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Objective: Cognitive remediation therapy is a moderately effective intervention for ameliorating cognitive deficits in individuals with schizophrenia-related disorders. With reports of considerable variability in individual response to cognitive remediation therapy, we need to better understand factors that influence cognitive remediation therapy efficacy to realise its potential. A systematic review was conducted to identify and evaluate predictors of cognitive outcome. Methods: An electronic database search was conducted identifying peer-reviewed articles examining predictors of cognitive response to cognitive remediation therapy. Results: A total of 40 articles accounting for 1681 cognitive remediation therapy participants were included; 81 distinct predictors of cognitive response were identified. Data synthesis and discussion focused on 20 predictors examined a minimum three times in different studies. Few of the examined predictors of cognitive outcome following cognitive remediation therapy were significant when examined through systematic review. A strong trend was found for baseline cognition, with reasoning and problem solving and working memory being strongly predictive of within-domain improvement. Training task progress was the most notable cross-domain predictor of cognitive outcome. Conclusion: It remains unclear why a large proportion of participants fail to realise cognitive benefit from cognitive remediation therapy. However, when considering only those variables where a majority of articles reported a statistically significant association with cognitive response to cognitive remediation therapy, three stand out: premorbid IQ, baseline cognition and training task progress. Each of these relates in some way to an individual’s capacity or potential for change. There is a need to consolidate investigation of potential predictors of response to cognitive remediation therapy, strengthening the evidence base through replication and collaboration.

Positive neuropsychological and neuroimaging results require replication, preferably with multi-site studies using standardized methodology. Increased standardized testing and analyses across the literature, as a whole, would improve the utility and interpretability of knowledge in this field. (JINS, 2018, 24, 188-205).

Anxiety is a prevalent condition in older adults with neurocognitive disorders such as dementia. Interventions based on cognitive behavioral therapy (CBT) appear to be an emerging area of treatment innovation for treating anxiety in older adults with cognitive impairment. Drawing on the empirical literature on CBT for late-life anxiety and recent trials of CBT for anxiety in persons with mild-to-moderate dementia, this article provides an overview of the customization of CBT to the needs of older adults with anxiety and cognitive impairment. Adaptations for assessment, case conceptualization, socialization, therapeutic alliance, and treatment strategies are discussed. A case study to illustrate implementation of these adaptations is presented. Limitations to the current state of the literature on the efficacy and feasibility of CBT for anxiety in older adults with cognitive impairment are identified, and future directions for treatment research are proposed.

Background Schizophrenia spectrum disorder (SSD) typically presents with a diverse range of cognitive impairments, with the effective treatment of which is advocated as an important future focus for the field. Currently, cognitive remediation therapy (CRT) is the most widely administered form of cognition enhancing treatment, however individual responses to CRT are highly variable in SSD, warranting examination of whether alternative approaches can also enhance cognition. Mindfulness-based interventions (MBI) have shown potential in alleviating the negative impact of clinical SSD symptoms and show promising pro-cognitive treatment effects. The aim of the current study was to retrospectively compare cognitive improvements following two different CRT programs (multi-domain drill and strategy; visually intensive drill and practice) an MBI targeting persistent auditory verbal hallucinations, and a video game-based active control. Methods Data was retrospectively pooled for participants who completed measures of perceptual processing speed, sustained and switching attention, and inhibitory control. Twelve SSD participants completed four weekly one-hour individual sessions of the Individual Mindfulness Program for Voices, 22 completed a minimum of ten one-hour group-/computed-based sessions of the multi-domain drill and strategy intervention COGPACK, 22 completed a minimum of 24 one-hour group-/computer-based sessions of BrainHQ’s (Posit Science) VISUAL Intensive drill and practice intervention, and 17 participants completed a minimum of 10 one-hour group-/computed-based sessions of games putatively similar to exercises common to CRT (active control). Baseline/Post-treatment change effects were calculated for each intervention across specified cognitive variables and converted to standardised Z-scores based on the performance of the active control group. Results Unique and overlapping pro-cognitive effects were identified for each of the three intervention types compared to the active control. MBI produced moderate standardized pro-cognitive effects above the active control in perceptual processing speed (z-score□: 0.62) and switching attention (z-score: 0.45). This somewhat overlapped with the change effects calculated for the visually intensive drill and practice (z-score□: 0.57) CRT program. Both the visually intensive drill and practice (z-score: 0.47) and the multi-domain drill and strategy (z-score: 0.52) CRT programs resulted in moderate-to-large improvements v. control in sustained attention, whilst the MBI had no such effect (z-score: 0.10). The video-gamed based active control produced moderate improvements in inhibitory control in comparison to all three interventions (z-score□: -0.37). Discussion Overall, these preliminary findings suggest that a brief MBI can produce similar performance enhancing effects to that of the lengthier CRT programs in a discrete subset of cognitive tests. More extensive examinations of the cognitive benefits and their translation to real world functional improvements in SSD are needed.