patients completed all 40 sessions, and all patients completed all primary outcome measures. Preliminary efficacy results indicated that, after 20 sessions, patients in the cognitive remediation condition demonstrated mean MATRICS Consensus Cognitive Battery composite score improvements that were 3.7 (95% CI, 0.05-7.34) T-score points greater than in patients in the computer-games control group (F(1,46) = 4.16, P = .047). At the end of treatment, a trend favoring cognitive remediation was not statistically significant (F(1,47) = 2.26, P = .14). CONCLUSION Multisite clinical trials of cognitive remediation using the Posit Science Brain Fitness auditory training program with the NEAR method of weekly bridging groups at traditional clinical sites appear to be feasible. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00930150.
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Affiliation(s)
- Richard S.E. Keefe
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Sophia Vinogradov
- Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Alice Medalia
- Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Stanley N. Caroff
- Psychiatry, Veterans Affairs Medical Center, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Phillip D. Harvey
- Psychiatry, University of Miami Miller School of Medicine Miami VA Medical Center, Miami, FL, USA
| | - Karen A. Graham
- Psychiatry and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert M. Hamer
- Psychiatry and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephen M. Marder
- Psychiatry, Semel Institute at UCLA and VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | | | | | - Jayendra K. Patel
- Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Dawn Velligan
- Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Trina M. Walker
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Adam J. Haim
- Psychiatry, National Institute of Mental Health, Bethesda, MD
| | - T. Scott Stroup
- Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
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