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Cognition Workshop Dr Jill Rasmussen Dr Amy Chappell
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2 Declaration of Interests NHS: East Surrey CCG Commisisioning Lead for Mental Health, Learning Disability and Dementia Strategic Clinical Network Lead Dementia SE Coast Co-developer of Depression Anxiety Pathway Royal College of General Practitioners Chair Learning Disability Special Interest Group Clinical Champion Dementia Consultancy/ Advisory Boards / Speakers Bureau Chair Lewy Body Society, GP Advisor to Alzheimer’s Society Autism Therapeutics, Chronos, Lilly, Lundbeck, Napp, Novartis, Otsuka, Pfizer, Roche, Servier, Targacept, TauRX.
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3 Overview 7.30 – 7.35 Welcome and Introduction Jill Rasmussen 7.35 am – 7.55 am Designing a Battery for Clinical Trials: The MATRICS Project for Schizophrenia Richard Keefe, PhD, Duke University Medical Center 7.55 am – 8.20 am The Problem of Cognitive Dysfunction/Decline in Epilepsy Kimford Meador, MD, Stanford University School of Medicine 8.20 to 8.40 Regulatory Considerations Philip Sheridan Div Neurology Products FDA 8.40 am – 9.00 am Panel Discussion
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Cognition Workshop – The Issue Cognitive impairment is a feature of many psychiatric and neurological disorders and is a major cause of poor functioning for patients. Compounding this problem many treatments for these disorders are also associated with cognitive impairment. There is a growing interest in developing treatments for cognitive impairment but a major obstacle to the field has been the lack of an accepted standard for measuring cognitive change.
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Cognitive Impairment in Epilepsy Factors Seizure type, frequency, duration severity AED Side-effects Psychosocial factors Cerebral function During ictal / post- Ictal phases Age of Onset of Epilepsy Cerebral Damage Prolonged seizures Status, surgery 5
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Cognitive Impairment in Epilepsy – Issues & Examples of Domains Affected Adults newly diagnosed epilepsy: Pts under-report cognitive problems 75% have deficits in attention, executive function, memory Attentional and executive function 49.4% Memory deficits 47.8% Chr Temporal Lobe Epilepsy – 20% patients Pts with lower baseline IQ, longer epilepsy duration, older age, and smaller baseline lt hippocampal volume were most susceptible to cognitive decline. Domains most adversely affected over time - memory, psychomotor speed, executive function, naming. Ref: Rudzinski and Meador Continuum (Minneap Minn) 2013;19(3):682–696
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Cognitive Impairment in Epilepsy – Challenges The discrepancy between subjective perception and objective measures of cognitive performance in epilepsy patients requires a different approach is needed when evaluating patients. Need to evaluate cognition at initial presentation and over the course of the disorder to detect: Detect Improvement / Deterioration Intervene as appropriate
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8 Cognitive Impairment in Epilepsy - Questions How should we be addressing the issue of cognitive impairment in epilepsy: Identification Ongoing evaluation Management Rationale for standardisation in approach? Impact of AEDs on developing / mature brain Risk / benefit current treatments New treatments – drug / non-drug What can we learn from others? MATRICS
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9 Overview 7.30 – 7.35 Welcome and Introduction Jill Rasmussen 7.35 am – 7.55 am Designing a Battery for Clinical Trials: The MATRICS Project for Schizophrenia Richard Keefe, PhD, Duke University Medical Center 7.55 am – 8.20 am The Problem of Cognitive Dysfunction/Decline in Epilepsy Kimford Meador, MD, Stanford University School of Medicine 8.20 to 8.40 Regulatory Considerations Philip Sheridan Div Neurology Products FDA 8.40 am – 9.00 am Panel Discussion
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