035-36 standard deviations on the part of an individual patient to be nonrandom,

suggesting that quite substantial improvements may be required with current instrumentation. Reduction, or at least the clear recognition, of practice effects is an important goal, because large practice effects in treatment studies on the part of the patients in the inactive treatment group can make it impossible to detect change in the treatment group.37 Certain measures are particularly vulnerable to such effects, and some of them may actually change in their characteristics upon repeated administration. Episodic Inhibitors,research,lifescience,medical memory tests are particularly vulnerable to practice effects, because of the possibility of learning of the content. However, it is critical to have alternate forms of such measures be closely equivalent, because if the alternate forms are different in their difficulty, an apparently Inhibitors,research,lifescience,medical improvement

effect can be spuriously detected. Problem-solving tests are quite vulnerable to changes with retesting, because if there is only one problem, like in the widely used Wisconsin Card Sorting Test, once it is solved the test is no longer a problem-solving test. As a result, BI6727 systematic efforts to develop problem-solving tests with similarly problems (like mazes) but Inhibitors,research,lifescience,medical with alternative stimuli have been conducted. One of the major issues in using neuropsychological assessment as a sole outcome measure to measure either spontaneous recovery or treatment response is the lack of definitive information as to how much change is required to be important. In a sense, this Inhibitors,research,lifescience,medical is the converse of how much worsening due to illness or injury is significant, because both are equally hard to define without additional reference points. For an adequately powered randomized trial, separation of active treatment from inactive

treatment is certainly one standard; one that will be Inhibitors,research,lifescience,medical applied by regulatory agencies. Another perspective is the empirically derived standard described above a ½ standard deviation improvement as having clinical meaning. A third strategy, which is optimal in certain circumstances where it can be applied, is that of using concurrent assessment of functional outcomes. As improvement in functioning is the goal of treatment of cognition, whenever possible improvements in functioning occur, accompanying Phosphoprotein phosphatase cognitive improvements should be measured. For instance, in a study of cognitive remediation in schizophrenia published a few years ago, the level of improvement in neuropsychological test performance on the part of patients was less than 0.5 SD compared with the inactive treatment group.38 However, the patients who received cognitive remediation were able to work much more effectively and earned more than 10 times as much money in the ensuing 3-year follow-up period compared with patients randomized to the inactive treatment.