CANTAB for cognitive screening in a young adult mental health unit

What is the rationale behind your study?

Over 75% of all serious mental health illnesses commence before the age of 25. This period has been described as critical in terms of intervention and understanding illness trajectory (Scott et al, 2012). Furthermore, there is growing evidence to support the need for personalised intervention and feedback in the early stages of major psychiatric illness, as well as the importance of intervention that focuses on functioning and integrated information to increase the chances of positive outcomes (O’Dea et al, 2016).

The aim of our study was to gauge feasibility, protocol and potential effects of feedback interventions and cognitive screening in an inpatient unit (Tickell et al, 2018).

 

Can you tell us more about your study design? 

Inpatients admitted to Uspace (an inpatient young adult mental health unit for 16-30 year olds) were eligible for participation, with all assessments completed on a touch-screen device (iPad), including:

• Cognitive screening with CANTAB, to assess neurocognitive domains such as memory, attention and psychomotor speed
• Standardised questions on patient’s subjective insight of any cognitive impairments
• A self-report questionnaire on levels of distress, onset of symptoms, sleep patterns, demographics, substance use, etc.

Following completion of the study assessments, inpatients received feedback (a 15-20 minute session with clinician and researcher) about their results, possible interventions, and further assessment, management and planning.

 

What are your main study findings?

The study demonstrated the effectiveness of cognitive screening and feedback as standard clinical care in an inpatient unit (Tickell et al, 2018). 

The study also demonstrated a classification of two neurocognitive clusters (Tickell et al, 2018); differentiated by more severe inpatients having impairments in sustained attention and memory comparable to higher levels of anxiety, and the less severe cluster showing the most impaired attentional switching.

All inpatients demonstrated impaired performance on at least one neurocognitive task, however we can also see differences based on symptom severity (i.e. more severe clinical presentation correlated with more severe neurocognitive global impairments) (Tickell et al, 2018), in line with previous studies from our team (Hermens et al, 2011).

These findings support the notion of neurocognitive profiles being important in understanding clinical phenotypes (Lee et al, 2015), and neurocognitive performance being directly correlated to longitudinal outcomes (for example, long-term functioning and diagnostic course) (Lee et al, 2015; Lee et al, 2013; Tickell et al, 2017).

 

What is the impact of your study for patients and clinicians? 

The ability to easily test a patient’s current cognitive and functioning abilities has informed further assessment, changes in medication, interventions in education facilities, and confirmation of patients’ self-reported decline.

The overall implications of this study have led to changes in protocols, clinicians now having direct access to referring patients to have neurocognitive screening completed quickly and easily during their hospitalisation, psychoeducation for inpatients, and further planning and treatment.

 

Why did you choose CANTAB for your study?

Our research team chose CANTAB due to our long history with Cambridge Cognition CANTAB, and use in previous large longitudinal studies at our original study site (Brain & Mind Centre, University of Sydney). Thus, we have had a large amount of experience using these reliable and valid tests.

Implementing a new standard of clinical care in an inpatient unit, we were confident that CANTAB would be an iPad assessment platform that would prove to be easy to use, detailed, and informative for all involved. The logistics of working within the constraints of a hospital setting with current inpatients are many, as such we were able to carefully handpick the cognitive domains and assessments based on years of research, which matched with CANTAB’s offering.

CANTAB, with largely culture- and language-independent tests, allows for the collection of large amounts of adaptable research data, and immediate data generation.

Interestingly, we have had a very positive reaction from inpatients about this study. They often speak with each other about their experiences, and a lot of the inpatient enjoy the battery itself, and are extremely fascinated in the psychoeducational groups that correspond. We have also had a positive reaction from hospital staff and clinicians that has only grown stronger. The hospital staff has also been interested in completing demonstration versions of the battery themselves, and have enjoyed looking at various areas of their cognition and results.

 

What are the next steps for your research?

The main goal of this research is the implementation of an automated test battery as standard clinical care in an inpatient unit, as well as furthering clinician-patient collaboration, management and planning, through the use of personalised feedback. This study is part of a larger multimodal assessment of personalised interventions in youth mental health, and is on-going. Our team is dedicated to using new and emerging technologies, as well as investigating early interventions.

 

Find out more 

References

Hermens, D.F., Redoblado Hodge, .A., Naismith, S.L., Kaur, M., Scott, E., Hickie, I.B., 2011. Neuropsychological clustering highlights cognitive differences In young people presenting with depressive symptoms. J Int Neuropsychol Soc 17.

Lee, R.S., Hermens, D.F., Naismith, S.L., Lagopoulos, J., Jones, A., Scott, J., Chitty, K.M., White, D., Robillard, R., Scott, E.M., Hickie, I.B., 2015. Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study. Transl Psychiatry 5, e555.

Lee, R.S., Hermens, D.F., Redoblado-Hodge, M.A., Naismith, S.L., Porter, M.A., Kaur, M., White, D., Scott, E.M., Hickie, I.B., 2013. Neuropsychological and socio-occupational functioning in young psychiatric outpatients: a longitudinal investigation. PLoS One 8, e58176.

O'Dea, B., Lee, R.S., McGorry, P.D., Hickie, I.B., Scott, J., Hermens, D.F., Mykeltun, A., Purcell, R., Killackey, E., Pantelis, C., Amminger, G.P., Glozier, N., 2016. A prospective cohort study of depression course, functional disability, and NEET status in help-seeking young adults. Soc Psychiatry Psychiatr Epidemiol 51, 1395-1404.

Scott, E.M., Hermens, D.F., Glozier, N., Naismith, S.L., Guastella, A.J., Hickie, I.B., 2012. Targeted primary care-based mental health services for young Australians. The Medical Journal of Australia; 196.

Tickell, A.M., Scott, E.M., Davenport, T., Iorfino, F., Ospina-Pinillos, L., Harel, K., Parker, L., Hickie, I.B., & Hermens, D.F, 2018. Neurocognitive clusters: A pilot study of young people with affective disorders in an inpatient facility. Journal of Affective Disorders (In Press).

Tickell, A.M., Lee, R.S.C., Hickie, I.B., & Hermens, D.F. (2017). The course of neuropsychological functioning in young people with attenuated vs discrete mental disorders. Early Interv Psychiatry. doi:10.1111/eip.12499

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