Cognitive testing primarily involves the use of pencil and paper tasks to assess a wide range of abilities, including attention, memory, problem-solving, language skills and intellectual functioning. It is the process of determining a patient’s cognitive strengths and weaknesses through qualitative (approach to tasks and observed behaviour) and quantitative (standardized and scaled measures) approaches. Test scores are interpreted on the basis of normative data and expected level of performance for a given individual based upon their educational/occupational level and premorbid estimates of their intellectual functioning.
There are five main areas of functioning addressed by the PEPP cognitive assessments:
- Intellectual Functioning
- Executive Functioning
- Attention/Concentration, Working Memory, and Speed of Processing
- Learning and Memory
- short-term and long-term
- auditory and visual
- recall and recognition
- Self-Reported Cognition and Emotional Functioning
The list of tests administered to each patient includes the following:
- National Adult Reading Test (NART): estimate of premorbid IQ
- Wechsler Adult Intelligence Scale - Third Edition (WAIS-III) provides Verbal and Performance IQ scores and a Processing Speed Index
- Wechsler Memory Scale - Third Edition (WMS-III): provides indexes of immediate and delayed auditory and visual memory, and working memory
- Wisconsin Card Sorting Test (WCST): measure of executive functioning
- Stroop Test: measure of divided attention, mental flexibility, processing speed
- Trail Making Test (Parts A and B): measure of attention and visual-motor sequencing
- Oral and Written Word Fluency: measures of executive functioning
- Prospective Memory Screening Test: measure of planning and recall for future tasks
- Paced Auditory Serial Addition Task: measure of sustained and speeded processing
- Continuous Performance Task: measure of sustained attention/concentration and processing speed
- Neo Personality Inventory: brief measure of personality traits
- Cognitive Failures Questionnaire: self-report measure of cognitive complaints
Once a patient’s acute psychotic symptoms have stabilized enough to be able to complete the tests, they will be scheduled to complete their baseline cognitive assessment. If a patient is stable enough to be able to complete the tasks prior to intervention with antipsychotic therapy, this is preferable, however, in a large proportion of individuals, this is not possible.
Testing Process:
Testing is usually undertaken over two half-days (approximately 2.5-3.0 hours each in duration) and each patient meets the psychologist prior to commencement of testing to complete an interview, review the testing process, and have their concerns or questions directly addressed. Testing is then administered by a Bachelor’s degree level research assistant trained to conduct cognitive assessments. One to two weeks following completion of their assessment, most patients can expect to again meet with the psychologist and their case manager to receive feedback and recommendations relating to the results of their assessment. Again, they will have an opportunity to have their concerns or questions addressed and family members are welcome to attend this appointment with them (provided the patient has consented to this). A copy of the assessment report (written by the psychologist) is then placed in the PEPP chart. Patients will typically be followed up after one year to complete a reassessment of cognitive functioning at that time.
