using the cantab to investigate cognitive deficits in aspd executive functions
TRANSCRIPT
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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