using the cantab to investigate cognitive deficits in aspd executive functions

Using the CANTAB to investigate cognitive deficits in ASPD

Executive functions

ASPD Prevalent

1-1.3% in GP 47% in prisons

Poor prognosis High societal costs Resistance to treatment

Cognitive functions (Lezak et al., 2004)

Executive Volition Planning Purposive action Self-regulation Effective performance

Planning & Effective performance Planning

ToL: Barkataki et al. (2005) SOC: Dolan & Park (2002) n-back: Kumari et al. (2006) Porteus mazes: Stevens et al. (2003)

Effective performance C/W Stroop: Barkataki et al. (2005)

Self-regulation (1) Productivity

COWAT: Stevens et al. (2003)

Motor regulation Response inhibition

Go/NoGo (Barkataki et al., 2008; Dolan & Park, 2002; Howard et al., 1997; Völlm et al., 2010)

Response delay (Swann et al., 2009)

Self-regulation (2) Cognitive flexibility

Response reversal IED: Dolan & Park (2002)

Attentional set-shifting WCST: Barkataki et al. (2005) & Stevens et al. (2003) IED: Dolan & Park (2002)

Alternating stimuli TMT-B: Stevens et al. (2003)

METHOD

Participants 102 male inpatients at the PDS, Arnold Lodge

Regional Secure Unit 17 excluded:

IQ<70 History of MMI & TBI

ASPD n=52; non-ASPD n=33 AGN & CGT

20 male ancillary staff IQ>70 Free from MMI & TBI Free from current/past substance abuse

Measures Patients: ASPD vs. non-ASPD

SADS-L/SCID-I:CV IPDE WAIS-III

Healthy controls MINI Quick Test IPDE Screening questionnaire

Interview if necessary

The Executive CANTAB Planning

Decision-making

Response control

Cognitive flexibility

Planning:Stockings of Cambridge (SOC)

Perfect solutions Mean moves to

solution

Executive CANTAB Planning – SOC

Decision-making

Decision-making:Cambridge Gambling Task (CGT)

Quality of decision-making

Overall proportion bet

Executive Planning – SOC

Decision-making – CGT

Response control

Motor/response control: InhibitionAffective Go/NoGo (AGN)

# Commission errors

Executive Planning – SOC

Decision-making – CGT

Motor/response control – AGN

Cognitive flexibility

Cognitive flexibility:Intra/extra-dimensional set-shifting (IED)

Cognitive flexibility:Attentional set-shifting (IED)

# Errors Reversal EDS

The Executive CANTAB Planning – SOC

Decision-making – CGT

Motor/response control – AGN & IED

Cognitive flexibility – IED

RESULTS

Sample characteristics Groups matched on:

IQ Basic education (yrs) Number of PDs other than ASPD Mood stabilisers

Age: non-ASPD>ASPD SRD: ASPD>non-ASPD Antidepressants: non-ASPD>ASPD

Planning (SOC): Perfect solutions

ASPD & N-ASPD<HC but not different compared to each other.

Planning (SOC): Mean moves

ASPD & N-ASPD<HC but not different compared to each other

1.8

2.8

3.8

4.8

5.8

6.8

2 3 4 5

Mov

es

Problem difficulty (minimum moves to solution)

ASPD

N-ASPD

HC

Decision-making (CGT): Qualityof decision-making

ASPD & N-ASPD<HC Group x increment interaction

0.75

0.8

0.85

0.9

0.95

1

Ascending Descending

Decis

ion

-mak

ing

Bet increment

ASPD

N-ASPD

HC

Decision-making (CGT): Qualityof decision-making

ASPD & N-ASPD<HC Group x odds interaction

0.650.7

0.750.8

0.850.9

0.951

9:1 8:2 7:3 6:4

Decis

ion

-mak

ing

Betting odds

ASPD

N-ASPD

HC

Response inhibition (AGN):Commission errors

ASPD>HC

Response reversal & Attentionalset-shifting (IED): # errors

Reversal: ASPD>N-ASPD & HC EDS: ASPD>HC

Results summary Non-characteristic deficits:

Planning Broadly agreed with Dolan & Park (2002)

Quality of decision-making

Characteristic deficits (?): Response inhibition Response reversal & Attentional set-shifting

Some agreement with Dolan & Park (2002)

Limitations Unable to place N-ASPD

Effect of substance abuse

Confounding of offending

Limited power for AGN and particularly CGT

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