Cognitive remediation for patients with late-life schizophrenia: A follow-up pilot study

The number of older adults with schizophrenia ("late-life schizophrenia" (LLS)) is growing with the aging of the general population. Cognitive impairment in adults with LLS predicts functioning. Cognitive remediation (CR) improves cognition in schizophrenia, however literature in LLS is sparse. Anticholinergic burden (ACB) impacts CR effects. We previously showed that CR is feasible in LLS but did not produce a promising cognitive effect. This study examined the feasibility, tolerability, and effect of an intensive, prolonged and flexible CR on overall and specific cognitive functions in LLS. We also assessed ACB impact on CR effect on global cognition. Pre-post intervention SETTING PARTICIPANTS: Tertiary care outpatients with LLS INTERVENTION: We adapted the CR protocol from our previous pilot study, providing CR over 24, twice-weekly, therapist-guided group sessions that combined computerized drill-and-practice exercises with skills transference strategies, with additional time allocated for exercise practice. We assessed participants at baseline and at study completion using clinical and cognitive measures. Thirty-four participants (mean (SD) age = 65.8 (5.7)) attended at least one CR session, 25 participants completed baseline and follow-up assessments, and 20 participants completed at least 75 % of the CR sessions. There was no time effect on global cognition, although there was an interaction with ACB. There was also a pattern of improvement in executive function across several cognitive tests. An intensive, prolonged and flexible CR was feasible and well-tolerated, showing promise in improving executive function of patients with LLS. Larger and randomized controlled trials are needed in this population.