Treating impaired cognition in schizophrenia: The case for combining cognitive-enhancing drugs with cognitive remediation

• Published in: European neuropsychopharmacology Vol. 23; no. 8; pp. 790 - 798
• Main Authors: Michalopoulou, Panayiota G, Lewis, Shôn W, Wykes, Til, Jaeger, Judith, Kapur, Shitij
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.08.2013
• Subjects: Animals; Cognition - drug effects; Cognition Disorders - drug therapy; Cognition Disorders - etiology; Cognition Disorders - rehabilitation; Cognitive ability; Cognitive impairment; Cognitive remediation; Cognitive-enhancing drugs; Combination of cognitive remediation with cognitive-enhancing drugs; Combined Modality Therapy; Evidence-Based Medicine; Humans; Internal Medicine; Performance-Enhancing Substances - therapeutic use; Psychiatry; Remedial Teaching; Schizophrenia; Schizophrenia - physiopathology; Schizophrenia; Combination of cognitive remediation with cognitive-enhancing drugs; Cognitive-enhancing drugs; Cognitive remediation; Cognitive impairment
• ISSN: 0924-977X; 1873-7862
• DOI: 10.1016/j.euroneuro.2013.03.012

Abstract Cognitive impairment is a well-documented feature of schizophrenia and represents a major impediment to the functional recovery of patients. The therapeutic strategies to improve cognition in schizophrenia have either used medications (collectively referred to as ‘cognitive-enhancing drugs’ in this article) or non-pharmacological training approaches (‘cognitive remediation’). Cognitive-enhancing drugs have not as yet been successful and cognitive remediation has shown modest success. Therefore, we may need to explore new therapeutic paradigms to improve cognition in schizophrenia. The optimal approach may require a combination of cognitive-enhancing drugs with cognitive remediation. We review the available data from animal and human studies that provide the conceptual basis, proof-of-concept and illustrations of success of such combination strategies in experimental and clinical paradigms in other conditions. We address the major design issues relevant to the choice of the cognitive-enhancing drugs and cognitive remediation, as well as the timing and the duration of the intervention as will be relevant for schizophrenia. Finally, we address the practical realities of the development and testing of such combined approaches in the real-world clinical situation and conclude that while scientifically attractive, there are several practical difficulties to be overcome for this approach to be clinically feasible.