Objective: To obtain Food and Drug Administration approval for the treatment of cognitive impairments associated with schizophrenia, a drug will need to demonstrate benefits beyond those that may be documented on objective cognitive tests. Interview-based measures of cognition such as the Cognitive Assessment Interview (CAI) are candidate coprimary outcome measures. Methods: Psychiatrically stable schizophrenia outpatients (n 5 150) were studied using the CAI to obtain information about cognitive functioning from both the patient and an informant. Patients also received objective assessments of neurocognition, functional capacity, functional outcome, and symptoms, at baseline and 1 month later. Results: The CAI had good internal consistency (Cronbach's alpha 5 .92) and good test-retest reliability (r 5 .83). The CAI was moderately correlated with objective neurocognitive test scores (r's 5 2.39 to 2.41) and moderately correlated with social functioning (r 5 2.38), work functioning (r 5 2.48), and overall functional outcome (r 5 2.49). The correlations of CAI scores with external validity indicators did not differ significantly by source of information (patient alone ratings were valid). Overall functional outcome correlated more strongly with patient CAI scores (r 5 2.50) than with objective neurocognitive test scores (r 5 .29) or functional capacity (r 5 .29). Conclusions: Field testing of the CAI produced reliable ratings of cognitive functioning that were correlated with functional outcome. Patient ratings alone yielded scores with reliability and validity values appropriate for use in clinical trials. The CAI appears to provide useful complementary information and possesses practical advantages for rating cognitive functioning including an interview-based method of administration, brief assessment time (15 min for the patient assessment), little or no practice effects, and ease of scoring.Key words: schizophrenia/functional outcome/functional capacity/symptoms/informant ratings/neurocognition
IntroductionEvidence continues to accrue indicating that cognitive deficits are pronounced in schizophrenia and that those deficits impinge on a patient's quality of life and ability to function on a daily basis. Traditionally, objective tests have been used to assess cognition. But the assessment of cognitive functioning might benefit from nonperformance-based person-oriented assessments. Assessing cognitive functioning through interview-based methods is practical and might enable the examination of the impact of cognition on daily functioning. Interview-based measures of cognitive functioning are already in the second generation of development, following Food and Drug Administration (FDA) guidance on the development of methods for assessing patient reported outcomes.1-3 The assessment protocol for the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative included both of the first-generation instruments, the Schizophrenia Cognition Rating Scale (SCoRS) 2 and the Clinical Global ...