Assessing cognition and cognitive impairment

Question 1

What do we study when we study cognition?

Answer 1

We study mental processes related to perceiving, attending, thinking, language, and memory, mainly through inferences from behaviour. Not constrained by knowledge about the brain.

Question 2

What is behaviour(ism)?

Answer 2

Study of objective, observable facts (e.g., stimulus-response relationships), and behaviours (e.g., choices made), which can be investigated through laboratory experiments under controlled conditions.

Question 3

What is neuropsychology?

Answer 3

The branch of science that studies the physiological processes of the nervous system and relates them to behaviour and cognition, in terms both of normal function and the dysfunctional processes associated with brain damage

Question 4

What areas does early psychosis research include?

Answer 4

All 3 of cognition, neuropsychology and behaviourism

Question 5

Why study and assess cognition in psychosis?

Answer 5

1) Alterations in these processes are a core symptom of psychosis, that often precedes psychosis-ones

2) Cognitive deficits are also predictive of clinical and functional outcomes

3) Cognitive impairment are not secondary to psychotic symptoms, negative symptoms, or socioeconomic status

4) Diagnosis: we need to know if symptoms are because of psychosis or other issues (maybe biological)

5) Treatment: show strengths and weakness to guide therapy, improve patient functioning

6) Progression: know who is more likely to progress into psychosis

Question 6

Why investigate cognition in FEP?

Answer 6

1. Explain the neurocognitive basis of psychosis/ psychotic symptoms Cognitive functions are thought to represent the intermediate mechanisms that link clinical symptoms to neurobiological deficits
2. We can observe and measure that cognitive impairment is affecting psychosis but we don’t know exactly what is their relationship? Causation? Correlation?
3. Predict prognosis and/ or treatment response in UHR and FEP

Question 7

What makes cognitive functions ‘easy’ to investigate?

Answer 7

They are straightforward to assess = they can be assessed repeatedly

Question 8

Practical advantages of ‘Cognition’ as prognostic/ predictive markers

Answer 8

1) They can be measures via non-invasive methods
2) We can use cognitive measures which we already know are connected to some neural processes allowing to speculate the neurobiological mechanisms involved
3) They can be conducted at any place
4) They are more cost effective than some biological measures

For pen and pencil:
1) Skills assessors can allow comparison between tests
2) They have neuropsychological test norms established
3) Many research papers are using them

Question 9

PAPER AND PENCIL ASSESSMENT OF COGNITION - DISADVANTAGES

Answer 9

1. Full cognitive assessment can be time-consuming + Shortened versions (often use in research) are less sensitive and might provide less accurate results
2. Have low ecological validity
3. Are often considered ‘boring’ and can make participants feel evaluated/ judged + prone to fatigue effect
4. Many validated tests require a trained specialists assessor
5. Patient’s performance might depend on their rapport with the assessor
6. Omit more novel cognitive tasks, performance on which has been linked to psychosis

==> They are being replaces with computer assessments

Question 10

Adv and disadv of computer testing

Answer 10

§ Computerized assessment = more engaging

§As the researcher does not directly assess participants, they can feel less judged

§ However, there is limited comparisons of paper and pencil vs computerized tests, in part because there are many different online batteries

§The clinical environment (testing rooms) and repetition of trials are, however, still unfavorable

§ In addition, it is still time- consuming for researchers to test well-powered samples

§ These limitations have helped to drive a rise in online cognitive testing

Question 11

Adv of online cognitive testing (4)

Answer 11

1. Testing at home on tech devices = limits ppts to those who use these (less old people)
2. Increased feasibility of longitudinal and large, well-powered samples
3. More representative samples = eliminates the limitations of travels, anxiety, co-morbidity)
4. Promotes methodological standardization = reproducibility

Especially true for groups with psychosis b.c. more anxiety, more comorbidity, less organisation

Question 12

Challenges of online assessment of cognition (5)

Answer 12

1. Participants have little incentive to lie online (on e.g., questionnaires) > insufficiently tested in psychosis
2. Attention and socially-desirable responding are comparable in online and lab-based testing > insufficiently tested in psychosis
3. Results of cognitive and perceptual tasks are similar in samples tested online and, in the lab > insufficiently tested in psychosis
4. The large sample size vastly outweighs the noise inherent in collecting data outside a controlled laboratory setting > very difficult to recruit and retain large samples in psychosis research
5. Online samples are more representative of the general population compared to laboratory samples, with respect to socioeconomic standing & geographic location> very difficult to recruit and retain large samples in psychosis research
6. Overall, response times measured online are reliable; there is, however, more variability in response times (Crump et al, 2013). == response-time is not an ideal outcome measure

Question 13

Why is online testing of cognition still in its infancy?

Answer 13

1. Online research of many cognitive domains remains underexplored = almost no standardized tests
2. Limited online research linking psychological illness with cognitive symptoms
3. Not a lot of online assessments of cognition for FEP and UHR

Question 14

What can improve cognitive testing?

Answer 14

Gamification of cognitive tasks can improve engagement and ecological validity