Visual and Auditory Training Improve Different Aspects of Schizophrenia

By Marilynn Larkin

June 05, 2020

NEW YORK (Reuters Health) - Visual training and auditory training were "differentially efficient" at improving cognitive deficits and symptoms in a randomized trial of schizophrenia patients in Brazil.

"The visual training significantly improved attention and reasoning and problem-solving, while the auditory training improved reasoning and problem solving only," Dr. Rogerio Panizzutti of Federal University of Rio de Janeiro told Reuters Health by email. "The discovery may tailor the development of training regimens to improve cognition in individuals suffering with schizophrenia."

"Our main discovery, however, is that improvements in attention were associated to improvements in clinical symptoms, mainly negative symptoms," he said.

Also important, he added, was finding that "digital cognitive training may be delivered successfully to underprivileged individuals in a developing country."

As reported in Schizophrenia Research, 79 participants with schizophrenia were randomly assigned to 40 hours of auditory or visual computerized training. The two methods were dynamically equivalent and progressive.

Participants' mean age was 42. Most were men, and all except two took antipsychotics over the course of the study. There were no significant socio-demographic or clinical differences between the groups

Fifty-three participants completed the training. The visual training group improved in global cognition, with specific improvement in both low-order (attention) and high-order (reasoning and problem-solving) cognitive processes.

By contrast, as Dr. Panizzutti noted, the auditory group improved over time in reasoning and problem-solving, but not attention. "The higher efficiency of the visual training may be explained by the predominance of the visual over the auditory processing system," the authors suggest.

Further, schizophrenia symptoms improved after training in both groups, whereas quality of life did not.

Dr. Panizzutti said "Results indicate that individuals with schizophrenia may benefit from both types of training, although it is possible that other unknown factors might impact which patients respond better to each type. Further studies with larger cohorts are needed to replicate the findings and confirm this potential."

Dr. Alice Medalia, Director of the Lieber Recovery Clinic at Columbia University Irving Medical Center in New York City noted in an email to Reuters Health, "The authors speculate that the higher efficiency of the visual training may be explained by the predominance of the visual over the auditory processing system. It is reasonable to also consider alternative interpretations. For example, the results may reflect the fact that attention was tested with a visual test."

"However, the broader, important message is that sensory-specific training may be a way to personalize treatment of cognitive deficits in schizophrenia," she said.

"An easily administered and well tolerated eight-minute test can identify the roughly 50% of patients who in fact have early auditory deficits in need of remediation (, " she added. "By routinely incorporating tests of early sensory processing into cognitive assessments, it would be possible to identify which patients might respond better to the two techniques studied in this paper."

Dr. Shaun Eack, Associate Dean for Research at the University of Pittsburgh's School of Social Work, also commented in an email to Reuters Health. "While promising, the treatment of cognition is largely a means to an end. The broad goal is to improve functioning, such as employment, family relationships, and engagement in social leisure. The authors did not report impact on functioning, but did find that quality of life did not improve, so there is still important work to be done to address the larger outcomes that are of interest to patients and families."

SOURCE: Schizophrenia Research, online May 21, 2020.