Clinical trial NCT00431223: Brain Activation Patterns in Schizophrenia After Computerized Cognitive Skills Training
Official title: Does Computerized Cognitive Skills Training Change Brain Activation Patterns in Schizophrenia?
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Schizophrenia
Keywords: fMRI
working memory
schizophrenia
treatment refractory
cognitive skills training
dorsolateral prefrontal cortex
cognitive remediation
treatment refractory schizophrenia of > 5 years duration
Lead sponsor: Manhattan Psychiatric Center
Sponsor class: OTHER
Collaborators: name: Nathan Kline Institute for Psychiatric Research
First posted: 2007-02-05
Enrollment: 11
Sex: MALE
Minimum age (years): 18
Maximum age (years): 55
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This project is a novel exploratory research project to investigate changes in activation patterns of the dorsolateral prefrontal cortex (DLPFC) in inpatients with schizophrenia who received a 12-week computerized cognitive remediation (CRT) program. The hypothesis is that patients receiving CRT will show greater increase in activation patterns in the brain as compared to controls, and the degree of brain activation will correlate with improvements in working memory.

Detailed description: Abnormalities in the domains of attention, working memory (WM) and information processing are important features of schizophrenia. There is growing literature that cognitive remediation therapy (CRT) can produce modest improvements in cognitive functioning in schizophrenia, suggesting that systematic efforts at improving cognitive functioning are feasible. Cognitive improvement after CRT may correlate with changes in brain activation patterns in specific areas.

After screening, patients are randomized to a 12 week trial of CRT using COGPACK (Marker Software), or to a 12-week control condition. All patients attend 3 weekly 1-hour laboratory sessions, with 1 discussion session per week.

Patients continue their antipsychotic treatment with a typical or atypical antipsychotic during the CRT and 4 weeks prior to enrollment in the study (Phase A). Following Phase A they receive baseline evaluations, including an cognitive activation task (N-back visual-letter task) while being scanned for fMRI , MATRICS neuropsychological test battery, and psychiatric, social functioning, and symptoms assessment.

Patients then enter Phase B with randomization to control or CRT for 12 weeks (36 laboratory sessions). Upon successful completion of 36 sessions, endpoint evaluations include an N-back task while fMRI scan, MATRICS, psychiatric, and social functional assessments.

All baseline and endpoint fMRI scans are conducted at the Center for Advanced Brain Imaging (CABI) at Nathan Kline Institute for Psychiatric Research.

Eligibility criteria: Inclusion Criteria:

* Inpatient status
* Age 18 - 55
* Male gender (females are enrolled but will not be scanned)
* DSM-IV diagnosis of schizophrenia (all subtypes) and schizoaffective disorder
* illness duration \> 5 years
* MMSE score \> 24 (inclusive) at screening
* Stable dose of oral atypical antipsychotic for at least 4 weeks prior to study entry
* Total PANSS score \> 60 at screening
* Capacity and willingness to give written informed consent
* Patients deemed not ready to be discharged within the next 12 weeks

Exclusion Criteria:

* Inability to read or speak English
* Documented disease of the central nervous system
* History of intellectual impairment pre-dating onset of symptoms of psychosis (e.g. mental retardation)
* Clinically significant or unstable cardiovascular, renal, hepatic, gastrointestinal, pulmonary, or hematological conditions; HIV positive
* Any medical condition rendering the subject unable to receive an fMRI scan

Primary outcomes:
measure: Brain activation changes after stimulation with a neurocognitive task in the dorso-lateral prefrontal cortex (DLPFC)
timeFrame: 12 weeks
Secondary outcomes:
measure: Examine the relationship of changes in DLPFC activation patterns in relation to improvement on neurocognitive tests
timeFrame: 12 weeks
Other outcomes:
Locations:
city: New York
country: United States
facility: Manhattan Psychiatric Center
state: New York
Study officials:
affiliation: Manhattan Psychaitric Center
name: Saurabh Kaushik, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Manhattan Psychiatric Center
name: Jean-Pierre Lindenmayer, MD
role: STUDY_CHAIR
affiliation: Dartmouth College, Hanover
name: Susan McGurk, PhD
role: STUDY_CHAIR
affiliation: Center for Advanced Brain Imaging, NKI
name: Craig A. Branch, PhD
role: STUDY_CHAIR
References:
citation: Wykes T, Reeder C, Corner J, Williams C, Everitt B. The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophr Bull. 1999;25(2):291-307. doi: 10.1093/oxfordjournals.schbul.a033379.