April 12, 2005

MATRICS - Improving cognition

MATRICS (Measurement and treatment to improve cognition in schizophrenia)

Recently, a special issue of the journal Schizophrenia Research (December, 2004) was devoted to discussing a new research initiative spearheaded by the National Institute for Mental Health (NIMH) and in collaboration with researchers around the country including Stephen Marder from UCLA (see recently posted interview here). The goal of this research initiative is to lead to collaborations with pharmaceutical companies, academics and governmental researchers to develop medications that will target the cognitive aspects of schizophrenia. Schizophrenia may be most well known for effects on perceptions (i.e. hallucinations, delusions, paranoia) but it may be the effects on working memory and cognition that are the most long lasting and damaging to patients. There are many effective medications available for treating the psychotic symptoms, but currently no medications are approved to help treat the cognitive deficit that many people with schizophrenia endure.

Here are some highlights from the series of articles published in the journal Schizophrenia Research:

1. Marder and Fenton – This article highlights the goals of the MATRICS initiative. The authors comment that current medications, while effective for treatment of psychosis in many individuals, do not help alter the course of the cognitive aspects of schizophrenia. The MATRICS study is designed to help bring together the various entities needed to develop medications that can be helpful in ways other than in treatment of positive symptoms of psychosis. According to the authors, “Neuropsychologists and neurophysiologists with an interest in schizophrenia rekindled an interest in cognition in schizophrenia. There is a greater recognition that impairments in domains that include memory, attention, executive functioning, verbal fluency, and psychomotor performance are experienced, to some degree, by the great majority of individuals with schizophrenia and that these impairments are core features of the disorder.” It is thought that the cognitive features are more consistent and do not wax and wane like some of the positive symptoms can. Also, they are seen as more predictive of future outcome than the level of hallucination and therefore are an important target. The authors describe how there are rodent and other animal models that have recently demonstrated new potential targets for treatment in this area leading to optimism that these targets will also be useful in humans. However, there are many hurdles that preclude immediate development. First there are financial obstacles to overcome. However, the financial gain that a company would reap from such a medication however would be substantial. There is also some difficulty over the standard in which patients will be measured. There are many possibilities, but none that has been decided upon yet.

2. Kern, et al.: This article discusses the conference in which the MATRICS cognitive assessment was discussed. 74 leading experts came for a conference that led to the beginning of the standards set.
3. Nuechterlein et al., This paper focused on the choice of which features of cognition should be targeted. It was decided that there were eight categories to consider: Speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning/problem solving, verbal comprehension, and social cognition. However, verbal comprehension was excluded because it was considered to be too constant and not as likely to change with therapy.
4. Green, et al., published a review article on 18 longitudinal (over 6 month duration) studies that looked at cognition and community outcome. While it is generally accepted that cognition influences outcome, this paper compiles a large amount of data to make the point more strongly.

Overall, this series of articles is important in outlining the framework for what is one of the most important studies being undertaken currently. While it will be years until much of the data and progress is realized from this project, it will have long lasting implications and will be something to follow closely.

Schizophrenia Research, Volume 72, Issue 1 , 15 December 2004,

More Information: All the meetings related to MATRICS are listed on their web sites, with transcripts of the meetings and copies of the presentations made at the meetings. These are a very good source of information for people interested in this.

See: MATRICS Meeting Transcripts and Information


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