Owens, SF; (2013) The Assessment of Neurocognition in Twin and First-Episode Studies of Schizophrenia using the Cambridge Neuropsychological Test Automated Battery. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Computerised neuropsychology test batteries are becoming increasingly popular in research studies in schizophrenia, due to their highly standardised approach and non-verbal nature, which allows easier comparison across studies and in multisite trials. The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a well validated computerised battery designed to assess visuo-spatial skills in: recognition memory, planning ability, working memory, strategy learning, sustained attention and attentional set shifting. This thesis explores performance on the CANTAB using two different study designs. Part one is a systematic review summarising the evidence of cognitive performance using the CANTAB in patients experiencing a first episode in schizophrenia. Studies differed along several dimensions which limited the interpretability of results and threatened validity. Important methodological differences included patient diagnosis, medicated status, CANTAB subtest used, and recruitment strategy for controls. Despite these limitations CANTAB appears to be sensitive to detecting visuo-spatial neurocognitive impairments. Part two is an empirical study investigating whether the unaffected co-twins of patients diagnosed with schizophrenia show impairment on the CANTAB. Thereby questioning whether it may be a useful tool in future endophenotype research in schizophrenia. The unaffected co-twins of patients had more subtle cognitive impairments, with monozygotic (MZ) unaffected co-twins showing a broader range of difficulties than dizygotic (DZ) co-twins. Both MZ and DZ co-twins showed impairments in pattern recognition memory and planning ability. MZ co-twins also showed impairments’ on spatial working memory and sustained attention. The CANTAB may be a useful tool in endophenotype research. Part three is a critical appraisal of the thesis, where I discuss in more detail future directions for genetic research in schizophrenia. I also describe some of the theoretical and ethical issues in neurocognitive research in schizophrenia that I struggled with while undertaking this thesis.

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