Using the CANTAB to investigate cognitive deficits in ASPD

1. Using the CANTAB to investigate cognitive deficits in ASPD Executive functions

2. ASPD • Prevalent • 1-1.3% in GP • 47% in prisons • Poor prognosis • High societal costs • Resistance to treatment

3. Cognitive functions (Lezak et al., 2004) • Executive • Volition • Planning • Purposive action • Self-regulation • Effective performance

4. 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)

5. 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)

6. 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)

7. Method

8. 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

9. 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

10. The Executive CANTAB • Planning • Decision-making • Response control • Cognitive flexibility

11. Planning:Stockings of Cambridge (SOC) • Perfect solutions • Mean moves to solution

12. Executive CANTAB • Planning – SOC • Decision-making

13. Decision-making:Cambridge Gambling Task (CGT) • Quality of decision-making • Overall proportion bet

14. Executive • Planning – SOC • Decision-making – CGT • Response control

15. Motor/response control: InhibitionAffective Go/NoGo (AGN) • # Commission errors

16. Executive • Planning – SOC • Decision-making – CGT • Motor/response control – AGN • Cognitive flexibility

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

18. Cognitive flexibility:Attentional set-shifting (IED) • # Errors • Reversal • EDS

19. The Executive CANTAB • Planning – SOC • Decision-making – CGT • Motor/response control – AGN & IED • Cognitive flexibility – IED

20. Results

21. 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

22. Planning (SOC): Perfect solutions • ASPD & N-ASPD<HC but not different compared to each other.

23. Planning (SOC): Mean moves • ASPD & N-ASPD<HC but not different compared to each other

24. Decision-making (CGT): Qualityof decision-making • ASPD & N-ASPD<HC • Group x increment interaction

25. Decision-making (CGT): Qualityof decision-making • ASPD & N-ASPD<HC • Group x odds interaction

26. Response inhibition (AGN):Commission errors • ASPD>HC

27. Response reversal & Attentionalset-shifting (IED): # errors • Reversal: ASPD>N-ASPD & HC • EDS: ASPD>HC

28. 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)

29. Limitations • Unable to place N-ASPD • Effect of substance abuse • Confounding of offending • Limited power for AGN and particularly CGT

30. Thank you