Skip to main content
Log in

Approaches to Cognitive Remediation of Neuropsychological Deficits in Schizophrenia: A Review and Meta-Analysis

Neuropsychology Review Aims and scope Submit manuscript

Abstract

A review and critique of the literature pertaining to the use of cognitive remediation techniques in patients with schizophrenia is presented. The review is organized into three sections, according to the neuropsychological deficit targeted for remediation: 1) executive-function, 2) attention, and 3) memory. With regards to executive-function, despite an initial report suggesting that Wisconsin Card Sorting Test performance cannot be remediated, subsequent studies suggest that performance can be improved on a variety of dependent measures including perseverative errors, categories achieved, and conceptual level responses. These observations were confirmed by a meta-analytic investigation that revealed large mean effects sizes (d + = 0.96) for these studies. Effect sizes were homogenous across discrepant remediation strategies and dependent measures. With regards to attention, serial scanning can be improved with instruction and reinforcement, whereas there is mixed evidence suggesting that practice-based attention drills can improve performance on measures of sustained attention in schizophrenia. With regards to memory, relatively simple semantic and affective elaborate encoding strategies elevates verbal list-learning memory in patients with schizophrenia to levels consistent with controls. A similar encoding procedure, combined with vigilance training, produces substantial improvement in social cue recognition. Avenues for future research are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

REFERENCES

  • American Psychological Association. (2000). PsychINFO Database, American Psychological Association, Washington, DC.

    Google Scholar 

  • Barlow, D. H., and Hersen, M. (1984). Single Case Experimental Design, Pergamon Press, New York.

    Google Scholar 

  • Bellack, A. S., Blanchard, J. J., Murphy, P., and Podell, K. (1996). Generalization effects of training on the Wisconsin Card Sorting Test for schizophrenia patients. Schizophrenia Research 19: 189–194.

    Google Scholar 

  • Bellack, A. S., Gold, J. M., and Buchanan, R. W. (1999). Cognitive rehabilitation for schizophrenia: Problems, prospects and strategies. Schizophrenia Bulletin 25: 257–274.

    Google Scholar 

  • Bellack, A. S., Meuser, K. T., Morrison, R. L., Tierney, A., and Podell, K. (1990). Remediation of cognitive deficits in schizophrenia. American Journal of Psychiatry 147: 165–1655.

    Google Scholar 

  • Benedict, R. H. B., and Harris, A. E. (1989). Remediation of attention deficits in chronic schizophrenic patients: A preliminary study. British Journal of Clinical Psychology 28: 187–188.

    Google Scholar 

  • Benedict, R. H. B., Harris, A. E., Markow, T., McCormick, J. A., Neuchterlein, K. H., and Asarnow, R. F. (1994). Effects of attention training on information processing in schizophrenia. Schizophrenia Bulletin 20: 537–546.

    Google Scholar 

  • Berg, E. A. (1948). Asimple objective technique for measuring flexibility in thinking. The Journal of General Psychology 39: 15–22.

    Google Scholar 

  • Bracey, O. (1982). A Home-Based Cognitive Rehabilitation Program. Unpublished manuscript, Psychological Software Service, Indianapolis, IN.

    Google Scholar 

  • Broadbent, D. (1958). Perception and Communication, Pergamon Press, London.

    Google Scholar 

  • Cannon, T., Zorilla, L. E., Shtasel, D., Gur, R. E., Gur, R. C., Marco, E. J., Moberg, P. J., and Price, A. (1994). Neuropsychological functioning in siblings discordant for schizophrenia and healthy volunteers. Archives of General Psychiatry 51: 651–661.

    Google Scholar 

  • Censits, D., Ragland, J. D., Gur, R. C., and Gur, R. E. (1997). Neuropsychological evidence supporting a neurodevelopmental model of schizophrenia: A longitudinal study. Schizophrenia Research 24: 289–298.

    Google Scholar 

  • Cohen, J. (1977). Statistical Power Analysis for the Behavioral Sciences, Academic Press, New York, pp. 25–26.

    Google Scholar 

  • Cooper, H., and Hedges, L. V. (1994). The Handbook of Research Synthesis, New York: Russell Sage Foundation.

    Google Scholar 

  • Corrigan, P., Hirschbeck, J. N., and Wolfe, M. (1995). Memory and vigilance training to improve social perception in schizophrenia. Schizophrenia Research 17: 257–265.

    Google Scholar 

  • Diller, L., and Ben-Yishay, Y. (1987). Outcomes and evidence in neuropsychological rehabilitation in closed head injury. In Levin, H. S., and Grafman, J. (eds.), Neurobehavioral Recovery From Head Injury, Oxford, New York, pp. 146–165.

  • Flesher, S. (1990). Cognitive habilitation in schizophrenia: A theoretical review and model of treatment. Neuropsychology Review 1: 223–246.

    Google Scholar 

  • Glass, G. V. (1977). Integrating findings: The meta-analysis of research. Review Research Education 5: 351.

    Google Scholar 

  • Gold, J., Randolph, C., Carpenter, C. J., Goldberg, T. E., and Weinberger, D. R. (1992). Forms of memory failure in schizophrenia. Journal of Abnormal Psychology 101: 487–494.

    Google Scholar 

  • Goldberg, T. E., and Weinberger, D. R. (1994). Schizophrenia, training paradigms, and the Wisconsin Card Sorting Test redux. Schizophrenia Research 11: 291–296.

    Google Scholar 

  • Goldberg, T. E., Weinberger, D. R., Berman, K. F., Pliskin, N. H., and Podd, M. H. (1987). Further evidence for dementia of the prefrontal type? Archives General Psychiatry 44: 1008–1014.

    Google Scholar 

  • Goldman, R. S., Axelrod, B. N., and Tompkins, L. M. (1992). Effects of instructional cues on schizophrenic patients' performance on the Wisconsin Card Sorting Test. American Journal of Psychiatry 149: 1718–1722.

    Google Scholar 

  • Green, M. F. (1993). Cognitive remediation in schizophrenia: Is it time yet? American Journal of Psychiatry 150: 178–187.

    Google Scholar 

  • Green, M. F. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153: 321–330.

    Google Scholar 

  • Green, M. F., Satz, P., Ganzell, S., and Vaclev, J. F. (1992). Wisconsin Card Sorting Test performance in schizophrenia: Remediation of a stubborn deficit. American Journal of Psychiatry 149: 62–67.

    Google Scholar 

  • Hedges, L. V. (1981). Distribution theory for Glass's estimator of effect size and related estimators. Journal of Educational Statistics 6: 107–128.

    Google Scholar 

  • Hedges, L. V., and Olkin, I. (1985). Statistical Methods for Meta-Analysis, Academic Press, New York.

    Google Scholar 

  • Heinrichs, R. W., and Zakzanis, K. K. (1998). Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology 12: 426–445.

    Google Scholar 

  • Hellman, S. G., Kern, R. S., Nielson, L. M., and Green, M. F. (1998). Monetary reinforcement and Wisconsin Card Sorting performance in schizophrenia: Why show me the money? Schizophrenia Research 34: 67–75.

    Google Scholar 

  • Hunter, J. E., Schmidt, F. L., and Jackson, G. B. (1982). Meta-Analysis: Cumulating Findings Across Research, Sage, Beverly Hills, CA.

    Google Scholar 

  • Jaeger, J., Berns, S., and Douglas, E. (1993). Wisconsin card sorting performance predicts vocational outcome following psychiatric rehabilitation. Schizophrenia Research 9: 179.

    Google Scholar 

  • Jaeger, J., and Douglas, E. (1992). Neuropsychiatric rehabilitation for persistent mental illness. Psychiatric Quarterly 63: 71–94.

    Google Scholar 

  • Kareken, D., Moberg, P. J., and Gur, R. C. (1996). Proactive inhibition and semantic organization: Relationship with verbal memory in patients with schizophrenia. Journal of the International Neuropsychological Society 2: 486–493.

    Google Scholar 

  • Kern, R. S., Green, M. F., and Goldstein, M. J. (1995). Modification of performance on the span of apprehension, a putative marker of vulnerability to schizophrenia. Journal of Abnormal Psychology 104: 385–389.

    Google Scholar 

  • Kern, R. S., Wallace, C. J., Hellman, S. G., Womack, L. M., and Green, M. F. (1996). A training procedure for remediating WCST deficits in chronic psychotic patients: An adaptation of error-less learning principles. Journal of Psychiatric Research 30: 283–294.

    Google Scholar 

  • Koh, S. D., Kayton, L., and Berry, R. (1973). Mnemonic organization in young non-psychotic schizophrenics. Journal of Abnormal Psychology 81: 299–310.

    Google Scholar 

  • Koh, S. D., Kayton, L., and Peterson, R. A. (1976). Affective encoding and consequent remembering in schizophrenic young adults. Journal of Abnormal Psychology 85: 156–166.

    Google Scholar 

  • Lezak, M. (1995). Neuropsychological Assessment, Oxford University Press, New York.

    Google Scholar 

  • Liberman, R. P., DeRisi, W. D., and Meuser, K. T. (1989). Social Skills Training for Psychiatric Patients, Allyn and Bacon, Boston.

    Google Scholar 

  • Lysaker, P., Bell, M., and Beam-Goulet, J. (1995). Wisconsin Card Sorting Test and work performance in schizophrenia. Psychiatry Research 56: 45–51.

    Google Scholar 

  • McGhie, A., and Chapman, J. (1962). Disorders of attention and perception in early schizophrenia. British Journal Medical Psychology 34: 103–116.

    Google Scholar 

  • Medalia, A., Aluma, M., Tryon, W., and Merriam, A. E. (1998). Effectiveness of attention training in schizophrenia. Schizophrenia Bulletin 24: 147–152.

    Google Scholar 

  • Meichenbaum, D., and Cameron, R. (1973). Training schizophrenics to talk to themselves: A means of developing attention controls. Behavior Therapy 4: 515–534.

    Google Scholar 

  • Meltzer, H. Y., and McGurk, S. R. (1999). The effects of clozapine, risperidone, and olanzapine on cognitive function in schizophrenia. Schizophrenia Bulletin 25: 233–255.

    Google Scholar 

  • Metz, J. T., Johnson, M. D., Pliskin, N. H., and Luchins, D. J. (1994). Maintenance of training effects on the Wisconsin Card Sorting Test by patients with schizophrenia or affective disorders. American Journal of Psychiatry 151: 151–152.

    Google Scholar 

  • National Library of Medicine. (1994). MEDLINE Database, BRS Information Technologies, McLean, VA.

    Google Scholar 

  • Neuchterlein, K. H. (1977). Reaction time and attention in schizophrenia: A critical evaluation of data and theories. Schizophrenia Bulletin 3: 373–428.

    Google Scholar 

  • Neuchterlein, K. H., and Dawson, M. (1984). Information processing and attention functioning in the developmental course of schizophrenic disorders. Schizophrenia Bulletin 10: 160–203.

    Google Scholar 

  • Nisbet, H., Siegert, R., Hunt, M., and Fairley, N. (1996). Improving schizophrenic in-patients Wisconsin card-sorting performance. British Journal of Clinical Psychology 35: 631–633.

    Google Scholar 

  • Palmer, B. W., Heaton, R. K., Kuck, J., and Braff, D. (1997). Is it possible to be schizophrenic yet neuropsychologically normal? Neuropsychology 11(3): 437–446.

    Google Scholar 

  • Paulson, J. S., Heaton, R. K., Sadek, J. R., Perry, W., Delis, D. C., Braff, D., Kuck, J., Zisook, S., and Jeste, D. V. (1995). The nature of learning and memory impairment in schizophrenia. Journal of the International Neuropsychological Society 1: 88–99.

    Google Scholar 

  • Penn, D. L., and Meuser, K. T. (1996). Research update on the psychosocial treatment of schizophrenia. American Journal of Psychiatry 153: 607–617.

    Google Scholar 

  • Purdon, S. R. E., Jones, B. D., Stip, E., Labelle, A., Addington, D., David, S., Breier, A., and Tollefson, G. (2000). Neuropsychological change in early phase schizophrenia during 12 months of treatment with olanzapine, risperidone or haloperidol. Archives of General Psychiatry 57(3): 249–258.

    Google Scholar 

  • Rosenthal, R. (1986). Meta-Analytic Procedures for Social Research, Sage Publications, London.

    Google Scholar 

  • Rosenthal, R. (1994). Parametric measures of effect size. In Cooper, H., and Hedges, L. V. (eds.), TheHandbook of Research Synthesis, Russell Sage Foundation, New York, pp. 231–244.

    Google Scholar 

  • Saykin, A. J., Gur, R. C., Gur, R. E., Mozley, D., Mozley, L. H., Resnick, S. M., Kester, D. B., and Stafiniak, P. (1991). Neuropsychological function in schizophrenia: Selective impairment in learning and memory. Archives of General Psychiatry 48: 618–624.

    Google Scholar 

  • Saykin, A. J., Shtasel, D. L., Gur, R. E., Kester, D. B., Mozley, L. H., Stafiniak, P., and Gur, R. C. (1994). Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia. Archives of General Psychiatry 51: 124–131.

    Google Scholar 

  • Serper, M. R., and Harvey, P. D. (1994). The need to integrate neuropsychological and experimental schizophrenia research. Schizophrenia Bulletin 20: 1–11.

    Google Scholar 

  • Shallice, T., Burgess, P. W., and Frith, C. D. (1991). Can the neuropsychological case-study approach be applied to schizophrenia? Psychological Medicine 21: 661–673.

    Google Scholar 

  • Smith, T. E., Bellack, A. S., and Liberman, R. P. (1996). Social skills training for schizophrenia: Review and future directions. Clinical Psychology Review 16(7): 599–617.

    Google Scholar 

  • Sohlberg, M., and Mateer, C. (1987). Effectiveness of an attention training program. Journal of Clinical and Experimental Neuropsychology 9: 117–130.

    Google Scholar 

  • Sohlberg, M. M., McLaughlin, K. A., Pavese, A., Heidrich, A., and Posner, M. I. (2001). Evaluation of attention process training and brain injury education in persons with acquired brain injury. Journal of Clinical and Experimental Neuropsychology 22(5): 656–676.

    Google Scholar 

  • Steffy, R. A., and Galbraith, K. J. (1980). Relation between latency and redundancy associated deficit in schizophrenic reaction time performance. Journal of Abnormal Psychology 89: 419–427.

    Google Scholar 

  • Stratta, P., Mancinia, F., Mattei, P., Casacchi, M., and Rossi, A. (1994). Information processing strategies to remediate Wisconsin Card Sorting Test performance in schizophrenia: A pilot study. American Journal of Psychiatry 151: 915–918.

    Google Scholar 

  • Summerfelt, A. T., Alphs, L. D., Wagman, A. M., and Funderburk, F. R. (1991). Reduction of perseverative error in patients with schizophrenia using monetary feedback. Journal of Abnormal Psychology 100: 613–616.

    Google Scholar 

  • Vollema, M. G., Guertsen, G. J., and van Voorst, A. J. P. (1995). Durable improvements in Wisconsin Card Sorting Test performance in schizophrenic patients. Schizophrenia Research 16: 199–207.

    Google Scholar 

  • Wagner, B. R. (1968). The training of attending and abstracting responses in chronic schizophrenics. Journal of Experimental Research in Personality 3: 77–88.

    Google Scholar 

  • Weinberger, D. R., Berman, K. F., and Zec, R. F. (1986). Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia:1. Regional cerebral blood flow evidence. Archives of General Psychiatry 43: 114–124.

    Google Scholar 

  • Wykes, T., Reeder, C., Corner, J., Williams, C., and Everitt, B. (1999). The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophrenia Bulletin 25: 291–307.

    Google Scholar 

  • Young, D. A., and Freyslinger, M. G. (1995). Scaffolded instruction and the remediation of Wisconsin Card Sorting Test deficits in chronic schizophrenia. Schizophrenia Research 16: 199–207.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kurtz, M.M., Moberg, P.J., Gur, R.C. et al. Approaches to Cognitive Remediation of Neuropsychological Deficits in Schizophrenia: A Review and Meta-Analysis. Neuropsychol Rev 11, 197–210 (2001). https://doi.org/10.1023/A:1012953108158

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1012953108158

Navigation