Cognitive Assessment and Training using Virtual-Reality in Schizophrenia Patients

Cognitive Assessment and Training using Virtual-Reality in Schizophrenia Patients Background Individuals with schizophrenia suffer from various cognitive impairments, often causing difficulties in daily functioning and reducing quality of life (Green et al., 2000; Ranganath et al., 2008), with only minimal improvements under pharmacological treatment (McGurk et al., 2007).

The predictive value of standard neurocognitive assessments for real-world functioning is limited and highlights the need for developing novel assessments of life-skill capacities (Rizzo et al., 2004).

Virtual reality (VR) is a computerized 3D representation of the world, which creates an ecologically valid environment while maintaining high experimental control.

The applications of VR are limitless and it has become an increasingly popular tool in clinical research, including neuropsychological testing in psychosis (Josman et al., 2009; Ruse et al., 2014; Greenwood et al., 2016). VR may also be useful to treat and improve cognition in this population (Chan et al., 2010).

Spatial working memory is a well-known cognitive deficit in schizophrenia, associated with hippocampal volume reduction (Nelson et al., 1998).

A designated study (Lövdén et al., 2012) found that intensive spatial memory training in VR protect hippocampal integrity in elderly.

Moreover, a recent study reported that computerized spatial memory training can improve cognition and global functioning in individuals with psychosis (Sahakian et al., 2015).

Objective This project aims to establish whether immersive spatial memory training can improve cognitive performance in schizophrenia. Cognition will be assessed using standard measures, as well as a novel VR cognitive task.

Specifically, we aim to 1) establish changes (i.e., potential improvement) in cognition following spatial memory training on the MATRICS Consensus Cognitive Battery and VR assessment, and 2) test whether baseline negative symptoms moderate the efficacy of the training programme. Methods Study population includes a sample of 40 outpatients diagnosed with schizophrenia.

Participants are 18 to 50-years old, stable on antipsychotic medication for at least 3 months and have the capacity to provide informed consent. The study involves screening, baseline and follow-up visits.

Patients complete the following assessments at baseline and follow-up: MCCB – (gold standard cognitive assessment in schizophrenia), VStore (VR cognitive assessment), Positive and Negative Syndrome Scale (PANSS), and various functional capacity assessments including the UCSD Performance-based Skills Assessment (UPSA), Global Assessment of Functioning (GAF), and Social and Occupational Functioning Assessment Scale (SOFAS).

Between study visits, participants undergo 12 hours of app-based spatial memory training. They are randomly assigned to either receive 2D or 3D training. Training efficacy is evaluated by examining the changes in the MCCB composite score and VStore performance.

MCCB scores pre- and post-training are compared using a mixed ANOVA model, where intervention is included as a between-subject factor (3D Maze / 2D Maze), and timepoints are included as a within-subject factor (Pre- / Post-training). This analysis is repeated using VStore outcomes. Moderation effect will be tested using structural equation modelling.