Validation of the Computerized Neurocognitive Battery in individuals - - PowerPoint PPT Presentation

Validation of the Computerized Neurocognitive Battery in individuals with 22q11.2 deletion syndrome (22q11DS) Ronnie Weinberger, PhD

• Prof. Doron Gothelf, MD

Sheba Medical Center Tel Aviv University

Big Thanks

Raquel Gur Ruben Gur

Children's Hospital of Philadelphia, Penn University

Main Ideas

• The importance of cognition in everyday

functioning

• Results from cognitive studies with individuals

with 22q11DS

• The Computerized Neurocognitive Battery

(CNB)

Most of individuals with 22q11DS cope with learning disabilities

Real world functioning Complex problem soloing, planning,

• rganization

Working Memory Inhibition Processing Speed Non-cognitive factor (e.g. motivation)

Basic cognition

The Cognitive Profile of Select Psychiatric Disorders

Attention Deficit and Hyperactivity Disorder

Deficits in attention, global memory, working memory, speed of processing

Depression

Cognitive deficits may range from mild to severe. Global deficits in attention, memory, speed of processing

Anxiety Disorder

Attention processing are captures by negative emotions, thereby slow down or impaired overall cognitive performance

Everyday functioning

Neuro- Cognitive Deficits in Schizophrenia

Verbal Fluency Reasoning/ Problem solving WM Social Learning Verbal Memory Visual Learning Attention Sponheim et al, 2010/ Schimansky et al, 2010/ Bowie et al 2006

Cognitive Deficits in Psychosis

Antshel, K. M., Fremont, W., Ramanathan, S., & Kates, W. R. (2016).

Traits that are preexisting and raise the risk for psychosis Associated with the

• nset of

psychotic symptoms

Frequent neurocognitive evaluations in 22q11DS

Bassett, A. S., et al (2011).Practical guardedness for managing patients with 22q11.2 deletion syndrome.

Studies recommendation

Limitations of Previous Studies

• IQ test is essential for later diagnosis-

BUT it has limitations

• Little used a comprehensive computerized

battery adapted for use in 22q11DS The field should place emphasis on early identification and intervention

Neurocognitive evaluation should be…

Can be used periodically Thorough Can be used frequent if needed Reliable Comprehensive Efficient

The Penn Computerized Neurocognitive Battery (CNB)

• Develop in Penn university
• Previous used in schizophrenia studies, and

was adapted for 22q11DS research

• It takes ~1 hour to administer, by trained staff
• CNB performance is compared to

chronological age, based on typically developed controls

• Continuous Performance Test
• Conditional Exclusion
• Letter-N-back

Executive Function

• Line Orientation Test
• Matrix Analysis

Complex Cognition

• 5 Emotion Recognition
• Pair of faces, which one is older
• Pair of faces with emotions, which one is more intense

Social Cognition

• Words Recall
• Faces Recall
• Visual Object learning

Episodic Memory

• Click a moving green square that gets smaller
• Spacebar tapping

Praxis Speed

Computerized Neurocognitive Battery

• To monitor the attention functions

Problems in attention

• Visual memory may be a relative

strength Assess memory

• John seems to perform better when

the instruction is clear and familiar Problems in abstract tasks

• Escorting John through

interpersonal relationships and in complex social situations Problems in social cognition

• Ensure frequent repetition and

reinforcement of information Problems with following new rules

Examples for clinical recommendations

=IQ Score?

Demographic Characteristics

356 n 22.6±8.3 Age (mean) 8.06-52.44 Age range 51/49 Male / Female (%) 77.03±12.05 FSIQ

CNB - IQ

77,03 88,45 40 50 60 70 80 90 FSIQ GNP

IQ CNB

Neurocognitive evaluation should be…

Can be used periodically Thorough Can be used frequent if needed Reliable Comprehensive Efficient

Conclusions

• The CNB can be used to assess efficiently

neurocognitive performance in individuals with 22q11DS

• The CNB can obtain a reliable proxy of

general intelligence

SIPS

Risk for subthreshold psychotic symptoms by association to neurocognitive abilities

p WS 22q11DS

.008 0.26 0.74 GNP (general neurocognitive performance ) .040 0.37 0.70 Executive Function .050 0.38 0.67 Social Cognition

Adjusted probability for the emergence of baseline negative subthreshold psychotic syndrome

Neurocognitive trajectories and effect

• f medication in 22q11DS
• Deficits in GNP predicted negative

subthreshold psychotic syndrome in 22q11DS

• There was a significant progress for

individuals with 22q11DS under psychiatric medication Also, medication treatments is a significant predictor for GNP change.

Conclusions

• The CNB is a potentially a useful tool for

identifying cognitive deficits associated with psychosis disorders in 22q11DS.