THINC-it® tool launched at Expert Forum in Brazil

As readers of these web pages know, a core objective of the international THINC Task Force is to improve physician awareness of the need to recognize, assess, monitor and manage cognitive dysfunction in patients with depression. In April 2016, a day-long expert meeting provided a welcome opportunity for knowledge-sharing and exchange between the THINC Task Force and psychiatrists and general practitioners from Brazil.

Knowledge-factory

Professor Roger McIntyre of the University of Toronto, Canada, described this and other THINC meetings as ‘knowledge factories’ that thrive on ‘the oxygen’ supplied by expert input and ideas. He and Professor John Harrison of the University Medical Center, Amsterdam, The Netherlands chaired a programme of lectures and workshop sessions and encouraged meeting delegates to visit the THINC website and to access and share its information, resources and tools with their local colleagues.

Getting the word out about cognitive dysfunction in depression

Getting the word out

Professor Harrison said that THINC offers an important platform for getting the word out about cognitive dysfunction in depression.

The THINC website offers digital resources – including the THINC-it® tool –  and Professor Harrison also directed delegates to a new text book, published in April 2016 by Cambridge University Press, edited by Professor McIntyre and with contributions from many of the THINC Task Force – “Cognitive Impairment in Major Depressive Disorder: Clinical Relevance, Biological Substrates and Treatment Opportunities.”

An eye-opener

Setting the scene for the day’s work and discussions, Professor Raymond Lam of the University of British Columbia, Canada, reminded delegates of the ubiquitous nature of cognitive dysfunction in patients with major depressive disorder (MDD).

He described some facts and figures from the literature as eye-opening – such as the data showing that despite adequate treatment of depression, and a response described as remission, patients report cognitive symptoms associated with depression up to 44% of the time. Professor Lam and other speakers also stressed that with each recurrence of depression, cognitive dysfunction is shown to worsen.

Despite adequate treatment of depression, and a response described as remission, patients still report cognitive symptoms.

In presentations by Professor Philippe Fossati, Hôpital de La Salpêtrière Paris, France and Professor Catherine Harmer of Oxford University, UK, delegates learned about the domains of cognitive dysfunction in depression and their neurological correlates. These speakers also described clinical studies and research which suggests that risk factors and altered neuronal networks associated with cognitive change may be present before the onset of depression – underscoring the core place of cognition in depression.

Treat to target

Several speakers said that there is a need for new treatment targets in depression management – targets that seek to achieve not only full symptom remission using traditional scales but also remission of cognitive dysfunction. Professor McIntyre said it was time for psychiatry to adopt the language of other chronic diseases – and to treat-to-target, having set mutually agreed goals. In depression he described cognitive impairment as a priority therapeutic target.

Define that target

However, as Professor Harrison explained, the standard outcome measures and assessment scales used in depression have traditionally only included one or two items relating to cognition. The THINC Task Force have therefore dedicated research time and effort to developing a practical tool, founded on and composed of tried-and-tested subjective and objective assessments, that easily and rapidly can be administered in daily practice to screen and measure cognitive dysfunction in depression.

THINC-it® – simple-and rapid digital screener

Professor Harrison demonstrated the THINC-it® tool – a freely available digital application that in around 15 minutes can provide a read-out describing and measuring cognitive function in the patient with depression. The tool uses objective tests and self-rating that assess key constructs of cognition - employing a choice-time-reaction task, the trail-making B tests, the digital symbol substitution test (DSST) and the perceived-deficits questionnaire-5 (PDQ-5). In an animated format, the THINC-it tests are administered in one easy-to-use programme on a desktop or tablet.

THINC-it® has been designed primarily to screen for cognitive impairments but may also be used to measure changes in cognitive function over time or as a result of management interventions.

THINC-it® uses objective tests and self-rating that assess key constructs of cognition.

Validation of THINC-it®

Professor McIntyre shared the preliminary results of the validation study of THINC-it® which is ongoing at the Brain and Cognition Discovery Foundation in Toronto. He reported that the English language version (THINC-it® will be available in a number of local languages) is being assessed in patients with MDD, aged 18-65 years of age and age-matched controls, to determine its convergent validity with pen-and-paper versions of the component test elements.

Interim data show that the tool can distinguish between-group differences in cognition effectively and accurately, and is sensitive enough to detect standard deviation changes in cognitive function that are known to correlate with clinical cognitive impairment.

Trying out THINC-it®

Delegates at the meeting spent time trying out THINC-it® for themselves. An audience poll showed that currently, most psychiatrists do not use any formal tests to assess cognition in depression, or may use tools such as the MMSE to approximate cognitive impairment. So having a one-stop, quick-to-use and valid screening tool would be welcomed.

In feedback, delegates had a number of comments and queries about THINC-it®. While some delegates were concerned that THINC-it® might be used instead of a rigorous clinical assessment of the patient, Professor Harrison was keen to reassure that the tool has been designed to assist and complement practice. He highlighted that the tool can actually help protect consultation time and data gathered by the THINC-it tool can be interrogated to provide new insights into cognitive changes in patients with depression.

Professor Harrison said that the Task Force believes that THINC-it® offers a good tool to address the importance of cognition in depression, and he described the tool as empowering – with the potential to help support individual patients in changing lifestyle and making management choices that could help protect cognition.

Professor McIntyre echoed these sentiments and said that the issues of pre-emption and prevention should be given more prominence in psychiatry. He concluded the day of knowledge-sharing by thanking delegates for the ‘wisdom of the crowd’. He noted the positive and hopeful tone of the meeting and concluded that with THINC-it®, more can now be done in daily practice to support active investigation of cognition. It will also help ensure that cognition is taken into account when assessing and treating people with depression.