Predicting drug efficacy for cognitive deficits in schizophrenia

The purpose of this article is to discuss the prediction of cognitive enhancement in schizophrenia from preclinical data. Despite increasing focus on the significance of cognitive impairment in schizophrenia, the progress of novel treatments has been slow. Hyman and Fenton's identification of a "translational gap" between preclinical and clinical science underscores the need to revise preclinical, clinical, and regulatory practice. A review of the clinical literature identifies evidence for some cognitive benefits with current antipsychotics. The magnitude of these effects may, in some cases, be too small to be functionally relevant, and many studies are methodologically flawed, but the data might nevertheless allow translational links to be identified between clinical and preclinical studies. The literature is reviewed to determine if the cognitive signal reported in clinical studies is detectable in preclinical studies. The effects of antipsychotics on prepulse-inhibition deficits in animals is robust and demonstrates a reversal of drug-induced and developmentally induced deficits, although predictive links to the clinic are not well established. The preclinical literature on antipsychotic effects on attention, learning and memory, and recognition and executive function shows, with rare exceptions, impaired learning or task performance, rather than improvement. In general, therefore, preclinical studies have not detected the small pro-cognitive signal evident in the clinical literature. A number of factors may account for this. Effective closure of the translation gap for cognitive deficits in schizophrenia will require the design of a coherent preclinical strategy, and some of the potential elements of such a strategy are outlined and discussed.