Cognitive performance is typically conceptualized in terms of domains of
functioning. These domains are hierarchical in nature, with the bottom referring to more
basic sensory and perceptual ...processes and the top referring to elements of executive
functioning and cognitive control. Domains are not independent of each other and
executive functioning exerts control over the utilization of more basic processes.
Assessments are typically targeted at subdomains of each ability area and careful
combination of tasks can reveal patterns of performance consistent with a variety of
different neurological and neuropsychiatric conditions. This review covers the general
structures of domains, the patterns of impairments across domains seen in common
neuropsychiatric conditions, and use of assessment strategies to differentiate, to the
extent possible, between different types of conditions manifesting cognitive
impairment.
Abstract
Social cognition is increasingly recognized as an important treatment target in schizophrenia; however, the dearth of well-validated measures that are suitable for use in clinical trials ...remains a significant limitation. The Social Cognition Psychometric Evaluation (SCOPE) study addresses this need by systematically evaluating the psychometric properties of promising measures. In this final phase of SCOPE, eight new or modified tasks were evaluated. Stable outpatients with schizophrenia (n = 218) and healthy controls (n = 154) completed the battery at baseline and 2–4 weeks later across three sites. Tasks included the Bell Lysaker Emotion Recognition Task (BLERT), Penn Emotion Recognition Task (ER-40), Reading the Mind in the Eyes Task (Eyes), The Awareness of Social Inferences Test (TASIT), Hinting Task, Mini Profile of Nonverbal Sensitivity (MiniPONS), Social Attribution Task—Multiple Choice (SAT-MC), and Intentionality Bias Task (IBT). BLERT and ER-40 modifications included response time and confidence ratings. The Eyes task was modified to include definitions of terms and TASIT to include response time. Hinting was scored with more stringent criteria. MiniPONS, SAT-MC, and IBT were new to this phase. Tasks were evaluated on (1) test-retest reliability, (2) utility as a repeated measure, (3) relationship to functional outcome, (4) practicality and tolerability, (5) sensitivity to group differences, and (6) internal consistency. Hinting, BLERT, and ER-40 showed the strongest psychometric properties and are recommended for use in clinical trials. Eyes, TASIT, and IBT showed somewhat weaker psychometric properties and require further study. MiniPONS and SAT-MC showed poorer psychometric properties that suggest caution for their use in clinical trials.
Harvey discusses the clinical trial by Keefe et al with several important features. The study examines the efficacy of a technology-based intervention, "AKL-T03," which is a multitasking video ...intervention in which participants simultaneously respond to or ignore stimuli based on prior instruction while navigating in space to approach or avoid these designated targets or nontargets. Immediate functional gains on self-report measures were not detected despite cognitive gains in the active training group. Like the results of the Mahncke et al study, short-term cognitive gains did not translate into detectable functional changes.
Until recently, the dominant view was that schizophrenia patients have limited, if any, neuropsychological impairments, and those that are observed are only secondary to the florid symptoms of the ...disorder. This view has dramatically changed. This review integrates recent evidence demonstrating the severity and profile of neuropsychological impairments in schizophrenia. We present quantitative evaluation of the literature demonstrating that the most severe impairments are apparent in episodic memory and executive control processes, evident on a background of a generalized cognitive deficit. The neuropsychological impairments potentially represent genetic liability to the disorder, as similar, yet milder, impairments are evident in schizophrenia patients even before the onset of psychotic symptoms, as well as in the nonpsychotic relatives of schizophrenia patients. Corresponding cognitive neuroimaging literature on executive functions, episodic memory, and working memory in schizophrenia documenting abnormalities in frontal and medial temporal lobes is summarized, and current models integrating neuropsychological and neuroimaging data are discussed.
Full text
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
Measurement of social cognition in treatment trials remains problematic due to poor and limited psychometric data for many tasks. As part of the Social Cognition Psychometric Evaluation (SCOPE) ...study, the psychometric properties of 8 tasks were assessed. One hundred and seventy-nine stable outpatients with schizophrenia and 104 healthy controls completed the battery at baseline and a 2-4-week retest period at 2 sites. Tasks included the Ambiguous Intentions Hostility Questionnaire (AIHQ), Bell Lysaker Emotion Recognition Task (BLERT), Penn Emotion Recognition Task (ER-40), Relationships Across Domains (RAD), Reading the Mind in the Eyes Task (Eyes), The Awareness of Social Inferences Test (TASIT), Hinting Task, and Trustworthiness Task. Tasks were evaluated on: (i) test-retest reliability, (ii) utility as a repeated measure, (iii) relationship to functional outcome, (iv) practicality and tolerability, (v) sensitivity to group differences, and (vi) internal consistency. The BLERT and Hinting task showed the strongest psychometric properties across all evaluation criteria and are recommended for use in clinical trials. The ER-40, Eyes Task, and TASIT showed somewhat weaker psychometric properties and require further study. The AIHQ, RAD, and Trustworthiness Task showed poorer psychometric properties that suggest caution for their use in clinical trials.
Measurement of cognitive functions is an increasingly important goal for clinicians and researchers. Many neuropsychological test batteries are comprehensive and require specialized training to ...administer and interpret. The Trail Making Test is an accessible neuropsychological instrument that provides the examiner with information on a wide range of cognitive skills and can be completed in 5-10 min. Its background, psychometric properties, administration procedures and interpretive guidelines are provided in this protocol.
A growing body of research has shown that two domains of cognition, neurocognition and social cognition, predict different domains of real-world outcomes in people with schizophrenia. Social ...cognition has been shown to predict social outcomes but not non-social outcomes (e.g. living independently), and neurocognition provides minimal prediction of social outcomes (e.g. interpersonal relationships). The differing predictive value of neurocognition and social cognition has led to an exploration of potential factors that interact with cognition to influence everyday outcomes. Functional skills, negative symptoms, and self-assessment have shown particularly promising relationships with cognitive ability. Several consensus studies have pinpointed valid performance-based assessments. High-contact informant ratings have additionally been shown to be highly accurate. The emerging understanding of divergent patterns of predicting outcomes and reliable assessments present an opportunity to improve treatment targets and real-world outcomes for individuals with schizophrenia. In particular, a recently defined component of metacognition has shown particular promise. Introspective accuracy (IA) addresses how well individuals evaluate their own abilities. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures of neurocognitive skills and has found that IA of social cognition accounts unique variance in real world disability above social cognitive abilities. Intriguingly, IA of neurocognition appears to preferentially predict non-social outcomes while IA of social cognition predicts social outcomes.
Cognitive deficits in schizophrenia are important predictors of impairment in most functional domains and are a critical therapeutic target. These deficits appear at or before the onset of illness, ...are stable across time in most patients, and can be improved by cognitive remediation treatments. Recent evidence, however, suggests that cognitive function does not necessarily follow a pattern of age-related decline. Several studies evaluated this pattern of decline in schizophrenia patients compared to both natural aging and degenerative conditions such as Alzheimer's disease. Age-related differences were not comparable to either normal aging or Alzheimer's disease. Older patients with an extensive history of illness and protracted institutionalization have shown a greater progressive decline. These deficits were also observed in older patients who were no longer institutionalized, with these patients demonstrating decline in functional capacity across time compared to healthy controls and patients with no lengthy institutional stay. There were 2 clear conclusions from this body of data. First, there appear to be 2 separate periods of deterioration in schizophrenia patients. These patients appear to decline the most at 2 key time points; the first occurs some time prior to the first psychotic episode and the second begins at approximately 65 years of age. The second important conclusion is that these 2 important periods of time may be the time point at which an aggressive intervention may have the greatest impact.
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