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The Spatial Performance Assessment for Cognitive Evaluation (SPACE) is a novel iPad serious game designed to identify differences in spatial ability indicative of early signs of cognitive impairment. This paper reports on the development of SPACE and presents the results from three usability studies across different ages. Study 1 compared the traditional tap and swipe control interface with a semiautomated interface. Study 2 investigated the benefits of a UI widget that displayed the rotation performed in the Virtual Environment (VE). Study 3 evaluated the effects of a simplified configuration of landmarks explored in the VE. Findings across the studies indicated that age was the primary factor influencing performance. Younger participants consistently outperformed older ones across various tasks and reported higher usability and lower workload. Despite notable performance improvements for the tasks in SPACE, the new control interface, UI widget, and simplified configuration only had a minimal impact on usability. Younger participants rated SPACE above the level of mature products, while older participants found it useable but not always engaging. Critically, the significant interactions between age and experimental conditions indicated that younger and older participants benefited differently from the design modifications. Here, the semi-automated control, the simplified configuration, and, to a lesser extent, the UI widget showed promise in mitigating age-related performance differences while maintaining the level of challenge necessary to assess differences in cognitive status. This research showcases the potential of SPACE as a serious game and emphasises the importance of balancing simplicity with task demands for future unsupervised deployment. • SPACE is a novel iPad serious game that identifies deficits in spatial ability indicative of cognitive impairment. • A new semi-automated and user-friendly control interface improved the performance of older adults in the tasks in SPACE. • A UI navigation aid enhanced the performance of younger adults but increased the cognitive load of older adults. • A simplified spatial configuration boasted the best performance and usability while providing a sufficient level of challenge. • The simplified configuration mitigated age-related performance differences, making it suitable for assessing cognitive status. [ABSTRACT FROM AUTHOR]

Introduction: Chronic polysubstance abuse (SUD) is associated with neurophysiological and neuroanatomical changes. Neurocognitive impairment tends to affect quality of life, occupational functioning, and the ability to benefit from therapy. Neurocognitive assessment is thus of importance, but costly and not widely available. Therefore, in a busy clinical setting, procedures that include readily available measures targeting core cognitive deficits would be beneficial. This paper investigates the utility of psychometric tests and a questionnaire-based inventory to assess "hot" and "cold" neurocognitive measures of executive functions (EF) in adults with a substance use disorder. Hot decision-making processes are associated with emotional, affective, and visceral responses, while cold executive functions are associated with rational decision-making.Material and Methods: Subjects with polysubstance abuse (n=126) and healthy controls (n=32) were compared on hot (Iowa Gambling Task) and cold (Stroop and the Trail Making Test) measures of EF, in addition to a questionnaire assessing everyday EF related problems (BRIEF-A; Behavior Rating Inventory of Executive Function - Adult, self-report version). Information about the substance abuse and social adjustment were assessed by self-report. Logistic regression analyses were applied to assess independent correlates of SUD status and social adjustment. A multiple linear regression was performed to predict the number of previous treatment attempts.Results: The psychometric test of hot EF (the Iowa Gambling Task) did not differentiate the patients with polysubstance abuse from controls, and was not associated with social adjustment. The psychometric tests of cold EF distinguished somewhat between the groups and were associated with one indicator of social adjustment. The BRIEF-A differentiated between groups on all the clinical scales and was associated with three out of five social adjustment indicators ("criminal lifestyle," "conflict with caregiver," and "stable housing.").Conclusions: The BRIEF-A inventory was the most sensitive measure of executive function in patients with substance use disorder, followed by measures of cold executive function. BRIEF-A should therefore be considered as an integral part of the clinical routine when assessing patients with SUD. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The child and adolescent first-episode psychosis study (CAFEPS) is a multicenter, two-year, longitudinal project aiming to evaluate different clinical, neuropsychological, neuroimaging, biochemical, immunological, and genetic variables and treatment and prognostic factors in these patients. This paper describes the methods and rationale behind the study and the general characteristics of the sample. Method: At six different centers, from March 2003 through November 2005, we consecutively recruited 110 patients, ages 9–17 years, who presented with a first psychotic episode. Controls were recruited from the same geographic areas and were matched for gender and age. Results: Patients had lower socioeconomic status (SES) (p =0.018) and parental years of education (p <0.001) than controls. The percentage of patients recruited increased with age (p <0.001) and there was a higher percentage of males (p <0.001). The total mean PANSS score was 89.03±20.1, the positive score 23.8±6.5 and the negative score 20.02±8.8. There were no significant differences between the genders with respect to age, parental years of education, SES, or scores in premorbid adjustment or general functioning. There were statistically significant positive correlations between age and positive symptoms and between all PANSS subscales and the Disability Assessment Schedule, and negative correlations between positive symptoms and global functioning. Diagnoses after the baseline evaluation were: psychotic disorder not otherwise specified (NOS) 35.5%, schizophreniform disorder 24.5%, mood disorder with psychotic symptoms 22.7%, schizophrenia 10%, schizoaffective disorder 2.7%, and other psychotic disorders 4.5%. Patients had worse premorbid adjustment (p <0.001) and global functioning (p <0.001) than controls after controlling for SES. Conclusions: Infancy and adolescence adjustment and global functioning are lower in children and adolescents with psychotic disorders than in controls, severity of symptoms are related to general disability, and the most frequent diagnoses are psychotic disorders NOS. [Copyright &y& Elsevier]

Background: This paper examines the potential impact of recruitment source differences in schizophrenia research by comparing the neuropsychological performance of volunteers from the NISAD Schizophrenia Research Register with recently published schizophrenia normative data for the Repeatable Battery for Neuropsychological Status (RBANS). Methods: The Register sample comprised 285 volunteers with schizophrenia or schizoaffective disorder. Their RBANS performance was compared with US data from 575 predominantly outpatient-recruited schizophrenia patients. Results: The Register sample displayed impairments in immediate and delayed memory, but near-normal language, attention and visuospatial-constructional performance (mean RBANS total score=88.72, SD=16.35). By contrast, health service-recruited schizophrenia patients displayed impairments on all RBANS scales (mean RBANS total score=70.54, SD=14.80). Within the Register sample, volunteers with low levels of current functioning had immediate and delayed memory performance comparable to the US schizophrenia sample. Gender and school completion status were also associated with different RBANS profiles. Conclusions: These findings reinforce the notion that a severity/functioning gradient exists across schizophrenia recruitment sources, which has important implications for research design and generalizability. Memory impairments have emerged as a central feature of schizophrenia. [ABSTRACT FROM AUTHOR]

Previous Presentation: Some of the contents of this paper have been previously presented at the 16th Annual Meeting of the International Society for Technology Assessment in Health Care June 20, 2000 in the Hague, Netherlands and at the 21st Annual Meeting of the Society for Medical Decision Making as a poster on October 3, 1999 in Reno, NV.Background: Studies of schizophrenia treatment often oversimplify the array of health outcomes among patients. Our objective was to derive a set of disease states for schizophrenia using the Positive and Negative Symptom Assessment Scale (PANSS) that captured the heterogeneity of symptom responses.Methods: Using data from a 1-year clinical trial that collected PANSS scores and costs on schizophrenic patients (N=663), we conducted a k-means cluster analyses on PANSS scores for items in five factor domains. Results of the cluster analysis were compared with a conceptual framework of disease states developed by an expert panel. Final disease states were defined by combining our conceptual framework with the empirical results. We tested its utility by examining the influence of disease state on treatment costs and prognosis.Results: Analyses led to an eight-state framework with varying levels of positive, negative, and cognitive impairment. The extent of hostile/aggressive symptoms and mood disorders correlated with severity of disease states. Direct treatment costs for schizophrenia vary significantly across disease states (F=27.47, df=7, p<0.0001), and disease state at baseline was among the most important predictors of treatment outcomes.Conclusion: The disease states we describe offer a useful paradigm for understanding the links between symptom profiles and outcomes. [ABSTRACT FROM AUTHOR]

Background: This paper investigates the durability of the effects of cognitive remediation therapy (CRT). In a randomised control trial, CRT was compared with a control therapy (intensive occupational therapy activities), matched for length of therapist contact. The main three cognitive outcomes, (i) number of categories achieved on the Wisconsin Card Sort Test, (ii) age-scaled score on the Digit Span subtest of the WAIS-R, and (iii) mean number of moves on the Tower of London test, were chosen because they are known to be problematic in schizophrenia. In addition, a wide variety of other outcomes (symptoms, social functioning, self-esteem and cognition) were assessed. At the end of treatment, CRT conferred a benefit to people with schizophrenia in cognition and self-esteem [Schizophr. Bull. 25 (1999) 291]. This study investigates these outcomes 6 months after the therapies were withdrawn. Method: Participants were assessed at baseline, posttreatment and 6-month follow-up (n=17 for the CRT group; n=16 for the control therapy group). In addition to the functioning measures, data on use of services and cost of therapy were collected. Results: The effects of CRT on cognition were still apparent at follow-up, particularly in the memory domain. When these cognitive improvements reached a criterion threshold, there were also improvements in social behaviour and symptoms. The gains made in self-esteem disappeared following the withdrawal of therapy. The economic analysis showed overall reductions in the care packages of both patient groups but there was a significant increase in day-care costs for patients who have received CRT. This additional use of day care may confer further advantages to the CRT group, such as improved social functioning and quality of life. Conclusions: The overall results of this first trial of a novel CRT approach have produced encouraging results which merit further investigation. [Copyright &y& Elsevier]

Clinical trials for the treatment of schizophrenia now often include cognitive assessments in addition to clinical ratings of symptoms. Recently, these trials have included cross-national assessments. It is not clear if translated psychological tests produce consistent results across different languages. This paper presents the results of a study of the comparability of the results of cognitive assessments in different English-speaking countries and a number of countries where tests were translated into other languages. Performance on tests of executive functioning, verbal and visuo-spatial learning and memory, language skills, psychomotor speed, and vigilance was compared across the first episode patients with schizophrenia (n=301) assessed in six different languages (English, French, Finnish, German, Hebrew, and Afrikaans), including two different countries where patients were assessed in English and other languages: Canada (French) and South Africa (Afrikaans). The variance in performance across the sites tested in English was as large as the variance between English and non-English speakers when all tests were considered. Performance differences across English and other languages were found only for executive functions, vigilance, and psychomotor speed, with executive functioning differences nonsignificant when education was considered. No differences were found between English and non-English speakers in Canada. These results suggest that the translation of tests of memory and verbal skills can lead to consistent results across translated versions of the tests. Differences between countries were greater than differences between languages, suggesting the need to consider representativeness of patient samples in terms of local educational attainment. In general, these data support the validity of cross-national neuropsychological assessments. [Copyright &y& Elsevier]

Genetic epidemiological studies indicate that schizophrenia is a complexly inherited disorder, whereby multiple genes, additively and in interaction with environmental factors, contribute to increasing risk for phenotypic expression. Linkage studies have identified a number of chromosomal regions as likely to harbor susceptibility genes for schizophrenia, but the linked regions span relatively large chromosomal segments in each case. These efforts have been hindered in part by a lack of means to detect nonpenetrant carriers of predisposing genes and in part by uncertainties concerning the nature of the nongenetic factors involved and their mechanisms of action in relation to genetic factors. Our strategy has focused on elucidating changes in central nervous system structure, physiology, and function that mark an inherited genotype for schizophrenia and on identifying specific environmental and etiological contributors and their modes of action in relation to genetic factors. The research reviewed in this paper, making use of family and twin designs, suggests that certain neural system deficits in schizophrenia (e.g., prefrontal cortex, working memory) are reflective of an inherited diathesis to the disorder, while others (e.g., temporal cortex, episodic memory) result from the interacting influences of genetic factors and particular types of biologically disruptive environmental events (e.g., fetal hypoxia). These findings help to reveal continuities and discontinuities in the neural disturbances characteristic of the schizophrenia genotype and phenotype and encourage the use of quantitative neural trait measures in the search for schizophrenia susceptibility genes. [Copyright &y& Elsevier]