Report on ISCTM Consensus Meeting on Clinical Assessment of Response to Treatment of Cognitive Impairment in Schizophrenia

Richard S.E. Keefe*, George M. Haig, Stephen R. Marder, Philip D. Harvey, Eduardo Dunayevich, Alice Medalia, Michael Davidson, Ilise Lombardo, Christopher R. Bowie, Robert W. Buchanan, Dragana Bugarski-Kirola, William T. Carpenter, John T. Csernansky, Pedro L. Dago, Dante M. Durand, Frederick J. Frese, Donald C. Goff, James M. Gold, Christine I. Hooker, Alex KopelowiczAntony Loebel, Susan R. McGurk, Lewis A. Opler, Amy E. Pinkham, Robert G. Stern

*Corresponding author for this work

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

If treatments for cognitive impairment are to be utilized successfully, clinicians must be able to determine whether they are effective and which patients should receive them. In order to develop consensus on these issues, the International Society for CNS Clinical Trials and Methodology (ISCTM) held a meeting of experts on March 20, 2014, in Washington, DC. Consensus was reached on several important issues. Cognitive impairment and functional disability were viewed as equally important treatment targets. The group supported the notion that sufficient data are not available to exclude patients from available treatments on the basis of age, severity of cognitive impairment, severity of positive symptoms, or the potential to benefit functionally from treatment. The group reached consensus that cognitive remediation is likely to provide substantial benefits in combination with procognitive medications, although a substantial minority believed that medications can be administered without nonpharmacological therapy. There was little consensus on the best methods for assessing cognitive change in clinical practice. Some participants supported the view that performance-based measures are essential for measurement of cognitive change; others pointed to their cost and time requirements as evidence of impracticality. Interview-based measures of cognitive and functional change were viewed as more practical, but lacking validity without informant involvement or frequent contact from clinicians. The lack of consensus on assessment methods was viewed as attributable to differences in experience and education among key stakeholders and significant gaps in available empirical data. Research on the reliability, validity, sensitivity, and practicality of competing methods will facilitate consensus.

Original languageEnglish (US)
Pages (from-to)19-33
Number of pages15
JournalSchizophrenia bulletin
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • cognitive assessment
  • neuropsychology
  • treatment

ASJC Scopus subject areas

  • Psychiatry and Mental health

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    Keefe, R. S. E., Haig, G. M., Marder, S. R., Harvey, P. D., Dunayevich, E., Medalia, A., Davidson, M., Lombardo, I., Bowie, C. R., Buchanan, R. W., Bugarski-Kirola, D., Carpenter, W. T., Csernansky, J. T., Dago, P. L., Durand, D. M., Frese, F. J., Goff, D. C., Gold, J. M., Hooker, C. I., ... Stern, R. G. (2016). Report on ISCTM Consensus Meeting on Clinical Assessment of Response to Treatment of Cognitive Impairment in Schizophrenia. Schizophrenia bulletin, 42(1), 19-33. https://doi.org/10.1093/schbul/sbv111