Original article Cognitive remediation and functional improvement in schizophrenia: Is it a matter of size? M. Bosia a,b,1 , M. Buonocore a, * ,1 , M. Bechi a , M. Spangaro a,b , A. Pigoni a , M. Croci a , F. Cocchi a , C. Guglielmino a , L. Bianchi a , E. Smeraldi a,b , R. Cavallaro a a Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy b Universita ` Vita-Salute San Raffaele, Milan, Italy 1. Introduction Neurocognitive impairment represents a core feature of schizophrenia, strongly correlated to global functional outcome [1,2] and poorly responsive to antipsychotic treatment [3,4]. A large number of randomized controlled trials have firmly established the efficacy of Cognitive Remediation Therapy (CRT), an evidence-based behavioral treatment that aims to improve cognitive processes supporting everyday life abilities [5,6]. Despite several studies highlighted benefits of cognitive remediation in schizophrenia [5,7–9], the rate of these improve- ments is still highly heterogeneous [10,11], probably depending on many different factors including demographic and clinical varia- bles, therapeutic features and genetic underpinnings [12–19]. So far, a few studies explored possible predictors of functional outcome after cognitive remediation, suggesting a role of neurocognitive baseline performances in different domains, as well of clinical variables, such as antipsychotic dosage and disorganization symptoms [20,21]. Still, the relationship between cognitive and functional improvement is not fully elucidated. Do cognitive changes need to be of a definite size and/or encompass a certain number of domains in order to impact on daily functioning? Up to date, an unambiguous answer cannot be derived from available literature. In general, a positive correlation is seen between the degree of European Psychiatry 40 (2017) 26–32 A R T I C L E I N F O Article history: Received 18 March 2016 Received in revised form 23 May 2016 Accepted 21 June 2016 Available online Keywords: Psychosis Quality of Life Neurocognition Rehabilitation Daily Functioning Equivalent scores A B S T R A C T Background: Cognitive Remediation represents the best available tool to treat cognitive deficits in schizophrenia and evidence suggests an effect also on global functioning. However, the relationship between cognitive and functional improvement is not yet fully elucidated: do cognitive changes need to be of a definite size and/or encompass a certain number of domains in order to impact on daily functioning? This study aims to explore the role of cognitive improvement, evaluated both quantitatively and qualitatively through the use of Italian equivalent scores, on the daily functioning of patients. As secondary goal, the influence of demographic, clinical and neuropsychological variables on functional outcome was also systematically investigated. Methods: One hundred subjects with a diagnosis of schizophrenia underwent 36 sessions of Cognitive Remediation and were evaluated at baseline and after the training with the Brief Assessment of Cognition in Schizophrenia and the Quality of Life Scale. Results: A total of 70% of patients improved in at least one cognitive domain and over 50% obtained a normalized score. Among the clinical and neurocognitive factors examined, the only significant predictor of quality of life’s improvement was the proportion of cognitive functions that reached an equivalent score of ‘‘normal’’. Conclusions: This study suggests that improvements in daily functioning depend on the achievement of a cognitive profile as much as possible ‘‘normal’’, harmonious and balanced, supporting the idea that a qualitative leap in cognition is needed in order to gain an advantage in real life activities. ß 2016 Elsevier Masson SAS. All rights reserved. * Corresponding author. Department of clinical neurosciences, IRCCS San Raffaele Scientific Institute, Via Stamira d’Ancona 20, 20127 Milano, Italy. Tel.: +390226433418. E-mail address: buonocore.mariachiara@hsr.it (M. Buonocore). 1 Authors Marta Bosia and Mariachiara Buonocore equally contributed to this work. Contents lists available at ScienceDirect European Psychiatry jo u rn al h om epag e: h ttp ://ww w.eu ro p s y- jo ur n al.co m http://dx.doi.org/10.1016/j.eurpsy.2016.06.007 0924-9338/ß 2016 Elsevier Masson SAS. All rights reserved.