Report on ISCTM Consensus Meeting on Clinical Assessment of Response to Treatment of Cognitive Impairment in Schizophrenia

Abstract

If treatments for cognitive impairment are to be utilized successfully, clinicians must be able to determine whether they are effective and which patients should receive them. In order to develop consensus on these issues, the International Society for CNS Clinical Trials and Methodology (ISCTM) held a meeting of experts on March 20, 2014, in Washington, DC. Consensus was reached on several important issues. Cognitive impairment and functional disability were viewed as equally important treatment targets. The group supported the notion that sufficient data are not available to exclude patients from available treatments on the basis of age, severity of cognitive impairment, severity of positive symptoms, or the potential to benefit functionally from treatment. The group reached consensus that cognitive remediation is likely to provide substantial benefits in combination with procognitive medications, although a substantial minority believed that medications can be administered without nonpharmacological therapy. There was little consensus on the best methods for assessing cognitive change in clinical practice. Some participants supported the view that performance-based measures are essential for measurement of cognitive change; others pointed to their cost and time requirements as evidence of impracticality. Interview-based measures of cognitive and functional change were viewed as more practical, but lacking validity without informant involvement or frequent contact from clinicians. The lack of consensus on assessment methods was viewed as attributable to differences in experience and education among key stakeholders and significant gaps in available empirical data. Research on the reliability, validity, sensitivity, and practicality of competing methods will facilitate consensus.

Association of fronto-temporal function with cognitive ability in schizophrenia

“…Neurocognitive and functional disabilities are credible treatment targets 4 . The association between improved neurocognitive skills and improved functional outcomes has led to the implementation of neurocognitive remediation programs aimed at improving an individual’s cognitive skills, and thereby, functional recovery and real world community outcomes 5 .…”

Cognitive impairment in schizophrenia: the great unmet need

“…Although it is generally acknowledged that cognitive impairment and functional disability are viewed as equally important treatment targets, there is little consensus on the best methods for assessing cognitive change in clinical practice. 14…”

“…Although it is generally acknowledged that cognitive impairment and functional disability are viewed as equally important treatment targets, there is little consensus on the best methods for assessing cognitive change in clinical practice 14 . Arguments are made that performance-based measures are essential for measurement of cognitive change, but they may be impractical because of their cost and time requirements.…”

“…Interview-based measures of cognitive and functional change are simpler to implement, but they can lack validity without informant involvement or frequent contact from clinicians. Examples of comprehensive cognitive performance assessments other than the MCCB include the CogState computerized assessment and the Cambridge Neuropsychological Test Automated Battery (CANTAB) 14 . Briefer cognitive performance assessments include the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Brief Assessment of Cognition in Schizophrenia (BACS), the Brief Cognitive Assessment, the Brief Cognitive Assessment Tool for Schizophrenia, and the Brief Neurocognitive Assessment (BNA) 14 .…”

“…Examples of comprehensive cognitive performance assessments other than the MCCB include the CogState computerized assessment and the Cambridge Neuropsychological Test Automated Battery (CANTAB) 14 . Briefer cognitive performance assessments include the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Brief Assessment of Cognition in Schizophrenia (BACS), the Brief Cognitive Assessment, the Brief Cognitive Assessment Tool for Schizophrenia, and the Brief Neurocognitive Assessment (BNA) 14 . Examples of performance-based measures of functional capacity other than the UPSA include the Test of Adaptive Behavior in Schizophrenia (TABS) and the Independent Living Scales (ILS) 14 .…”