Treating impaired cognition in schizophrenia: The case for combining cognitive-enhancing drugs with cognitive remediation
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’...
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Published in | European neuropsychopharmacology Vol. 23; no. 8; pp. 790 - 798 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.08.2013
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Abstract | 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. |
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AbstractList | 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. 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. 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 acognitive-enhancing drugsa in this article) or non-pharmacological training approaches (acognitive remediationa). 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. |
Author | Michalopoulou, Panayiota G Lewis, Shôn W Wykes, Til Jaeger, Judith Kapur, Shitij |
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Keywords | Schizophrenia Combination of cognitive remediation with cognitive-enhancing drugs Cognitive-enhancing drugs Cognitive remediation Cognitive impairment |
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Snippet | Abstract Cognitive impairment is a well-documented feature of schizophrenia and represents a major impediment to the functional recovery of patients. The... Cognitive impairment is a well-documented feature of schizophrenia and represents a major impediment to the functional recovery of patients. The therapeutic... |
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SubjectTerms | 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 |
Title | Treating impaired cognition in schizophrenia: The case for combining cognitive-enhancing drugs with cognitive remediation |
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