***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Schizophrenia is treated with medications that raise serum anticholinergic activity and are known to adversely affect cognition . The authors examined the relationship between serum anticholinergic activity and baseline cognitive performance and response to computerized cognitive training in out patients with schizophrenia . METHOD Fifty-five patients were r and omly assigned to either computerized cognitive training or a computer games control condition . A neurocognitive battery based on the Measurement and Treatment Research to Improve Cognition in Schizophrenia ( MATRICS ) initiative was performed at baseline and after the intervention . Serum anticholinergic activity , measured at study entry by radioreceptor assay , was available for 49 patients . RESULTS Serum anticholinergic activity showed a significant negative correlation with baseline performance in verbal working memory and verbal learning and memory , accounting for 7 % of the variance in these measures , independent of age , IQ , or symptom severity . Patients in the cognitive training condition ( N=25 ) showed a significant gain in global cognition compared to those in the control condition , but this improvement was negatively correlated with anticholinergic burden . Serum anticholinergic activity uniquely accounted for 20 % of the variance in global cognition change , independent of age , IQ , or symptom severity . CONCLUSIONS Serum anticholinergic activity in schizophrenia patients shows a significant association with impaired performance in MATRICS-based measures of verbal working memory and verbal learning and memory and is significantly associated with a lowered response to an intensive course of computerized cognitive training . These findings underscore the cognitive cost of medications that carry a high anticholinergic burden . The findings also have implication s for the design and evaluation of cognitive treatments for schizophrenia An emerging body of research has shown that computer-assisted cognitive remediation , consisting of training in attention , memory , language and /or problem-solving , produces improvement in neurocognitive function that generalizes to untrained neurocognitive tests and may also impact symptoms and work functioning in patients with schizophrenia . The active ingredient of these interventions , however , remains unknown as control groups in these studies have typically included few , if any , of the elements of these complex behavioral treatments . This study compared the effects of an extended ( 12-month ) , st and ardized , computer-assisted cognitive remediation intervention with those of a computer-skills training control condition that consisted of many of the elements of the experimental intervention , including hours spent on a computer , interaction with a clinician and non-specific cognitive stimulation .  Forty-two patients with schizophrenia were r and omly assigned to one of two conditions and were assessed with a comprehensive neuropsychological test battery before and after treatment . Results revealed that cognitive-remediation training produced a significant improvement in working memory , relative to the computers-skills training control condition , but that there was overall improvement in both groups on measures of working memory , reasoning/executive-function , verbal and spatial episodic memory , and processing speed . Taken together , these findings suggest that specific practice in neurocognitive exercises targeted at attention , memory and language , produce improvements in neurocognitive function that are not solely attributable to non-specific stimulation associated with working with a computer , interacting with a clinician or cognitive challenge , but that non-specific stimulation has a salutary effect on neurocognition as well Patients with schizophrenia have consistently been found to exhibit cognitive deficits , particularly in memory , which have been suggested to mediate functional outcomes . Several recent review s of cognitive retraining have concluded that these deficits respond to training , although the sustainability of cognitive improvement following completion of training has not been adequately evaluated . Most studies had small sample s and very short follow-up periods . As part of a larger study , we examined performance on two memory tasks in two groups of participants : those who received computerized cognitive remediation training in addition to work therapy ( n=45 ) , vs. those who only received work therapy ( n=49 ) .  Computerized cognitive remediation included hierarchical training on a computerized digit span task and a computerized words serial position task . Assessment s using the same computerized tasks were made at three time points : baseline , end of active intervention , and 6-month follow-up . Compared to the active control condition ( work therapy only ) , the group receiving computerized cognitive remediation in addition to work therapy showed significantly greater improvements on the trained digit span task following training . These improvements were maintained at the 6-month follow-up . There were no significant group differences on the word serial position task at any time point . Results indicate that computerized training can lead to sustained improvements on some , but not all , training tasks Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia , and new treatments are needed that address these impairments . The current study determined whether neurocognitive enhancement therapy ( NET ) in combination with work therapy ( WT ) would show improvement in performance on neuropsychological tests that endured 6 months after completion of training . A total of 145 participants with schizophrenia or schizoaffective disorder were r and omly assigned to NET + WT or WT alone . NET included computer-based training on attention , memory , and executive function tasks . WT included paid work activity in job placements at the medical center . Neuropsychological assessment was performed at baseline , at the end of the 6-month active intervention , and 12 months after training began . Repeated measures multivariate analyses of variance revealed greater neuropsychological improvements on working memory ( p < 0.05 ) and executive function ( p < 0.05 ) for the NET + WT group over the 12 months . Both groups showed sustained improvements on verbal and nonverbal memory BACKGROUND Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia . In this study , we determined whether neurocognitive enhancement therapy ( NET ) in combination with work therapy ( WT ) would improve performance on neuropsychological tests related to but different from the training tasks . METHODS Sixty-five patients with schizophrenia or schizoaffective disorder were r and omly assigned to NET plus WT or WT alone . Neurocognitive enhancement therapy included computer-based training on attention , memory , and executive function tasks ; an information processing group ; and feedback on cognitive performance in the workplace . Work therapy included paid work activity in job placements at the medical center ( eg , mail room , grounds , library ) with accompanying supports .  Neuropsychological testing was performed at intake and 5 months later . RESULTS Prior to enrollment , both groups did poorly on neuropsychological testing . Patients receiving NET + WT showed greater improvements on pretest-posttest variables of executive function , working memory , and affect recognition . As many as 60 % in the NET + WT group improved on some measures and were 4 to 5 times more likely to show large effect-size improvements . The number of patients with normal working memory performance increased significantly with NET + WT , from 45 % to 77 % , compared with a decrease from 56 % to 45 % for those receiving WT . CONCLUSIONS Computer training for cognitive dysfunction in patients with schizophrenia can have benefits that generalize to independent outcome measures . Efficacy may result from a synergy between NET , which encourages mental activity , and WT , which allows a natural context for mental activity to be exercised , generalized , and reinforced The goal of this study was to investigate the impact of Attention Process Training ( APT ) on cognitive functioning in schizophrenia . Twenty-four patients with schizophrenia were r and omly assigned to one of the two following conditions : training by means of APT or no training . The dependent variables included measures of attention , memory and executive functions derived from a cancellation task , dichotic listening , dual task , Trail Making Test , Paced Auditory Serial Addition Task , Everyday Attention Question naire , Spain-Complutense Verbal Learning Test and Wisconsin Card Sorting Test ( WCST ) . All participants were also rated on measures of positive and negative symptoms . The tasks were administrated to all participants at baseline . Participants in the training group received individual intensive APT twice a week , whereas the control group did not receive training . All participants were subsequently retested on the same tests . Although , contrary to expectations , neither group improved on clinical and information-processing measures of attention and memory , patients in the trained group had a significantly higher performance on executive function ( as measured by the WCST ) than did the control group . We conclude that it is feasible to use practice in attention to remediate executive function deficits in schizophrenia This study examined the link between executive function and functional outcome in schizophrenia to identify useful psychological intervention targets and explore how executive function changes affect social functioning and symptoms . Participants from two r and omized controlled trials ( n = 63 ) with poor social functioning , positive and negative symptoms , and cognitive impairment completed seven measures of executive function . Three cognitive factors were extracted : verbal working memory , response inhibition speed , and stimulus-driven responding . Participants received individual cognitive remediation therapy ( CRT ) ( n = 18 ) , a control therapy ( occupational therapy activities ) ( n = 14 ) , or treatment as usual ( n = 19 ) . Only the CRT group improved on verbal working memory . No group improved on the other factors . Although verbal working memory was significantly associated with social functioning and symptom severity 3 months after baseline , change in this factor did not predict change in either functional outcome . There was a significant interaction between group and the stimulus-driven responding factor , and for the CRT group only , a change to a more externally focused responding style was associated with reduced social problems and symptoms . Regardless of treatment type , increased response inhibition speed was associated with reduced negative symptoms . Stimulus-driven responding and response inhibition speed may therefore make useful targets for intervention Abstract The aim of the current pilot study was to compare two strategies in the application of the cognitive differentiation program of Integrated Psychological Therapy for people with schizophrenia . Twenty-six out patients were r and omly assigned to the application of the program in group sessions ( CDg ) , or to its application in individualized sessions ( CDi ) . The program provides cognitive exercises to promote better performance in cognition , and both groups of participants completed the same number of exercises following the same number of sessions per week . Outcomes were assessed on neuropsychological measures of attention , executive functioning and everyday memory , and everyday functioning . Effect sizes showed the absence of effects in everyday memory and social functioning , higher improvements in the  CDi group in attention , and a higher improvement in the  CDg condition in executive functioning . The results suggest that the program application model could be individualized , depending on patient-specific cognitive deficits This individual differences study examined the separability of three often postulated executive functions-mental set shifting ( " Shifting " ) , information updating and monitoring ( " Updating " ) , and inhibition of prepotent responses ("Inhibition")- and their roles in complex " frontal lobe " or " executive " tasks . One hundred thirty-seven college students performed a set of relatively simple experimental tasks that are considered to predominantly tap each target executive function as well as a set of frequently used executive tasks : the Wisconsin Card Sorting Test ( WCST ) , Tower of Hanoi ( TOH ) , r and om number generation ( RNG ) , operation span , and dual tasking .  Confirmatory factor analysis indicated that the three target executive functions are moderately correlated with one another , but are clearly separable . Moreover , structural equation modeling suggested that the three functions contribute differentially to performance on complex executive tasks . Specifically , WCST performance was related most strongly to Shifting , TOH to Inhibition , RNG to Inhibition and Updating , and operation span to Updating . Dual task performance was not related to any of the three target functions . These results suggest that it is important to recognize both the unity and diversity of executive functions and that latent variable analysis is a useful approach to study ing the organization and roles of executive functions OBJECTIVE There is considerable interest in cognitive remediation for schizophrenia . Our study aim ed to evaluate , in a large sample of patients with schizophrenia , the interest of a computer-assisted cognitive remediation program on cognitive performances of patients as well as in clinical and functional outcome . METHOD Seventy-seven patients with remitted schizophrenia were r and omly assigned to 14 2-hours individual sessions of computer-assisted cognitive remediation ( n=39 ) or a control condition ( n=38 ) . Remediation was performed using RehaCom ® software . Four procedures were chosen to train four cognitive functions involved in different stages of the information processing : attention/concentration , working memory , logic , and executive functions . Primary outcomes were remediation exercise metrics , neuropsychological composites ( episodic memory , working memory , attention , executive functioning , and processing speed ) , clinical and community functioning measures . RESULTS Cognitive performances concerning Attention/vigilance , verbal working memory and verbal learning memory and reasoning/problem solving improved significantly in the remediation condition when no difference was reported in the control condition between the 2 assessment s. However , there were no significant benefits of cognitive remediation on non-verbal working memory and learning and speed of processing or functional outcome measures . CONCLUSIONS Cognitive remediation for people with schizophrenia was effective in improving performance , but the benefits of training did not generalize to functional outcome measures . Long term follow-up studies are needed to confirm the maintenance of such improvements OBJECTIVE To address cognitive impairments that limit the effectiveness of supported employment services for patients with schizophrenia , a cognitive training program , the Thinking Skills for Work Program , was developed and integrated into supported employment services . METHOD Patients with severe mental illness ( N=44 ) and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City were r and omly assigned to receive either supported employment alone or supported employment with cognitive training . Measures at baseline and 3 months included a brief cognitive and symptom assessment . Work outcomes were tracked for 2 - 3 years . RESULTS Patients in the supported employment with cognitive training program demonstrated significantly greater improvements at 3 months in cognitive functioning , depression , and aut 
    Output:
    
The review ed articles corroborate the literature pointing that CR could be a promising therapeutic option for cognitive deficits in  schizophrenia .
In general , CR could improve cognitive domains and social adjustment either using computerized or paper- and -pencil programs .
Additionally , CR combined with cognitive behavioral therapy and /or group sessions is particularly effective .