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The Evolution of Cognitive Testing: Finally
Connecting the Brain With Behavior
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October 19th, 2021
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Disclaimer
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LOGISTICS
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Presenter: Mike Battista
Mike Battista is a scientist at
Cambridge Brain Sciences. His
research and science communication
focus on brain health, cognition, and
neuropsychological testing. He
received his PhD in personality and
measurement psychology at Western
University in 2010 and has been
making things happen at the
intersection of science and
technology ever since.
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NEPAL, 1960
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NEPAL, 1960
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NEPAL, 1960
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EARLY COGNITIVE TESTS
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1848: PHINEAS GAGE
Phineas P. Gage, 1823 – 1860
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EARLY COGNITIVE TESTING …
• Assessed one individual at a time, often in extraordinary circumstances
• Used physical objects or pen and paper responses that had to be set up,
monitored, and scored by hand.
• Were based on performance and intuition and had only loose connections with
the brain.
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1988: COMPUTERIZED TESTING
Adrian Owen, Chief Scientific Officer,
Cambridge Brain Sciences
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ADRIAN OWEN
FOUNDER AND CSO OF CAMBRIDGE BRAIN SCIENCES
Global neuroscience
leader
Trusted brain health
Published in prestigious scientific
publications
authority for media outlets
Best-selling author
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1990s: THE EVOLUTION OF
COGNITIVE TESTING
CORSI BLOCK TAPPING TASK (1972)
EARLY CAMBRIDGE SPATIAL
SPAN (1990s)
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VALIDATING COMPUTERIZED TESTS
Ensuring performance is sensitive to neurodegenerative conditions, such as
Parkinson’s disease and Alzheimer’s disease.
Owen et al., 1993; 1992; 1995; 1996.
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CONNECTING TESTING TO THE BRAIN
1976: RADIAL ARM MAZE FOR RATS:
https://www.youtube.com/watch?v=8LAvXj65JNI&t=25s
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CONNECTING TESTING TO THE BRAIN
1976: RADIAL ARM MAZE
FOR RATS
1990-1996: COMPUTERIZED,
SENSITIVE TO HUMAN BRAIN
DAMAGE
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CONNECTING TESTING TO THE BRAIN
1976: RADIAL ARM MAZE
FOR RATS
1990-1996: COMPUTERIZED,
SENSITIVE TO HUMAN BRAIN
DAMAGE
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CONNECTING TESTING TO THE BRAIN
1976: RADIAL ARM MAZE
FOR RATS
1990-1996: COMPUTERIZED,
SENSITIVE TO HUMAN BRAIN
DAMAGE
2010s: CAMBRIDGE
BRAIN SCIENCES
TOKEN SEARCH
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THE ROLE OF BRAIN IMAGING
1996-2005: IMAGING STUDIES USING PET AND FMRI
Owen et al., 1996; 1997; 1998; 1999; 2000
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2008: BORROWING FROM ANIMALS
https://www.youtube.com/watch?v=ravykEih1rE
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BORROWING FROM ANIMAL STUDIES
2005: MONKEY LADDER ASSESSES NONVERBAL MEMORY IN HUMANS
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2010: COGNITIVE TESTING GOES
ONLINE
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2010: COGNITIVE TESTING GOES
ONLINE
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2010: COGNITIVE TESTING GOES
ONLINE
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2010: COGNITIVE TESTING GOES
ONLINE
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IS WEB-BASED TESTING VALID?
• High correlation between in-lab and at-home
testing (r > 0.85).
• No significant difference between scores collected
in-lab vs. at-home.
• Both healthy and clinical populations.
• Interactive tutorials and practice rounds can
increase reliability of unsupervised testing.
• Database allows for detection of invalid results.
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2012: A LARGE-SCALE STUDY
OF COGNITIVE FUNCTION
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IS INTELLIGENCE UNITARY?
• An unresolved question after more than 100 years of study—can modernized
cognitive testing help?
• The study used 12 computerized cognitive tasks, based on well-established
paradigms, and validated through decades of research
• Spanning different cognitive domains (planning, reasoning, attention, working
memory, verbal ability)
• Given to two cohorts: a large internet cohort, and smaller neuroimaging cohort
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THE NEURON STUDY
• Internet cohort:
• Over 46,000 participants with complete data on all
12 tasks at home
• Factor analysis of behavioral data
• Neuroimaging cohort:
• 16 healthy participants completing the same 12
tasks in an fMRI scanner
• Factor analysis of brain imaging data
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THE NEURON STUDY
INTERNET (BEHAVIOURAL) FACTORS
LAB (BRAIN IMAGING) FACTORS
Spatial Span
Digit Span
Monkey Ladder
Token Search
Paired Associates
Feature Match
Polygons
Rotations
Spatial Planning
Grammatical Reasoning
Double Trouble
Odd One Out
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Factor 1
Factor 2
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THE NEURON STUDY
Spatial Span
Monkey Ladder
Token Search
Paired Associates
Spatial Planning
Rotations
Feature Match
Polygons
Odd One Out
Digit Span
Grammatical Reasoning
Double Trouble
0
0.1
0.2
Factor 1
0.3
0.4
0.5
Factor 2
0.6
0.7
0.8
Factor 3
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THE NEURON STUDY
Information must be held in short
term memory.
Spatial Span
Monkey Ladder
Token Search
Paired Associates
Spatial Planning
Rotations
Information is transformed
according to logical rules—
reasoning
Feature Match
Polygons
Odd One Out
Digit Span
Present linguistic (verbal) stimuli—
verbal ability
Grammatical Reasoning
Double Trouble
0
0.1
0.2
Factor 1
0.3
0.4
0.5
Factor 2
0.6
0.7
0.8
Factor 3
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THE NEURON STUDY
EACH TASK IS A MIX OF DISTINCT FACTORS
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SO, IS INTELLIGENCE UNITARY?
COMPUTERIZED TESTS HELP PROVIDE ANSWERS
• An adequate model of the distribution of test
scores in the population requires at least 3 factors.
• These factors:
• Are associated with distinct specialized brain networks,
• Are recruited in combination for specific cognitive tasks,
• And, correlate with demographic variables in a dissociable
manner (e.g., age, lifestyle, mental health).
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2010-2021: A USEFUL SCIENTIFIC
FRAMEWORK
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FROM 50,000 PARTICIPANTS TO
INDIVIDUAL PATIENTS
• Additional studies and testing have resulted in over
80,000 people in the Cambridge Brain Sciences database.
• Represents the general healthy population and can be
broken down by age but maintain a large normative
sample.
• Comparisons to the database provide age-matched
percentiles and standard scores for any individual.
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APPLYING MODERN COGNITIVE
TESTING TO HEALTHCARE
• Healthcare often relies on subjective reports, lengthy and costly
neuropsychological evaluations, or tests only appropriate for some patients.
• Computerized testing takes less time, is automatically scored, can be selfadministered, and is instantly compared to normative data.
• Healthcare providers can use the same tests refined over 35+ years to assess
patient cognition at baseline, during treatment, and through long-term
monitoring.
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TESTING COGNITION IN TREATMENT
Initial Evaluation
•
•
•
Comparative Evaluation
Patient intake & interview
Cognitive assessment
Mental health
questionnaires
•
•
•
Step 2
Step 1
Treatment
Cognitive assessment
Mental health questionnaires
Assessment of change
Step 3
E.g., therapy, rehab, medication,
to treat neurological or mental
health conditions
Step 4
Follow-Up
Automated follow-up cognitive
and mental health assessments
by email
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WHAT IS CBS HEALTH?
A scientifically-validated and easy-to-use cognitive assessment platform built
specifically for healthcare practitioners and their patients.
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TASK DEMONSTRATION: DOUBLE
TROUBLE
A TEST OF RESPONSE INHIBITION
• A “double” variant on the Stroop task
(Stroop, 1935).
• Patients must focus on the color of the
word at the top and choose the word at
the bottom that describes it.
• Three difficulty levels: congruent,
incongruent, or doubly incongruent,
depending on whether or not the color
of each word matches the color that it is
written in.
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2020: SENSITIVITY TO REAL-WORLD
OUTCOMES
• Double Trouble was found to
be impaired in members of
the general population with a
history of concussion—a
finding replicated in a
sample of football players.
Stafford, C. A., Stojanoski, B., Wild, C. J., Brewer-Deluce, D., Wilson, T. D., & Owen, A. M. (2020). Concussion-related deficits in the
general population predict impairments in varsity footballers. Journal of Neurology, doi: https://doi.org/10.1007/s00415-020-09749-9
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“If Hillary's climbers were sitting in their tents today,
they would not be sorting cards. They would be logged
on to the internet while their brains were monitored in
real time and compared to the brains of millions of
others at sea level, for signs that altitude and fatigue
were affecting their cognitive function. We’ve come a
long way in 60 years.”
--Adrian Owen
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QUESTIONS & ANSWERS
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• How can psychological testing be best done now with remote telehealth?
• I'm curious about results obtained from individuals who have had SARS-CoV-2 and
recovered (cognitive tests predominantly).
• How are these cognitive tests becoming more culture-fair and applicable to persons
of color? Do they need to?
• What is the correlation between intelligence and success in typical measurements?
• How does this connect with the latest psychedelic research.
• How is intuition addressed?
• Will more advanced imaging techniques eventually make cognitive testing for
diagnosis obsolete?
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RESOURCES
Hampshire, A., Highfield, R., Parkin, B. and Owen, A.M. (2012). Fractioning human intelligence. Neuron,
76. 225-1237. https://doi.org/10.1016/j.neuron.2012.06.022
Sternin, A., Burns, A., & Owen, A. M. (2019). Thirty-five years of computerized cognitive assessment of
aging—where are we now? Diagnostics, 9, 114. https://dx.doi.org/10.3390%2Fdiagnostics9030114
Cambridge Brain Sciences: https://www.cambridgebrainsciences.com - Get a free trial to try out CBS
Health
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Final Thoughts
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THANK YOU
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