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Cognition in MCI has responded poorly to pharmacological interventions, leading to use of computerized training. Combining computerized cognitive training (CCT) and functional skills training software (FUNSAT) produced improvements in 6 functional skills in MCI, with effect sizes >0.75. However, 4% of HC and 35% of MCI participants failed to master all 6 tasks. We address early identification of characteristics that identify participants who do not graduate, to improve later interventions.
Methods:
NC participants (n = 72) received FUNSAT and MCI (n = 92) participants received FUNSAT alone or combined FUNSAT and CCT on a fully remote basis. Participants trained twice a week for up to 12 weeks. Participants “graduated” each task when they made one or fewer errors on all 3–6 subtasks per task. Tasks were no longer trained after graduation.
Results:
Between-group comparisons of graduation status on baseline completion time and errors found that failure to graduate was associated with more baseline errors on all tasks but no longer completion times. A discriminant analysis found that errors on the first task (Ticket purchase) uniquely separated the groups, F = 41.40, p < .001, correctly classifying 94% of graduators. An ROC analysis found an AUC of .83. MOCA scores did not increase classification accuracy.
Conclusions:
More baseline errors, but not completion times, predicted failure to master all FUNSAT tasks. Accuracy of identification of eventual mastery was exceptional. Detection of risk to fail to master training tasks is possible in the first 15 minutes of the baseline assessment. This information can guide future enhancements of computerized training.
This chapter considers evidence from both perspectives and argues for a critical appraisal of the role of cognition in psychotic illness. The psychiatric pioneers of schizophrenia research considered a variety of cognitive problems in their clinical case descriptions, but these efforts were limited by the questionable validity of interviews and subjective data and observations as well as by sampling biases. The cognitive impairment reliably occurs at very high rates in schizophrenia, typically approaching 75% of the patient population, which equals or exceeds the prevalence of impairment in many neurological disorders. The possibility of preserved cognition in a significant minority of people with schizophrenia has not been resolved and this challenges the assertion that cognitive impairment is a truly defining characteristic of the illness. The majority of patients with Parkinson's disease eventually develop cognitive deficits, but psychosis is much less common and largely a by-product of medication.