Response to Cognitive Rehabilitation in Older Versus Younger Persons with Severe Mental Illness

Cognitive rehabilitation programs have been developed in an effort to overcome the effects of cognitive impairment on psychosocial functioning in persons with severe mental illness. Multiple studies have demonstrated the benefits of cognitive training for patients with SMI, but these studies have focused on younger patients. Our study evaluated the relationship between age and benefit from cognitive rehabilitation. We predicted that age would be associated with greater baseline impairments and diminished benefits from cognitive rehabilitation. Patients were drawn from two randomized controlled studies comparing cognitive training integrated with vocational rehabilitation and vocational rehabilitation alone. Cognitive training consisted of 24 hours of computerized exercises practicing a broad range of cognitive functions. Subjects were assessed on cognitive functioning and symptoms at baseline and 3 months later. Study participants included 34 clients aged 45 or older, and 42 clients under the age of 45. There were no differences between the younger and older clients at baseline on cognitive and symptoms measures. Results indicated that cognitive rehabilitation contributed to improved cognitive functioning across a range of measures, and it improved depression and autistic preoccupation on the symptom assessments for the younger patients. In contrast, the older clients showed few improvements in cognitive functioning but demonstrated significant reduction in negative symptoms. Results suggest that cognitive rehabilitation methods may need to be adapted to address special needs of older patients with severe mental illness.