THINC-it: what is it? John Harrison Alzheimer Center, VU University Medical Center, West London Mental Health Trust, Metis Cognition Ltd
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1 THINC-it: what is it? John Harrison Alzheimer Center, VU University Medical Center, West London Mental Health Trust, Metis Cognition Ltd
2 Disclosures Associate Professor in the Alzheimer Center at the VU University Medical Center, Amsterdam Honorary Professor at West London Mental Health Trust Principal Consultant at Metis Cognition Ltd Consulting roles (past 2 years) Research or grants Speaker Bureaus and CME activities Royalties Patents and share options AbbVie, Access to Quality, Amgen, Anavex, AstraZeneca, Avonex, Avraham, Axon, Axovant, Biogen Idec, Boehringer Ingelheim, Bracket, Cambridge Brain Sciences, Catenion, CRF Health, DeNDRoN, EnVivo Pharma, Enzymotec, epharmasolutions, Eisai, Eli Lilly, Forum Pharma, Fresh Forward, GfHEu, Heptares, Janssen AI, Johnson & Johnson, Kaasa Health, Kyowa Hakko Kirin, Lundbeck, MedAvante, Merck, MyCognition, Mind Agilis, Neurocog, Neurim, Neurotrack, Novartis, Nutricia, Orion Pharma, PharmaNet/i3, Pfizer, Prana Biotech, PriceSpective, Probiodrug, Prophase, ProStrakan, Regeneron, Reviva, Roche, Sanofi, Servier, Shire, Takeda, TCG, TransTech Pharma, Velacor Memorabel Lundbeck, Medscape Oxford University Press, Blackwell Publishers MyCognition, Neurotrack
3 Cognitive impairment in patients with depression 0.0 Detection task Timed chase GMLT ISLT GMLTdelay ISLTdelay SECT Verbal fluency Stroop test Magnitude of impairment relative to control (d) Clinically relevant -1.0 GMLT, Groton Maze Learning Test; ISLT, International Shopping List Task; SECT, Social Emotional Cognition Test; d, Cohen s d effect size Douglas KM et al. Br J Psychiatry 2011;198:115-22
4 Cognitive symptoms are common in depression Cognitive symptoms during depressive episodes Proportion of time spent without cognitive symptoms Residual cognitive symptoms in between depressive episodes Proportion of time spent without cognitive symptoms 94% Proportion of time spent with cognitive symptoms a 44% Proportion of time spent with cognitive symptoms a a According to Diagnostic and Statistical Manual of Mental Disorders 4th Edition: diminished ability to think or concentrate, or indecisiveness Prospective study (n=267) assessed 12 times over 3 years Conradi HJ et al. Psychol Med 2011;41:
5
6 THINC-it: a proposed solution 4 brief, reliable tests of Global cognition Attention Working memory Executive functions Non-expert administration Simple data reporting
7 PDQ-D5 The following questions describe problems people may have with their memory, attention or concentration. Please select the best response based on your experiences during the past 7 days During the past 7 days, how often did you Never in the past 7 days Rarely (once or twice) Sometimes (3 to 5 times) Often (about once a day) Very often (more than once a day) Have trouble getting things organised? Have trouble concentrating on what you were reading? Forget the date unless you looked it up? Forget what you talked about after a telephone conversation? Feel like your mind went totally blank? PDQ-D5, Perceived Deficits Questionnaire for Depression, 5-item version
8 Key domains: the atoms of cognition Episodic memory Working memory Executive functions Psychomotor speed Attention Social cognition
9 Digit Symbol Substitution Test (DSST) Wechsler D. Manual for the Wechsler Adult Intelligence Scale Revised. The Psychological Corporation, 1981; Taylor MA. The Fundamentals of Clinical Neuropsychiatry. Oxford University Press, 1999
10 Key domains: the atoms of cognition Episodic memory Attention Working memory Executive functions
11 Best-practice guidance for assessment of cognition TESTS MUST BE þ þ þ þ þ RELIABLE SENSITIVE VALID LONGITUDINAL USE CROSS CULTURAL USE Harrison J, Measuring the Mind: Detecting cognitive deficits and measuring cognitive change in patients with depression, in McIntyre RS (ed.), Cognitive Impairment in Major Depressive Disorder, Cambridge, Cambridge University Press, 2016
12 Identifying vs monitoring cognitive dysfunction Does the patient have cognitive dysfunction? X Has there been a change in cognitive function? X -3 SD -2 SD -1 SD 0 +1 SD +2 SD +3 SD -3 SD -2 SD -1 SD 0 +1 SD +2 SD +3 SD Abnormal Normal Decline Improve
13 Determining reliable change in individuals Requires the use of reliable tests Test score 2 Calculate test stability: within-subject standard deviation (WSD) Use WSD to plot the confidence interval around test score 1 No real change Test score 1 Test score 2 Confidence interval Mean Real change
14 Summary and recommendations l Cognitive function can be impaired in patients with MDD l Selected measures must be reliable, sensitive and valid l THINC-it has been designed to meet best practice guidance
15 Thank you
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