The Screen for Cognitive Impairment in Psychiatry … · The Screen for Cognitive Impairment in Psychiatry ... LD, Long Delayed; RAVLT, Rey Auditory Verbal Learning Test; SD, Short

The Screen for Cognitive Impairment in Psychiatry

Dr. Scot E. PurdonClinical Professor & Director of the BSRU, University of Alberta – Department of Psychiatry

Clinical Neuropsychologist & Professional Manager, AHE Neuropsychology, AHSClinical Co-Director, Edmonton Early Psychosis Intervention Clinic (EEPIC), AHS

Alberta Hospital Edmonton - Neuropsychology

Institut Universitaire en Santé Mentale de Montréal

11 Mars 2016

2

Disclosures

Dr. Purdon has gratefully received consulting fees, grants, speaking honoraria and/or royalties from:

Eli LillyJanssen Pharma

Astra-ZenecaSandozMerck

LundbeckPfizer

TEA Endiciones

The Screen for Cognitive Impairment in PsychiatryPart 1 – Developmental Rationale and Sensitivity





10 Mars 2016

4

Objectives

• Review instruments for quantification of cognitive deficits in psychiatry and sensitivity to change with treatment.

• Introduce the SCIP (Screen for Cognitive Impairment in Psychiatry).

• Present SCIP deficits associated with serious mental illness, and the effects of substance use and abstinence.

• WORKSHOP: Case Presentation of the SCIP.

5

Objective Measurement of Cognitive Deficits in Psychiatry

6

Neuropsychological Tests & Domains

CVLT-II, California Verbal Learning Test 2nd Edition; HVLT, Hopkins Verbal Learning Test; ID / ED, Intradimensional / Extradimensional; LD, Long Delayed; RAVLT, Rey Auditory Verbal Learning Test; SD, Short Delayed; SRT, Selective Reminding Test

Lee RS et al. J Affect Disord 2012;140:113-24

Spatial span back-wards

Rey Complex

Figure Test

30-min Delayed Recall Trail Making

Test B

Letter and SemanticFluency

Wisconsin Card Sorting Test

Psycho-motor speed

Verbal learning

and memory

Visuallearning

and memory

Verbalfluency

Cognitive flexibility

7

Standardization

8

Standardization of a Patient’s Score

• One common metric (Z-score) for all tests (M=0, SD=1).

• Subtract the Normative Mean from a patient’s score and divide by Normative Standard Deviation (e.g. (X-M)/SD).

• IQ example (M=100, SD=15):• your score (145) .• minus the Normative Mean: 145-100= 45.• divided by the Normative SD: 45/15=3.• An IQ of 145 = Z score of 3 which is > 99th %ile.

9

Standardization for Group Comparisons

• A common metric for Effect Size: Cohen’s d (M=0, SD=1).

• Subtract control sample M from patient sample M, and divide by SD (pooled).

• IQ example:• Patient Group: M=85, SD=15.• minus a Control Group: 85-100 = -15.• divided by the Pooled SD: -15/15 = -1.• Cohen’s d=1 (1 SD separates the patients from the controls). • 1SD = approximately the 16th percentile.

10

Cognitive Change to Antipsychotic MedsClozapine

-2.5

-2

-1.5

-1

-0.5

0

Attention Verbal Visual Learning Executive

Baseline

Clozapine

Olanzapine

-2.5

-2

-1.5

-1

-0.5

0


Baseline

Olanzapine

Risperidone

-2.5

-2

-1.5

-1

-0.5

0


Baseline

Risperidone

Quetiapine

-2.5

-2

-1.5

-1

-0.5

0


Baseline

Quetiapine

Purdon (1996). Schizophrenia Research, 12: 148.

Purdon et al. (2001). Journal of Psychiatry & Neuroscience, 26(2): 137-149.Purdon et al. (1998). Canadian Psychology, 39: 31.

Purdon et al. (2000) Archives of General Psychiatry, 5: 249-258.

Attention – Verbal – Visual – Learning – Executive Attention – Verbal – Visual – Learning – Executive

Attention – Verbal – Visual – Learning – Executive Attention – Verbal – Visual – Learning – Executive

11

Persistent Cognitive Deficits in Euthymic MDD

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Attention WorkingMemory

ProcessingSpeed

Verbal Memory Executive Overall

Bora et al. (2013). Cognitive impairment in euthymic MDD: a meta-analysis. Psychological Medicine 43, 2017–2026.

Domain Studies MDD (n) Tests

Attention 10 228 CPT, Cancellation, SRT

Working memory 14 475 Digit span, letter number sequencing, DMTS, reading span, digit sequencing

Processing speed 20 647 TMT-A, DSST, Verbal Fluency, Reaction Time

Verbal Memory 15 428 RAVLT, CVLT, other list learning tasks, logical memory

Executive 24 714 WCST, ToL, Hanoi tower, IDED, BADS, TMT-B, Stoop

Global 30 895

Effect Size (d)

12

Cognitive Domains Relevant to PsychiatryDOMAIN SUBJECTIVE OBJECTIVE

Attention• Have trouble concentrating on

things like watching a television program or reading a book (PDQ Attention).

• WAIS-IV Digit Span• WAIS-IV Arithmetic, Letter-Number Sequencing.• WMS-IV Visual Span.• SCIP Consonant Trigrams.

Memory

• Forgot the date, unless you looked it up (PDQ Prospective).

• Forgot what you talked about after a telephone conversation (PDQ Retrospective).

• Rey Auditory Verbal List Learning (RAVLT)• Other VLLT (CVLT, HVLLT, BSRT)• WMS-IV Logical Memory.• Non-Verbal Tests (ROCFT, WMS-IV Visual

Reproduction and Memory for Designs).• SCIP Verbal List Learning Test

Psychomotor speed

• Moving or speaking more slowly so other people would have noticed (PHQ-9, though confounded with ‘the opposite, moving or speaking faster’).

• WAIS IV Coding (aka. DSST)• Serial Response Tests (e.g. CPT)• Trail Making A• Trail Making B (exe)• SCIP Visuomotor Tracking Test

Executive function

• Have trouble getting things organized

• Feel like your mind went totally blank (PDQ Planning and Organization)

• Stroop Color Word Identification Test• Wisconsin Card Sorting Test (WCST)• Tower Tests (London, Toronto, etc.)• SCIP Verbal Fluency Test

13

Objective Cognitive Measures (OCM):Tests for Clinical Practice

14

Objective Cognitive Measurement - Example 1: Attention (WAIS-IV Digit Span Forward and Backward)

Wechsler D (2008). Wechsler Adult Intelligence Scale—Fourth Edition. San Antonio, TX: Pearson.

15

Objective Cognitive Measurement - Example 2: Rey Auditory Verbal List Learning Test (RAVLT)

Rey. L’Examen Clinique en Psychologie. 1964; Lezak. Neuropsychological Assessment. 1983

RAVLT PROCEDURE:-15 common nouns (A) presented one per second.- Subject asked to repeat list after each presentation.- Repeat (typically 5 times). - An interference list (B), a delayed recall trail (A), and recognition.

16

Objective Cognitive Measurement - Example 3: Psychomotor Speed with the DSST

• The strategy to solve the DSST consists of sequential

encoding and retrieval of numbers and matching

symbols

• The score is the number of correct number–symbol

matches (maximum number of correct, 133)

• Time given is 90 seconds

1. First, the subtest (the squares to the left of the heavy

black line) is encoded in short-term memory and

temporarily stored (the test should not proceed until the

patient has clearly understood the subtest)

2. Then the number is repeatedly retrieved and compared

with the numbers of the key grid

3. Once the number is recognised, the matching symbol is

encoded and attention is turned to the test session, the

symbol retrieved from the short-term memory and

copied below the number

• Incidental memory

• Perceptual organisation

• Visuomotor coordination

• Selective attention

• Ability to filter out irrelevant information (e.g., symbols

which may look alike)

Wechsler. Wechsler Adult Intelligence Scale. 1997

17

Objective Cognitive Measurement - Example 4: Executive Skills with the Stroop Interference Test

Congruent Stroop

Incongruent Stroop

STROOP(a measure of mental

[attentional] vitality and cognitive flexibility/response

inhibition )

• 50 words for each test• Time to complete (max 4 min)

Executive function

(verbal fluency, set-shifting, planning, response inhibition,

working memory)

18

Cognitive Deficits in Major Depressive Disorder

Lim et al., 2013 Int Psychoger., 25(9): 1543-5722 trials: participants in 14 trials were drug-free for at least 2 weeks; participants in 8 trials were taking medication

Patients performing worseControls performing worse

Trail Making Test A

Digit-Symbol Substitution Test

Stroop Test

Trail Making Test B

Immediate Verbal Memory

Delayed Verbal Memory

-2 -1 0 1 2

Std. mean differenceIV, random, 95% CI

Cog

nitiv

e Te

st

0.39 [-0.34, 1.13]

0.67 [0.18, 1.15]

0.83 [-0.49, 2.16]

0.84 [0.51, 1.17]

0.53 [0.15, 0.9]

0.48 [0.17, 0.79]

Std. mean differenceIV, random, 95% CI

(absolute value)

19

Sensitivity to Change in MDD

O’’’’Brien et al. (2004)

2

4

6

8

10

Baselne 6 Months

Dig

it S

pan

-Bac

kwar

ds

Assessment

Working Memory

HC (ES=0.44)

MDD (ES=0.58)

O’’’’Brien et al. (2004)

McIntyre et al. (2014)

Herrra-Guzman et al. (2010)

Memory

25

30

35

40

45

50

Baseline 6 Months

Assessment

RAV

LT HC (ES=0.30)

MDD (ES=0.49)

Executive

25

30

35

40

45

50

Baseline 6 Months

Assessment

Stro

op Inh

ibiti

on

HC (ES=0.15)

MDD SSRI(ES=0.45)

MDD SNRI(ES=0.39)

Processing Speed

30

35

40

45

50

55

60

65

70

75

80

Baseline 8 weeks

Assessment

Dig

it S

ymbo

l Sub

stitu

tion

Tes

t

HC from Manual (ES=0.55)

MDD placebo (ES=0.34)

MDD Vortioxetine 10 mg(ES=0.69)

MDD Vortioxetine 20 mg(ES=0.69)

O’Brien JT et al. AJP 2004; 161:2081–2090. Herrera-Guzmán I et al. Psychiatry Res. 2010 May 30;177(3):323-9. McIntyre RS et al. Int J Neuropsychopharmacol 2014; Apr 30.

Digit Span Backwards

Stroop

Rey Auditory Verbal Learning (RAVLT)

Digit Symbol Substitution (DSST)

20

The Screen for Cognitive Impairment in Psychiatry

21

The Screen for Cognitive Impairment in Psychiatry: A brief tool for bedside evaluation of cognitive im pairment in MDD, SC, and BPD.

22

SCIP Components

TEST Abbrev. Domain Origin Time (mins)

Verbal Learning Test –Immediate

VLT_I Declarative Memory Rey’s AVLT 4

Working Memory Test WMT Working Memory Peterson’s CTT 3.5

Verbal Fluency Test VFT Executive(speed and inhibition)

Benton’s COWA 2.5

Verbal Learning Test –Delayed

VLT_D Declarative Memory Rey’s AVLT 2.5

Visuomotor Tracking VMT Executive(speed and translation)

Purdon’s Coding 2.5

23

SCIP Components

TEST Abbrev. Domain Origin Time (mins)

Mémoire verbale: Apprentissage

MVA Declarative Memory Rey’s AVLT 4

Mémoire de Travail: rappel de trigrammes

MdT Working Memory Peterson’s CTT 3.5

Fluidité Verbale FV Executive(speed and inhibition)

Benton’s COWA 2.5

Rappel Verbal Différé RVD Declarative Memory Rey’s AVLT 2.5

Capacités Visuomotrices CV Executive(speed and translation)

Purdon’s Coding 2.5

24

SCIP in schizophrenia (SC) and Bipolar Disorders (B PD)in Canada and Spain

-3

-2.5

-2

-1.5

-1

-0.5

0

VLT_I VMT VFT PST VLT_D ALL

IP BPD CANADA

IP SCZ CANADA

-3

-2.5

-2

-1.5

-1

-0.5

0

VLT_I VMT VFT PST VLT_D ALL

SCHIZ SPAIN

BPD SPAIN

�VLT_I = Verbal List Learning Test. VMT = Visuomotor Tracking Test

�VFT = Verbal Fluency Test. PST = Psychomotor Speed Test

�VLT_D = Delayed List Recall. All = Average

Purdon (2005). The Screen for Cognitive Impairment in Psychiatry. Edmonton, AB, Canada: PNL Inc.

Purdon SE, Pino O, Guilera G. (2007) Cross-cultural comparisons of cognitive impairment in bipolar I disorder. JINS.

25

OTT et al. (2016). Screening for cognitive dysfunction in unipolar depression. Journal of Affective Disorders, 190, 607-615.

Tourjman, Potvin, Purdon, Djouni (2014). Subjective cognition across psychiatric disorders. 12th World Congress of Biological Psychiatry.

Cognitive Impairment in Major Depressive Disorder i n Denmark and Quebec

Verbal List Learning Verbal Fluency Psychomotor SpeedWorking Memory Delayed List Learning

Effect Size (Cohen’s d)

SCIP-D in MDD 100% in remission (n=53), age 42+/- 12, Education=15 years, VIQ=115 vs HC (n=103) age 35, Educ=15, VIQ=115.SCIP-F in MDD 25% in remission (n=40) Age=51+/-11, Education=15; vs HC (n=35), Age=30+/-8, Educ=17 years.

-4

-3,5

-3

-2,5

-2

-1,5

-1

-0,5

0

0,5

VLT_I WMT VFT VLT_D VMT

SCIP-D

SCIP-F

26

Lifetime Prevalence of Serious Mental Illness (SMI) in Substance Use Disorde rs (SUD)

% o

f SU

D R

espo

nder

s w

ith S

MI

Statistics Canada, Canadian Community Health Survey – Mental Health, 2012.

0

5

10

15

20

25

30

35

2012 CDN Alcohol Marijuana Cocaine

Schizophrenia

Affective Disorders

Anxiety Disorders

27

Substance Use Disorders are Related to Outcome

• Poorer response to treatment1

• Higher hospitalization rates due to relapses1,2

• Increased physical comorbidities such as HIV, hepatitis, and other infections2

• Increased risk of suicidal behavior, aggression, violence, victimization, homelessness, and incarceration3

• Increased services use and cost2

• More severe clinical presentation including more cognitive impairment?

1. Adams DH, J Dual Diagnosis. 2007;3:73-84. 2. Green AI. Am J Psych. 2007;164:402-408. 3. Buckley PF. J Clin Psych. 2006;67:5-9.

AHE Neuropsychology

28

• n=377 (males=294, females=83).

• SCID-IV-TR Diagnosis:• 171 Schizophrenia Spectrum• 75 Psychosis NOS n=75• 65 Substance Induced Psychosis, Mania, or Affective Disorder• 57 Affective Disorders (MDD=29, BPD n=28)• 9 Anxiety Disorders

• Age: 21.78 (4.59) years.

• Education: 12.11 (2.18) years.

• Estimated premorbid Intellect (PPVT-III): 99.08 (16.09).

Drug Use and Cognitive Impairment in a Young Adult S ample

Purdon SE (unpublished clinic intake data from AHE Neuropsychology). University of Alberta HREB approved on 20-Apr-2016 (Pro00039220).

29

Cognition and Lifetime Cannabis Use

-2,50

-2,00

-1,50

-1,00

-0,50

0,00zvlti_t1 zctt_t1 zvft_t1 zvltpd_t1 zvmt_t1

LIFETIME NO

LIFETIME YES


Purdon SE (unpublished clinic intake data from AHE Neuropsychology extracted 14 Jan 2016) with HREB approval (Pro00039220) 20-Apr-2016.

Z relative to HC norms

30

Cognitive Deficits in First Episode Psychosiswith self-reported Cannabis (none, abstinent, ongoi ng)

Z Scores(SD below Healthy Controls (Z=0)


-2,50

-2,00

-1,50

-1,00

-0,50


CAN < 6m

CAN > 6m

Never


Last used Cannabis

31

-2,50

-2,00

-1,50

-1,00

-0,50


Cannabis Absent (n=112)

Cannabis Detected (n=39)

Cognitive Deficits in Young Adults with Positive Ur inary Cannabis


Standardized Z


32

-1,60

-1,40

-1,20

-1,00

-0,80

-0,60

-0,40

-0,20

0,00SC PSYCH NOS SUD AFF

SCIP by Diagnostic Group

Cognitive Impairment by Diagnosis and Abstinence

-1,60

-1,40

-1,20

-1,00

-0,80

-0,60

-0,40

-0,20

0,00< 6 m > 6 m Never

SCIP by self-reported Last Use of Cannabis


SC = Schizophrenia SpectrumPsych NOS = Psychosis Not Otherwise SpecifiedSUD = Substance Use Disorders AFF = Affective Disorders (MDD and BPD)

33

-2,00

-1,80

-1,60

-1,40

-1,20

-1,00

-0,80

-0,60

-0,40

-0,20

0,00SC PSYCH NOS SUD AFF

Never

> 6 m

< 6 m

SCIP by Diagnosis and Last Use of Cannabis

Schizophrenia Psychosis NOS SIP, SIM, SIB Affective


Last used Cannabis

34

Urinary Cannabis by Self-Reported Abstinence

Proportion of sample with a Positive Urinary Cannabis Result

Self-Reported Last Use of Cannabis

0,00

0,10

0,20

0,30

0,40

0,50

0,60

0,70

0,80

0,90

< 24 hrs 2 to 14days

2 to 4 wks 1 to 12months

> 1 year Never


35

Cognitive Limitations and Abstinence

Negative n=233 (77%), Positive n=71 (23%)

Urinary Cannabis

SCIP Z

< 24 hrs to Never: n=17, 20, 21, 40, 31, 44.

Self-Reported Last Use of Cannabis

-1,65

-1,45

-1,25

-1,05

-0,85

-0,65

-0,45

-0,25

-0,05< 24 hrs 2 to 14

days2 to 4weeks

1 to 12months

< 1 year Never

-1,65

-1,45

-1,25

-1,05

-0,85

-0,65

-0,45

-0,25

-0,05

0,15

CAN Negative Can Positive

Purdon SE (2016). BC Active and Associates Meeting 28 Jan 2016). Intake data from AHE Neuropsychology (HREB approval Pro00039220 until 20-Apr-2016).

36

Summary

• Cognitive impairment is common to most serious mental illnesses.

• Large batteries of standardized neuropsychological t ests are useful for localization of pathology, and detection of deficits and change with medications (cost and degree of expertise is high).

• Individual standardized tests are available to detect deficits and medication effects including the popular Digit Span, RAVLT, DSST, Stroop (requires individual forms and manuals).

• The Screen for Cognitive Impairment in Psychiatry ( SCIP) is efficient, co-normed, sensitive to deficits in MDD, SC, and BPD, as well as sensitive to the effects of cannabis on cognition.

The Screen for Cognitive Impairment in Psychiatry:Part 2 – Practical Applications of the SCIP





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1. List Learning Test: You will read the list of words 3 times, requesting recall after each presentation. For the 1st trial , say "I am going to read a list of words to you. After I am done, I want you t o repeat back as many words as you can in any order ". Read the list of 10 words at a pace of about 3 seconds per word. Solicit and record recall. For the 2nd trial say "Now I am going to read the list of words again. Onc e again, when I am finished, repeat back as many words as you can remember in any order, including t he ones you have already told me ." 3rd trial say " I am going to repeat the list one last time. As bef ore, when I am finished, repeat back as many words as yo u can remember in any order, including the ones you have already told me." After subject has remembered all the words they can say "I want you to remember these words as best as you c an because I am going to ask you to recall the list again in a fewminutes".

2. Consonant trigrams: You will read a series of three letters and request recall after delays of varying lengths filled with a simple distraction task. The form has the stimulus letters, the delay interval (0 seconds, 3 seconds, etc.) and the distraction initiation number (i.e. the number from which the subject will begin to count down). Say, "I am going to say some letters and when I am finish ed I want you to repeat them. Ok? (give first set of 2 which have a delay of 0 seconds; hence no distraction). Then say, “Now I am going to say some letters and a number. Th is time I want you to count backwards from the numb er until I ask you for the letters. For example if I say ABC, 10 – you would count backwards out loud from 10 until I ask you for the letters and then you would say ABC ”. Solicit and record recall of the letters (score each letter recalled regardless of order recalled).

3. Verbal Fluency: You will request the subject to generate as many words as they can to a particular letter. Say, "I am going to say a letter of the alphabet and I want you to tell me as many words as you can that begin with that letter. There are th ree rules to this task. The first rule is that you c annot use words that are numbers, such as for the letter “T” saying thirty-one and thirty-two. The second r ule is that you cannot use any words that are common ly capitalized, such as the name of a place, a friend, or a city. The third rule is that you should not provide one word and repeatedly change the ending, such as dance, dancer, and dancing. Any questions? The first letter is __, tell me all the words you can t hink of that begin with ___. Allow 30 seconds for generation. Now tell me all the words you can thin k of that begin with the letter __. Go ahead ." Allow 30 seconds for generation.

4. Delayed List Learning: Say, "Do you remember that list that we went over the thr ee times earlier, I want you to tell me as many wor ds as you can from that list, in any order. " Do not read the words again. Solicit and record recall.

5. Visuomotor Tracking: You will request the subject to rapidly translate the symbols from the code listed at the top to the appropriate boxes below.The test has a series of (shaded) practice items to be used for training, followed by the formal stimuli. Allow 30 seconds. Say, "If you look at these letters (point to code box) you will see that each letter has a code. Down here what I want you to do is fill in each bo x with the code that corresponds to the letter." Fill in three of the letters, saying “ this is an ___, so I will put ___ in “ . ie. This is a w, so I put dot, dash dash. After filling in first three, tell subject to “Ok, now I want you to do these three in the shaded area for practice” , correcting any of S’s mistakes. After that say “When I say start, fill these in (pointing) one afte r another as quickly as you can without making any mistakes. Do you have any questions?

Z-Score conversions: Part 1. Z=(AVLT Immediate – 24)/3. Part 2. Z=(CTT total – 21)/3. Part 3. Z=(OWF total – 18)/5. Part 4. Z=(AVLD – 8)/2. Part 5. Z=(VMT-14)/2.5. Global index is the average Z across the five tests.

SCIP Instructions

39

SCIP - CONSIGNES

40

Case Study: Steve

• 52 years of age suffering chronic schizophrenia.• High school graduate with adequate grades.• Significant substance use prior to 17. • Negative syndrome apparent at 16.• Positive syndrome apparent at 18.• 34 years of illness, never employed, many years in

hospital.

41

1. Mémoire Verbale: Apprentissage (MVA)

42

1. Mémoire Verbale: Apprentissage (MVA)

43

SCIP Part 1: Verbal List Learning Test - Immediate

1. List learning test (Read the word list at roughly 3 seconds per word. Test recall. Repeat 2 more times). At the end of trial 3 let participant know they will be asked to recall the list again later:

Drum Curtain Bell Coffee School Parent Moon Garden Hat Farmer Σ/10

Tr. 1

Tr. 2

Tr. 3 Σ/30 =

44

1. List learning test (Read the word list at roughly 3 seconds per word. Test recall. Repeat 2 more times). At the end of trial 3 let participant know they will be asked to recall the list again later:

Drum Curtain Bell Coffee School Parent Moon Garden Hat Farmer Σ/10

Tr. 1

Tr. 2

Tr. 3

Σ/30 = 1 2

3

45

Mother (4)

1 2

3 5

4

656 1 2 3

77

7

6

18

5

SCIP Part 1: Verbal List Learning Test - Immediate

45

2. Mémoire de Travail: rappel de trigrammes (MdT )

46

2. Mémoire de Travail: rappel de trigrammes (MdT )

47

SCIP Part 2. Working Memory Test

2. Consonant repetition test: Read each set of three letters. Have the subject count backwards from the start # for the seconds under delay for each item, and then recall letters. Any order is fine):

Stimulus Start # Delay Response Stimulus Start # Delay Response

Q-L-X F-X-B 53 3

H-J-T J-C-N 46 9

X-C-P 94 18 B-G-Q 117 18

N-D-J 109 9 K-M-C 48 3 Σ/24 =

48

SCIP Part 2. Working Memory Test

2. Consonant repetition test: Read each set of three letters. Have the subject count backwards from the start # for the seconds under delay for each item, and then recall letters. Any order is fine):

Stimulus Start # Delay Response Stimulus Start # Delay Response

Q-L-X F-X-B 53 3

H-J-T J-C-N 46 9

X-C-P 94 18 B-G-Q 117 18

N-D-J 109 9 K-M-C 48 3

Σ/24 =---

Q-L-X

H-J-T

L-R-F

---

---

---

M-C-Q8

49

3. Fluidité Verbale (FV)

50

3. Fluidité Verbale (FV)

51

SCIP Part 3. Verbal Fluency Test

3. Verbal fluency test. Allow 30 seconds to generate words beginning with each letter.

Stimulus Response

C

L

52

3. Verbal fluency test. Allow 30 seconds to generate words beginning with each letter.

Stimulus Response

C cat, common, conversation, comedy, collect, converse(I), congruency, compassion, cooperative, congruent (I), center,can 11 Hits

2 Intrusions

L long, live, lead, look, like, learn, language, linquistic, ladder, living 10 Hits

Σ= 21 Hits, 2 Intrusions

SCIP Part 3. Verbal Fluency Test

53

4. Rappel Verbal Différé (RVD)

54

4. Rappel Verbal Différé (RVD)

55

SCIP Part 4. Verbal List Learning Test - Delayed

4. Delayed list learning: Ask the subject to recall the earlier words; do not repeat the list.

Drum Curtain Bell Coffee School Parent Moon Garden Hat Farmer

Tr. 4 Σ/.10 t4/t3 * 100

56

4. Delayed list learning: Ask the subject to recall the earlier words; do not repeat the list.

Drum Curtain Bell Coffee School Parent Moon Garden Hat Farmer

Tr. 4 Σ/.10 t4/t3 * 100

123 4 5 5 5/5*100=100%

SCIP Part 4. Verbal List Learning Test - Delayed

57

5. Capacités Visuomotrices (CV)

58

5. Capacités Visuomotrices (CV)

59

SCIP Part 5. Visuomotor Tracking Test

5. Visuomotor tracking test: After practice items, allow 30 seconds to complete left to right and top to bottom.

A V C U G Y

. - . . . - - . - . . . - - - . - . - -

Practice Test

G U C Y A V C A G

V Y U G U A Y C V

A C Y G U V C Y V

U G A V C G A V Y Σ/30

60

SCIP Part 5. Visuomotor Tracking Test

5. Visuomotor tracking test: After practice items, allow 30 seconds to complete left to right and top to bottom.

A V C U G Y

. - . . . - - . - . . . - - - . - . - -

Practice Test

G U C Y A V C A G

V Y U G U A Y C V

A C Y G U V C Y V

U G A V C G A V Y Σ/30 7

- - . . . - - . - . - . - - . - - . - - - . - . - .

. . . - - . - - . . - - - .

- - .

61

Verbal Learning Test - Immediate

0

5

10

15

20

15

17

19

21

23

25

27

29

Men

Women

Steve

Z=(18-23.28)/3.08 = -1.71

62

Working Memory Test

0

5

10

15

20

25

8

10

12

14

16

18

20

22

24

Men

Women

Steve

Z=(8-20.88)/2.57= -5.01

63

Verbal Fluency Test

0

2

4

6

8

10

12

14

6 9

12

15

18

21

24

27

30

Men

Women

Steve

Z=(21-17.54)/4.91 = 0.70

64

Verbal Learning Test - Delayed

0

5

10

15

20

25

30

0 1 2 3 4 5 6 7 8 9 10

Men

Women

Steve

Z=(5-7.39)/2.20 = -1.09

65

Visuomotor Tracking

0

5

10

15

20

25

30

7 9

11

13

15

17

19

Men

Women

Steve

Z=(7-13.73)/2.17 = -3.10

66

SCIP Z-SCORES

-6

-5

-4

-3

-2

-1

0

1

VLT_I WMT VFT VLT_D VMT

Steve

Z=(-1.71-5.01+0.70-1.09-3.10)/5 = - 2.04

67

SCIP Mean Z

0

5

10

15

20

25

30

-3 -2 -1 0 1 2 3

Men Women Steve

68

Thank You!

Questions/Comments?

Follow -up: [email protected]

AHE Neuropsychology

Documents

The Screen for Cognitive Impairment in Psychiatry … · The Screen for Cognitive Impairment in Psychiatry ... LD, Long Delayed; RAVLT, Rey Auditory Verbal Learning Test; SD, Short