A recent study supports the importance of addressing basic auditory deficits in persons with schizophrenia or schizoaffective disorder when attempting to remediate higher order auditory impairments such as verbal learning. In addition, researchers highlight the need for routine assessment of early auditory processing (EAP) in cognitive remediation participants, as well as the need for more effective programs to reverse these impairments. 103 outpatient adults diagnosed with schizophrenia or schizoaffective disorder were classified as having intact (48.5%) or impaired (51.5%) EAP and randomized to a cognitive remediation program with restorative exercise plans that either included EAP training (n=49) or did not (n=54). Cognitive and functional outcomes were measured post-treatment and 3 months later. They found:
- Only in EAP impaired participants was there a significant benefit from EAP training on verbal learning.
- Treatment condition did not significantly impact global cognitive or functional outcomes for either EAP group.
- Cognitive gains partially mediated the relationship between gains in EAP and functional capacity.
Medalia A, Saperstein AM, Qian M, Javitt DC. Impact of baseline early auditory processing on response to cognitive remediation for schizophrenia. [Published online ahead of print January 18, 2019]. Schizophr Res. doi:10.1016/j.schres.2019.01.012.
Early auditory processing (EAP) deficits found in some, but not all, people with schizophrenia present as impaired ability to discriminate length, intensity, and pitch of non-verbal sounds. This can lead to poor downstream functional and cognitive outcomes. Cognitive remediation (CR) is a current gold-standard treatment to improve cognitive processes in schizophrenia. This study investigated whether it might be helpful to target an earlier level of information processing in people with EAP deficits vs. those that do not have such deficits. It suggests that pre-training EAP can be most potentially helpful to individuals with EAP impairments and are one way to personalize a CR approach. Overall, this report highlights the role of EAP in driving cognitive and functional change and underscores the role of cognitive gain in improving functional outcome in people with schizophrenia.—Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.