Using the CANTAB to investigate cognitive deficits in ASPD Executive functions

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

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

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)

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)

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)

METHOD

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

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

The Executive CANTAB  Planning  Decision-making  Response control  Cognitive flexibility

Planning: Stockings of Cambridge (SOC)  Perfect solutions  Mean moves to solution

Executive CANTAB  Planning – SOC  Decision-making

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

Executive  Planning – SOC  Decision-making – CGT  Response control

Motor/response control: Inhibition Affective Go/NoGo (AGN)  # Commission errors

Executive  Planning – SOC  Decision-making – CGT  Motor/response control – AGN  Cognitive flexibility

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

Cognitive flexibility: Attentional set-shifting (IED)  # Errors Reversal EDS

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

RESULTS

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

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

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

Decision-making (CGT): Quality of decision-making  ASPD & N-ASPD<HC  Group x increment interaction

Decision-making (CGT): Quality of decision-making  ASPD & N-ASPD<HC  Group x odds interaction

Response inhibition (AGN): Commission errors  ASPD>HC

Response reversal & Attentional set-shifting (IED): # errors  Reversal: ASPD>N-ASPD & HC  EDS: ASPD>HC

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)

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

THANK YOU