Randomized trial of self-adaptive computerized cognitive remediation in schizophrenia

Computerized, self-adaptive cognitive training has emerged as a promising digital therapeutic for cognitive impairment; however, its underlying training mechanisms in schizophrenia remain poorly understood. This double-blind, randomized trial compared self-adaptive difficulty (SAD) with fixed-difficulty (FD) computerized cognitive training program, evaluating both domain-specific cognitive and clinical outcomes, and exploring difficulty-performance coupling as a potential active therapeutic mechanism. Seventy-two patients with schizophrenia (SAD = 41, FD = 31) completed 4 weeks of training, and 40 patients (n = 20 per group) were assessed at week 8. Cognitive outcomes were measured using the Cognitive Index (CI) and MATRICS Consensus Cognitive Battery (MCCB), while clinical symptoms were also assessed. Linear mixed-effects models (LMMs) revealed significantly greater and faster cognitive improvements in the SAD compared with the FD group in attention and agility, with faster improvement also observed in thinking. Robust difficulty-performance coupling was observed across all cognitive domains. Additionally, positive symptoms improved significantly in the SAD group compared to the FD group at week 4. Self-adaptive cognitive training enhances and accelerates cognitive improvements in schizophrenia, particularly in attention and processing speed, and also benefits positive symptoms. Difficulty-performance coupling may reflect dynamic load calibration as a key therapeutic mechanism in digital cognitive training. Trial registration: Chictr.org.cn, number, ChiCTR2000040326, registered 2020-11-27.