Optimizing Cognitive Remediation

Study Overview
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Brief Summary
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Veterans with mental illness face challenges with community reintegration, including achieving vocational success, attaining their educational goals and going back to school, and maintaining a high quality of life. VA Mental Health Residential Rehabilitation Treatment Programs, Psychosocial Rehabilitation and Recovery Centers and other mental health treatment programs are designed to help Veterans overcome these barriers, but cognitive impairment often seen in Veterans with mental illness limits gains from these settings. Cognitive remediation interventions can be helpful, but they are either one-size fits all, and thus may not be useful for all Veterans with mental illness, or are too narrow in scope, focusing on specific mental illnesses, limiting generalizability. This project will test whether an objective neurophysiological biomarker, mismatch negativity (MMN), can better match the right Veteran to the right cognitive remediation treatment regardless of their specific mental health diagnosis.

Detailed Description
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This is an observational, non-interventional study. Veterans with mental health diagnoses currently engaged in, or within 6 weeks of discharge from VA Mental Health Residential Rehabilitation Treatment Programs (RRTP), Psychosocial Rehabilitation and Recovery Centers (PRRC), and other mental health treatment settings (inpatient or outpatient mental healthcare) will be recruited. Veterans will have their cognitive functioning assessed. Following this, mismatch negativity (MMN) will be assessed via electroencephalography (EEG). Participants will undergo a 1 hour computerized cognitive training program. They will be interviewed about their attitudes about EEG and computerized cognitive training. They will be followed monthly for a total of 4 months from study entry to assess recovery trajectory. This study aims to enroll 104 Veterans from the VA San Diego Healthcare System. The Specific Aims of this proposal are 1) Determine whether MMN is related to functioning, psychosocial recovery in VA rehabilitation milieus and programs; 2) Determine whether MMN is linked to cognition and predicts cognitive remediation exercise performance in a heterogeneous group of Veterans with mental illness. The proposal will also assess feasibility and acceptability of using biomarker-guided cognitive rehabilitation interventions in VA mental health rehabilitation settings. Information gained from this study will help establish a precision-medicine approach towards cognitive rehabilitation for Veterans with mental illness.

Official Title
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Optimizing Cognitive Remediation in VA Mental Health Rehabilitation Settings

Conditions
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Schizophrenia, Stress Disorders, Post-Traumatic

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veterans are currently enrolled in or within 6 weeks of discharge from (as relevant): a VA San Diego Healthcare System (VASDHS) psychosocial rehabilitation and recovery center (PRRC), VASDHS mental health residential rehabilitation treatment program (RRTP), VASDHS acute inpatient hospitalization or VASDHS outpatient mental health treatment have a DSM-5 mental illness, including: schizophrenia schizoaffective disorder delusional disorder major depressive disorder bipolar disorder generalized anxiety disorder PTSD fluent and literate in English no impairment in hearing or vision Exclusion Criteria: active substance use within the last 30 days positive urine drug screen conducted as part of the screening process have acute/ongoing thoughts of self-harm or harming others intellectual disability or a neurocognitive disorder (i.e. dementia)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Veterans engaged in VA mental health rehabilitation/recovery<br>Veterans must be within 6 weeks of discharge from or current receive mental health treatment services in a VA San Diego Healthcare System psychosocial rehabilitation and recovery center (PRRC), mental health residential rehabilitation treatment program (RRTP), general mental health outpatient treatment, or recent acute mental health inpatient hospitalization. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mismatch Negativity (electrophysiological biomarker) | Mismatch negativity (micro-volts) | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognition | Performance on MATRICS Consensus Cognitive Battery | 5 years | 
| Cognitive training performance | Performance on a 1 hour computerized cognitive training exercise | 5 years | 
| WHOQOL-BREF | Scores on the World Health Organization Quality of Life scale | 5 years | 
| WHODAS 2.0 | World Health Organization Disability Schedule 2.0 | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Electroencephalography, Cognition, Rehabilitation