mobile phoneA ‘brain training’ game may improve the memory of people with schizophrenia, helping them in their daily lives at work and aiding them to live independently, according to new research.

The game, called Wizard, developed by a team of researchers led by Professor Barbara Sahakian from the Department of Psychiatry at Cambridge, aims to improve an individual’s episodic memory. Episodic memory is, for example, where you have to remember where you parked your car in a multi-storey car park after going shopping for several hours or where you left your keys at home. It is one of the facets of cognitive functioning to be affected in people with schizophrenia. 

The game, Wizard, was the result of a 9-month collaboration between psychologists, neuroscientists, a professional game-developer and people with schizophrenia. It was intended to be fun, attention-grabbing, motivating and easy to understand, while at the same time improving the player’s episodic memory. The memory task was woven into a narrative in which the player was allowed to choose their own character and name; the game rewarded progress with additional in-game activities to provide the user with a sense of progression independent of the cognitive training process. 

Schizophrenia is a long-term mental health condition that causes a range of psychological symptoms, ranging from changes in behaviour through to hallucinations and delusions. Psychotic symptoms are reasonably well treated by current medications, but people with the condition are still left with debilitating cognitive impairments, including in their memory, and so are frequently unable to return to university or work.

There are as yet no licensed pharmaceutical treatments to improve cognitive functions for people with schizophrenia. However, there is increasing evidence that computer-assisted training and rehabilitation can help people with schizophrenia overcome some of their symptoms, with better outcomes in daily functioning and their lives.

In a study published in the journal Philosophical Transactions of the Royal Society B, researchers assigned 22 participants with a diagnosis of schizophrenia to either the cognitive training group or a control group at random. Participants in the training group played the memory game for 8 hours over a 4-week period; participants in the control group continued their treatment as usual. At the end of the four weeks, the researchers tested all participants’ episodic memory using the Cambridge Neuropsychological Test Automated Battery (CANTAB) PAL, as well as their level of enjoyment and motivation, and their score on the Global Assessment of Functioning (GAF) scale, which doctors use to rate the social, occupational, and psychological functioning of adults. 

Professor Sahakian and colleagues found that the participants who had played Wizard made significantly fewer errors and needed significantly fewer attempts to remember the location of different patterns in the CANTAB PAL test relative to the control group. In addition, patients in the cognitive training group saw an increase in their score on the GAF scale. 

In addition, participants in the cognitive training group indicated that they enjoyed the game and were motivated to continue playing across the 8 hours of cognitive training. In fact, the researchers found that those who were most motivated also performed best at the game. This is important, as lack of motivation is another common facet of schizophrenia. 

It is not clear exactly how the apps also improved the patients’ daily functioning, but the researchers suggest it may be because improvements in memory had a direct impact on global functions or that the cognitive training may have had an indirect impact on functionality by improving general motivation and restoring self-esteem. Or indeed, both these explanations may have played a role in terms of the impact of training on functional outcome. 

“We need a way of treating the cognitive symptoms of schizophrenia, such as problems with episodic memory, but slow progress is being made towards developing a drug treatment,” said Professor Sahakian. “So this proof-of-concept study is important because it demonstrates that the memory game can help where drugs have so far failed. Because the game is interesting, even those patients with a general lack of motivation are spurred on to continue the training.” 

Professor Peter Jones, from the department of psychiatry at the University of Cambridge, added: “These are promising results and suggest that there may be the potential to use game apps to not only improve a patient’s episodic memory, but also their functioning in activities of daily living. We will need to carry out further studies with larger sample sizes to confirm the current findings, but we hope that, used in conjunction with medication and current psychological therapies, this could help people with schizophrenia minimise the impact of their illness on everyday life.” 

Reference

Sahakian BJ et al (2015) The impact of neuroscience on society: Cognitive enhancement in neuropsychiatric disorders and in healthy people. Phil. Trans. R. Soc. B.