Sophia Vinogradov1, Ian Ramsay1, Bruno Biagianti2, Rachel Loewy3, Melissa Fisher1, Dan Mathalon3, Sisi Ma1, Dan Ragland4, Tara Niendam4, Cam Carter4; 1Department of Psychiatry, University of Minnesota, 2Department of Psychiatry, UCSF, and Positscience, Inc, San Francisco, 3Dept of Psychiatry, UCSF, 4Dept of Psychiatry, UC Davis
The cognitive deficits that characterize patients with schizophrenia are present in the prodrome, worsen as the illness progresses, and predict functional outcome. Cognitive dysfunction thus must be a primary target for aggressive early intervention in in early phases of schizophrenia. We report on behavioral and imaging data from a randomized controlled trial of targeted auditory-system training (AT) in participants with recent onset schizophrenia (N=144, mean age 21 years). These findings begin to point to personalized psychiatry approaches. 1. Auditory training subjects demonstrated significant improvements in Global Cognition, Verbal Memory, and Problem-solving compared to computer games control subjects. Training-induced cognitive gains at 40 hours showed significant associations with improved auditory processing speed at 20 hours. 2. Global Cognition showed durable improvements at 6-month follow-up. Within the AT group, Global Cognition improvement after training was significantly correlated with positive symptom improvement at 6-month follow-up. 3. Baseline auditory MMN was significantly reduced in participants and associated with worse Global Cognition. MMN did not show changes after AT and exhibited trait-like stability. Greater deficits in double-deviant MMN predicted greater gains in Global Cognition in response to AT. 4. Change in Global Cognition was significantly related to change in left thalamus volume in the AT group. Greater symptom severity at baseline reduced the likelihood of response to AT both with respect to improved cognition and change in thalamic volume. 5. A model selection and regression analytic approach (LASSO) identified baseline Global Cognition, education, and gender in a model predictive of improvement on cognition following AT.
