Introduction to Cognition: Understanding the Complexity of the Human Brain and its Impact on Behavior

1. Understanding Cognition 16th September 2014, v1.0 draft

2. Aims of this resource This presentation provides an introduction to cognition, and has been developed as a resource for lecturers, for the teaching of undergraduate level students and below.

3. Summary of contents Derivation of the word ‘cognition’ and its definition Overview of the complexity of the human brain and the need for simplified scientific models Hierarchy: how behavior is governed by cognition, which is in turn dependent on brain circuitry and chemical neuromodulators Introduction to key brain regions and their connections Role of cognition across the lifespan, from the developing fetus, through to old age Cognitive deficits in different disorders as treatment targets • Examples: ADHD, obesity, depression, and dementia Overview of different cognitive functions and their measurement using computerized tests Try it yourself: interactive problem solving exercise for audience participation

4. What is cognition? Latin Latin Late Middle English cognition cognoscere cognitio- “get to know” “Mental processes relating to the acquisition, storage, manipulation, and retrieval of information”

5. What is cognition? Cognition has a physical basis in the brain However, the brain is complex! >100 billion nerve cells in the healthy human brain Each nerve cell connects with up to 10,000 other nerve cells To attempt to understand cognition, we rely on simplified scientific models, based on research work across species conscious awareness

6. Hierarchical understanding of behavior Behavior is underpinned by discrete cognitive functions, critical for day-to-day life Cognitive functions are regulated by discrete brain circuits and neurochemical transmitter systems Handful of brain chemicals play major roles in regulating cognition (“neuromodulators”): Dopamine Noradrenaline (norepinephrine) Serotonin Acetyl choline Opioid Glutamate GABA Behavior Cognition Brain circuits, neuromodulators Environment Genes

7. Cortico-striatal brain circuitry Distinct brain circuits have been identified regulating different aspects of behavior1 neuromodulators 1Arnsten et al., Bio Psych, 2011

8. Domains Sub-Domains Social cognition Responding to emotion-laden stimuli • Emotion Recognition • Identifying emotions in facial expressions • Emotional Bias • Information processing biases for positive/negative stimuli • Mental flexibility • Ability to adapt thinking and behaviour Planning and Strategic problem solving Executive function High level thinking and decision making • Working memory • Strategic thinking • Response inhibition • Ability to suppress inappropriate responses • Working memory • Holding and manipulating information in mind • Episodic memory • Associating an event with a place and time Memory Short-term or long-term storage of information • Recognition memory • Recognition of visual, object and spatial information • Sustained attention • Continuous performance and visual sustained attention. Attention Attending to specific information and ignoring others Psychomotor speed Detecting and responding to the presence of a stimulus • Choice Reaction Time • Reaction time, movement time and vigilance

9. Why is cognition important? Cognition changes over time, influenced by genes and the environment Environmental influences on cognition begin even before birth (e.g. fetal alcohol syndrome) Through infancy, childhood, and adolescence, cognitive functions develop Into middle and older age, some of these functions decline (vascular disease, loss of neurons) Regulates behavior across the lifespan

10. Why is cognition important? Multiple sclerosis Parkinson’s disease Drug and alcohol abuse Down’s syndrome Alzheimer’s disease Many of the biggest challenges facing the globe are conditions associated with core cognitive problems; these deficits represent key treatment targets for early intervention Understand and treat diseases Schizophrenia Autism ADHD Diabetes Pain Mood disorders

11. Why is cognition important? Example: attention deficit hyperactivity disorder (ADHD) ADHD is the most common psychiatric disorder in children, and often persists into adulthood Characterized by impulsivity, hyperactivity, and/or inattention Left untreated, associated with increased risk of unwanted long term outcomes1, such as: Worse educational achievement Driving accidents Unemployment Criminality and time in prison First-line medication treatments for ADHD reduces cognitive impairment by enhancing frontal lobe function, thereby improving symptoms2 1Shaw et al., BMC Med, 2012 2Chamberlain et al., Bio Psych, 2011

12. Why is cognition important? Example: obesity Ready access to cheap, high-fat, high-sugar food Obesity is one of the leading causes of early death across the world1 Safe, effective, medications to treat obesity are lacking Obesity is increasingly conceptualized in terms of reward-related brain circuitry (the “food addiction” model)2. This model has suggested novel treatment directions, which are now being investigated. 1World Health Organisation, 2014 2Chamberlain et al., in press, 2014

13. Why is cognition important? Example: depression Depression is the leading cause of disability worldwide1 Characterized by low mood, poor concentration, loss of interest in pleasurable activities, weight loss, reduced appetite, and poor sleep Patients experience a number of cognitive deficits, including decrements in memory, planning, and emotional processing Such patients show an attentional bias towards negative stimuli (such as towards unhappy faces or sad words) Anti-depressant medications and therapies shift attention away from negative stimuli towards more positive aspects of the environment2 1World Health Organisation, 2012 2Harmer, Curr Top BehavNeurosci, 2013

14. Why is cognition important? Example: dementia Dementia: a collection of disorders characterized by cognitive impairment and marked functional decline Dementia is one of the leading causes of disability worldwide: knock-on effects on caregivers, families, and society1 With an ageing population, dementia as a problem will continue to grow The search is on for treatments capable of slowing or even reversing dementia related cognitive decline Initial studies have found that cognitive tests can distinguish between elderly individuals likely to develop dementia, and the ‘worried well’2 1World Health Organisation, 2012 2Blackwell et al., Dement GeriatrCogn Dis, 2004.

15. Types of cognition Cognition can be considered in terms of Intelligence Quotient (IQ): a composite measure of intellect, comparing summative measures to the background population However, cognition is not unitary: various cognitive functions (or cognitive ‘domains’) have been identified These functions overlap to some extent, and operate synergistically Modern cognitive testing batteries are able to tease apart distinct cognitive functions, dependent on different brain circuits and neuromodulatory systems

16. Types of cognition Core examples

17. Types of cognition Core examples

18. Methods of cognitive assessment Cognitive assessment initially relied on pen/paper tests, before the advent of computer technology Computerized assessment is now the gold standard, with potential advantages: - Objectively tease apart distinct cognitive abilities - Automated data collection and processing; quality control - Accuracy (such as in measurement of response speeds) - Can be made less reliant on complex motor skill; special interface technology - Translational: neuroimaging, animal models Development of objective computerized tests

19. Cambridge Neuropsychological Test Automated Battery (CANTAB) Comprehensively captures all important cognitive domains Established validation including excellent psychometric properties Proven sensitivity to drug and disease effects where cognition is a factor Comprehensively validated by >30 years of global translational research, and >1300 peer-reviewed papers Used in over 700 academic research institutions worldwide Extensive normative and clinical data

20. Validated touchscreen tests Reaction Time Verbal Recall Emotion Recognition Compulsivity Spatial Working Memory Visual Information Processing Paired Associates Learning Measuring effects across cognitive domains Psychomotor speed Attention Memory Executive function Social cognition Applied to research of disorders and syndromes

21. CANTAB Cognitive Tests and Brain Regions Delayed Matching to Sample Rapid Visual Information Processing Affective Go/No-go Emotion Recognition Test Reaction Time Spatial Working Memory Stockings of Cambridge Attention Switching Task Pattern or Spatial Recognition Memory Paired Associates Learning Verbal Recall / Recognition Memory Stop Signal Task

22. Try it yourself! Executive planning test You will see a pattern of colored balls, hanging in stockings (or socks), at the top and bottom of the screen. The idea is to make the bottom arrangement look like the top.

23. Try it yourself! Executive planning test COPY THIS

24. Try it yourself! Executive planning test COPY THIS

25. Try it yourself! Executive planning test COPY THIS

26. CANTAB in translation Executive planning test The CANTAB executive planning test is sensitive to cognitive impairment in depression. Also, when used in the brain scanner (functional magnetic resonance imaging), it detects abnormal frontal cortex activation in depression, which normalizes with treatment1 * p < 0.05 abnormal brain activation 1van Tol et al., Acta Psych Scand, 2011; see also Fitzgerald et al., Hum Brain Mapp, 2008

27. Summary Understanding cognition Cognition: mental processes relating to the acquisition, storage, manipulation, and retrieval of information Important through life, in health and disease, across the age span: we touched upon four examples • ADHD • Obesity • Depression • Dementia Cognition can be separated into multiple distinct functions, dependent on particular brain circuits and neuromodulators (e.g. dopamine, serotonin, noradrenaline) Computerized cognitive testing has been developed and validated: advantages over older ‘pen/paper’ methods Additional resources available from Cambridge Cognition: ‘Assessing cognition’ slide pack ‘Cognitive impairment’ slide pack Research funding and grant application guide

28. UK Headquarters Cambridge Cognition  Tunbridge Court, Tunbridge Lane Bottisham, Cambridge CB25 9TU  UK Tel+44 (0)1223 810700 Emailinfo@camcog.com US Office 2750 Rasmussen RoadPark CityUtah 84098USA Tel +1 (801) 891-6155Emailinfo@camcog.com