“WHAT ACCOUNTS FOR POOR FUNCTIONING IN PEOPLE WITH SCHIZOPHRENIA: A RE-EVALUATION OF THE CONTRIBUTIONS OF NEUROCOGNITIVE V. ATTITUDINAL AND MOTIVATIONAL FACTORS” PAPER.
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Evidence Supporting Tests of Neurocognitive Deficits
For the purposes of this review, we will focus on findings from the two test batteries that have been used most widely worldwide: Gur and colleagues’ Penn Computerized Neurocognitive Battery [CNB] (Gur et al., 2001) and the Measurement and Treatment Research to Improve Cognition in Schizophrenia [MATRICS] Consensus Cognitive Battery (MCCB) (Kern, Green, Nuechterlein, & Deng, 2004). The CNB and MCCB are based on reliable and valid tests used to study brain damage (Heinrichs, 2001). The CNB assesses the domains of executive functioning, attention, word memory, facial memory, spatial memory, language, spatial abilities, and sensory-motor abilities (Gur et al., 2001; Gur et al., 2010), while the MCCB measures processing speed, attention, and vigilance, working memory, verbal learning and memory, visual learning and memory, reasoning and problem solving, and social cognition (Schulz & Murray, 2016). These domains have traditionally been identified in schizophrenia, dating back to Kraepelin and Bleuler.
Psychometric Properties of the MCCB and CNB
Reliability. The CNB demonstrates adequate internal consistency (Cronbach’s alphas are usually between 0.70 and 0.90 across studies) and comparable results from separate samples (Swagerman et al., 2016). Similarly, the MCCB exhibits adequate internal consistency (Cronbach’s alpha between 0.70 and 0.90; Kaneda et al., 2013), moderate to strong intercorrelations between the individual domains (August, Kiwanuka, McMahon, & Gold, 2012), and high test-retest reliability (r values greater than 0.70; Green, Harris, & Nuechterlein, 2014).
Convergent validity. The CNB correlates with traditional measures of neurocognition (Gur et al., 2001). The MCCB correlates with the IntegNeuro Test, a highly reliable and validated computerized neurocognitive test (Silverstein et al., 2010).
Criterion validity. The CNB is sensitive to key demographic variables linked with neurocognitive differences, including age and gender (Gur et al., 2001; Gur et al., 2010; Swagerman et al., 2016). Further, the CNB differentiates between individuals with schizophrenia, unaffected relatives, and healthy controls (Gur et al., 2007). Additionally, the test correlates with premorbid adjustment,
of illness onset, illness duration, quality of life, and symptom severity (Grant & Beck, 2009). The MCCB also demonstrates criterion validity, as it correlates with responsiveness to treatments such as cognitive remediation, neuroplasticity-based auditory training, and antipsychotic medication (Green et al., 2014).
Predictive validity. Scores on the CNB correlate with
and parental education levels (Gur et al., 2010; Swagerman et al., 2016), while scores on the MCCB are associated with education level and employment status (August et al., 2012; Lystad et al., 2014). MCCB performance correlates with community functioning cross-sectionally and longitudinally (Bryson & Bell, 2003; Shamsi et al., 2011). The MCCB performance correlates with self-rated social functioning (Lystad et al., 2014), clinical ratings of social functioning (Shamsi et al., 2011), and social
abilities (Quinlan, Roesch, & Granholm, 2014). Finally, meta-analyses indicate that performance on domains measured by the batteries is associated with functional outcomes (Heinrichs, 2001; Green, Kern, & Heaton, 2004).
Additionally, scores on the CNB and MCCB can predict conversion to psychosis. Individuals with psychosis spectrum disorders showed greater neurocognitive developmental lag on the CNB than individuals with subthreshold psychotic symptoms, detectable as early as age 8 (Gur et al. 2014). Similarly, at-risk individuals who later transitioned to a psychotic disorder exhibited poorer performance on the MCCB than controls and at-risk individuals who did not transition (Seidman et al., 2016). In another recent study, individuals in an at-risk mental state for psychosis performed significantly worse on the MCCB compared to controls (Eisenacher et al., 2016).
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