Assessing cognition in schizophrenia: a comparison of clinician and computerized test administration

Cognitive impairment is recognized as an important determinant of outcome in schizophrenia, but mental health services generally have little capacity to provide detailed neuropsychological assessments. Computerized testing would overcome this difficulty, provided that such testing was equivalent to testing by a clinician. Given that negative symptoms can include impaired motivation and attention, it is also important to know whether computerized testing is valid in people with more severe negative symptoms. Our study was designed to compare clinician-administered and computerized testing of two domains commonly impaired in schizophrenia, verbal memory and verbal fluency. We also evaluated the effect of negative symptoms on performance on computerized cognitive tests. Sixty-two participants with schizophrenia completed clinician-administered and computerized verbal memory and verbal fluency tasks. The Positive and Negative Syndrome Scale assessed negative symptom severity. The study found no difference in cognitive performance associated with the method of test administration. This finding held regardless of the severity of negative symptoms. We found that computerized cognitive testing was equivalent to clinician-delivered testing in assessing verbal memory and verbal fluency. This finding was not affected by the presence of negative symptoms. Our results support the use of computerized cognitive testing for people with schizophrenia.