Neurocognitive enhancement therapy with work therapy - Effects on neuropsychological test performance

Background: Cognitive deficits are a major determinant of social and occupa tional dysfunction in schizophrenia. In this study, we determined whether n eurocognitive enhancement therapy (NET) in combination with work therapy (W T) would improve performance on neuropsychological tests related to but dif ferent from the training tasks. Methods: Sixty-five patients with schizophrenia or schizoaffective disorder were randomly assigned to NET plus WT or WT alone. Neurocognitive enhancem ent therapy included computer-based training on attention, memory, and exec utive function tasks; an information processing group; and feedback on cogn itive performance in the workplace. Work therapy included paid work activit y in job placements at the medical center (eg, mail room, grounds, library) with accompanying supports. Neuropsychological testing was performed at in take and 5 months later. Results: Prior to enrollment, both groups did poorly on neuropsychological testing. Patients receiving NET+WT showed greater improvements on pretest-p ost test variables of executive function, working memory, and affect recogn ition. As many as 60% in the NET+WT group improved on some measures and wer e 4 to 5 times more likely to show large effect-size improvements. The numb er of patients with normal working memory performance increased significant ly with NET+WT, from 45% to 77%, compared with a decrease from 56% to 45% f or those receiving WT. Conclusions: Computer training for cognitive dysfunction in patients with s chizophrenia can have benefits that generalize to independent outcome measu res. Efficacy may result from a synergy between NET, which encourages menta l activity, and WT, which allows a natural context for mental activity to b e exercised, generalized, and reinforced.