Expert Consensus on Screening and Assessment of Cognition in Psychiatry

Abstract

During the past two decades, it has been amply documented that neuropsychiatric disorders (NPDs) disproportionately account for burden of illness attributable to chronic non-communicable medical disorders globally. It is also likely that human capital costs attributable to NPDs will disproportionately increase as a consequence of population aging and beneficial risk factor modification of other common and chronic medical disorders (e.g., cardiovascular disease). Notwithstanding the availability of multiple modalities of antidepressant treatment, relatively few studies in psychiatry have primarily sought to determine whether improving cognitive function in MDD improves patient reported outcomes (PROs) and/or is cost effective. The mediational relevance of cognition in MDD potentially extrapolates to all NPDs, indicating that screening for, measuring, preventing, and treating cognitive deficits in psychiatry is not only a primary therapeutic target, but also should be conceptualized as a transdiagnostic domain to be considered regardless of patient age and/or differential diagnosis.

The clinical characterization of the adult patient with depression aimed at personalization of management

“…Neurocognition may be disaggregated into executive functions, attention/concentration, learning/memory, and processing speed 98 . Executive functions can be further subdivided into the planning, initiation, sequencing, monitoring and inhibition of thoughts, moods and behavior 99 .…”

“…The prevalence, persistence, as well as the mediational effect of cognitive deficits on quality of life, psychosocial and workplace function, as well as response to treatment, suggests the need for systematic screening and measurement of neurocognition in adults presenting with clinically relevant depressive symptoms. The lack of a significant correlation between self-and objectively-measured cognitive functioning in depression indicates that the exclusive reliance on self-reported cognitive functions will insufficiently characterize the magnitude and complexity of cognitive disturbances in affected individuals 98 .…”

“…Psychotropic drugs that are known to interfere with cognitive functions should be discontinued. These include antidepressants with anticholinergic activity (e.g., tricyclic antidepressants), antipsychotics with significant anti-histamine properties, and benzodiazepines 98 . Moreover, recreational substances (e.g., cannabis) that interfere with cognition should be avoided.…”

“…Vortioxetine has been reported to improve executive functions, attention, learning/memory and processing speed 110 , while duloxetine has been found to have a favorable impact on learning/memory 111 . Psychostimulants, anti-inflammatory agents, and possibly ketamine may be pro-cognitive in select individuals 98 .…”

Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation

“…Other validated tools used to assess objective and subjective cognitive impairment in MDD include the Screen for Cognitive Impairment in Psychiatry (SCIP-D) and the Cognitive Complaints in Bipolar Disorder Assessment (COBRA) [70]. Assessment of cognitive impairment should be an integral part of the assessment and treatment of MDD [71,72].…”