Personalised treatment for cognitive dysfunction in individuals with schizophrenia spectrum disorders

Abstract

Cognitive deficits are a well-recognized issue for individuals diagnosed with schizophrenia spectrum disorders. Despite positive group findings for the use of cognitive remediation (CR) interventions, there are substantial individual differences in response to treatment. In addition, the aggregate CR literature reports low moderate effect sizes for cognitive and functional outcomes. Based on personalized medicine theory, this paper uses extant CR literature to examine the individual characteristics determined to predict treatment response. These characteristics, which fall into the broad categories of cognitive, psychological, and biological can be used as tailoring variables to personalize CR to an individual’s unique profile. Personalization through the use of these tailoring variables has the potential to improve the delivery of CR to maximize treatment outcomes.

Multivariate pattern analysis of brain structure predicts functional outcome after auditory-based cognitive training interventions

“…However, group-level analyses cannot take into account the substantial individual neuroanatomical heterogeneity that occurs at the individual level in SCZ (28). The goal of precision-medicine is to select and adapt therapeutic approaches based on each patient's individual neural and clinical characteristics (29,30). In order to take into account individual neuroanatomical heterogeneity at baseline and reliably validate the origin of the predictive information, we replaced patients' GAF scores at post ABCT with their baseline scores and repeated the sMRI GM analysis.…”

Improving Theory of Mind in Schizophrenia by Targeting Cognition and Metacognition with Computerized Cognitive Remediation: A Multiple Case Study

“…People with schizophrenia present with heterogeneous cognitive profiles, with some patients showing impairments in several areas and others presenting with only mild deficits [ 1 ]. In order to enhance CRT efficacy, it is thus important to determine the variables underlying each individual's deficits and tailor the CRT to suit these specific deficits [ 73 ]. All patients start CRT with their own strengths and weaknesses, and it is increasingly recognized that better outcome is achieved when the treatment is personalized for a given patient based on his cognitive profile [ 37 , 73 , 74 ].…”

“…In order to enhance CRT efficacy, it is thus important to determine the variables underlying each individual's deficits and tailor the CRT to suit these specific deficits [ 73 ]. All patients start CRT with their own strengths and weaknesses, and it is increasingly recognized that better outcome is achieved when the treatment is personalized for a given patient based on his cognitive profile [ 37 , 73 , 74 ]. In fact, patients' cognitive profiles before the start of CRT has been reported as an important factor for treatment outcome in several studies [ 73 , 75 – 77 ].…”

“…All patients start CRT with their own strengths and weaknesses, and it is increasingly recognized that better outcome is achieved when the treatment is personalized for a given patient based on his cognitive profile [ 37 , 73 , 74 ]. In fact, patients' cognitive profiles before the start of CRT has been reported as an important factor for treatment outcome in several studies [ 73 , 75 – 77 ]. The specific improvements in cognition or metacognition observed in our study highlight the positive impact of the individualized approach of CIRCuiTS, which sets personal goals before and during the therapy to improve the most impaired cognitive functions for each patient.…”

“…In light of the literature and the current results, it seems appropriate to acknowledge the cognitive profile of the patient before CRT and to adapt the treatment more specifically to his deficits, which may sometimes mean choosing a nonsocial CRT to improve ToM. In addition to the cognitive profile at baseline, several other variables could potentially influence the effect of CRT treatment, or how much treatment is required to observe an effect [ 73 ]. In a literature review, Medalia and colleagues [ 73 ] identified that factors that can promote a better response to CRT treatments include younger age (critical window given the higher neuroplasticity potential), shorter illness duration, increased number of CRT sessions, baseline cognitive reserve, motivation, perception of competence, and a good therapeutic alliance.…”