Evaluating cognitive dysfunction in major depressive disorder

Int J Methods Psych Res

Barry²,

Baune

et al. 2018

ObjectivesThere is a need for a brief, reliable, valid, and sensitive assessment tool for screening cognitive deficits in patients with Major Depressive Disorders. This paper examines the psychometric characteristics of THINC‐it, a cognitive assessment tool composed of four objective measures of cognition and a self‐rated assessment, in subjects without mental disorders.Methods N = 100 healthy controls with no current or past history of depression were tested on four sequential assessments to examine temporal stability, reliability, and convergent validity of the THINC‐it tests. We examined temporal reliability across 1 week and stability via three consecutive assessments. Consistency of assessment by the study rater (intrarater reliability) was calculated using the data from the second and third of these consecutive assessments.ResultsTest–retest reliability correlations varied between Pearson's r = 0.75 and 0.8. Intrarater reliability between 0.7 and 0.93. Stability for the primary measure for each test yielded within‐subject standard deviation values between 5.9 and 11.23 for accuracy measures and 0.735 and 17.3 seconds for latency measures. Convergent validity for three tasks was in the acceptable range, but low for the Symbol Check task.ConclusionsAnalysis shows high levels of reliability and stability. Levels of convergent validity were modest but acceptable in the case of all but one test.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stability, reliability, and validity of the THINC‐it screening tool for cognitive impairment in depression: A psychometric exploration in healthy volunteers

Int J Methods Psych Res

Barry²,

Baune

et al. 2018

“…On this theme, it is our contention that cognitive test selection should not be dogmatic, but instead based on two firm principles. First, cognitive measures should meet best practice guidance for test selection, such as those set out by Ferris et al (1997) and by Harrison (2016). Second, that the selected tests should successfully index the relevant cognitive domains.…”

Section: Discussionmentioning

confidence: 99%

Which Cognitive Domains are Improved by Treatment with Vortioxetine?

Lophaven

Olsen

2016

IJNPPY

Background:These post hoc analyses evaluated vortioxetine efficacy on cognitive dysfunction in depression. Data were from a double-blind, randomized, fixed-dose, placebo-controlled, 8-week depression study in adults aged 18–65 years (n = 602) with DSM-IV–defined major depressive disorder (MDD). Subjects were randomized (1:1:1) to vortioxetine 10mg/day or 20mg/day or placebo.Methods:Cognitive function was assessed at baseline, Week 1 (10mg/day only) and Week 8 using Digit Symbol Substitution Test (DSST) number of correct symbols, Rey Auditory Verbal Learning Test, Trail Making Test, Stroop test, Simple Reaction Time, and Choice Reaction Time tests. The cognition variables were standardized and used for constructing composite Z-scores for the cognitive domains of executive function, attention/speed of processing, and memory.Results:At Week 1, vortioxetine 10mg/day separated from placebo for attention/speed of processing (standardized composite Z-score = 0.21; p = 0.0238) and DSST number of correct symbols (standardized effect size = 0.18; p = 0.0458) and for executive function (standardized composite Z-score = 0.20; p = 0.0274). At Week 8, vortioxetine 10mg/day and 20mg/day separated from placebo for executive function and attention/speed of processing, with standardized composite Z-scores ranging from 0.35 to 0.49 (all p < 0.01). Standardized composite Z-scores for memory were 0.31 (p = 0.0036, 10mg/day) and 0.22 (p = 0.0349, 20mg/day). Standardized effect sizes for DSST were 0.51 (p < 0.0001, 10mg/day) and 0.52 (p < 0.0001, 20mg/day). Results are limited by the post hoc nature of the analyses and the absence of an active reference in the original study.Conclusions:Vortioxetine (10 and 20mg/day) had a multi-domain beneficial effect on cognitive performance, as evidenced by improvements in measures of executive function, attention/speed of processing, and memory. The effect on the DSST may be due to improvements in several cognitive skills.

“…1 In previous articles, we have offered best practice guidance on the assessment of cognitive status, which we define as a judgment regarding an individual's levels of performance on valid, reliable, and sensitive measures of various cognitive skills. 2 Such judgments are made in the context of expectations of performance based on comparison with normative data collected for cohorts appropriate for comparison, typically based on individuals of the same sex, with similar ages and levels of education. We have previously contrasted the question of determining impairment with the assessment of cognitive change, which we define as circumstances in which we wish to determine whether there has been a change in an individual's cognitive status.…”

Section: Introductionmentioning

confidence: 99%

Screening and measurement of cognitive impairment in psychiatry

2019

CNS Spectr.

A key message from the review of cognitive dysfunction in psychiatry published by Millan et al (2012) was not just that cognitive skills are often compromised in patients with psychiatric disorders, but that deficits in specific domains are common to a number of conditions. The review also highlighted that the magnitude of the observed deficits varied across disorders. A helpful element of the Millan et al study was the inclusion of a table in which the authors sought to convey the domains of cognition and a categorization of the magnitude of the observed deficits.In previous articles, we have considered best practice for the assessment of cognition. In these contributions, we have argued not for the use of specific tests, but instead for measures that meet acceptable standards of reliability, validity, and sensitivity. In the course of our discussions, we have included reference to test validity in the context of considering whether selected measures index appropriate domains of cognition. In this article, we begin with a brief discussion of the requirements for good test selection, especially with respect to issues of sensitivity, reliability, and validity. Thereafter the focus of this article is on the issue of domain validity. We will critically review the specification of the cognitive domains proposed by Millan et al, as well as those selected by authors of meta-analyses characterizing cognitive deficits in major depressive disorders. This focus is solely to make the discussion tractable, though we propose that the issues raised will be applicable across all psychiatric and neurological disorders.