Using brain imaging measures in studies of procognitive pharmacologic agents in schizophrenia: Psychometric and quality assurance considerations

The first phase of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICs) initiative focused on the identification of cognitive constructs from human and animal neuroscience that were relevant to understanding cognitive deficits in schizophrenia, as well as promising task paradigms that could be used to assess these constructs behaviorally. The current phase of CNTRICs has the goal of expanding this initial work by including measures of brain function that can augment these behavioral tasks as biomarkers to be used in drug development processing. Here we review many of the psychometric issues that need to be addressed regarding the development and inclusion of such methods in the drug development process. In addition, we review quality assurance concerns, issues associated with multicenter trials, concerns associated with potential pharmacologic confounds on imaging measures, as well as power and analysis considerations. Although review is couched in the context of the use of biomarkers for treatment studies in schizophrenia, we believe the issues and suggestions included are relevant to the entire range of neuropsychiatric disorders as well as to a wide range of imaging modalities (i.e., functional magnetic resonance imaging, positron emission tomography, event-related potentials, electroencephalography, transcranial magnetic stimulation, near infrared spectroscopy, etc.) and are relevant to both pharmacologic and psychological intervention approaches.