Using the CANTAB to investigate
cognitive deficits in ASPD
Executive functions
ASPD

Prevalent

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


1-1.3% in GP
47% in prisons
Poor prognosis
High societal costs
Resistance to treatment
Cognitive functions (Lezak et al., 2004)

Executive

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Volition
Planning
Purposive action
Self-regulation
Effective performance
Planning & Effective performance

Planning
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
ToL: Barkataki et al. (2005)
SOC: Dolan & Park (2002)
n-back: Kumari et al. (2006)
Porteus mazes: Stevens et al. (2003)
Effective performance

C/W Stroop: Barkataki et al. (2005)
Self-regulation (1)
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Productivity
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COWAT: Stevens et al. (2003)
Motor regulation
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Response inhibition
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
Go/NoGo (Barkataki et al., 2008; Dolan & Park,
2002; Howard et al., 1997; Völlm et al., 2010)
Response delay (Swann et al., 2009)
Self-regulation (2)
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Cognitive flexibility
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Response reversal
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Attentional set-shifting
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IED: Dolan & Park (2002)
WCST: Barkataki et al. (2005) & Stevens et al. (2003)
IED: Dolan & Park (2002)
Alternating stimuli
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TMT-B: Stevens et al. (2003)
METHOD
Participants
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102 male inpatients at the PDS, Arnold Lodge
Regional Secure Unit
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17 excluded:
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ASPD n=52; non-ASPD n=33
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IQ<70
History of MMI & TBI
AGN & CGT
20 male ancillary staff
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IQ>70
Free from MMI & TBI
Free from current/past substance abuse
Measures
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Patients: ASPD vs. non-ASPD
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SADS-L/SCID-I:CV
IPDE
WAIS-III
Healthy controls
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MINI
Quick Test
IPDE Screening questionnaire
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Interview if necessary
The Executive CANTAB
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Planning
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Decision-making
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Response control
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Cognitive flexibility
Planning:
Stockings of Cambridge (SOC)
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Perfect solutions
Mean moves to
solution
Executive CANTAB

Planning – SOC

Decision-making
Decision-making:
Cambridge Gambling Task (CGT)


Quality of decisionmaking
Overall proportion
bet
Executive

Planning – SOC
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Decision-making – CGT
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Response control
Motor/response control: Inhibition
Affective Go/NoGo (AGN)
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# Commission errors
Executive
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Planning – SOC
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Decision-making – CGT
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Motor/response control –
AGN
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Cognitive flexibility
Cognitive flexibility:
Intra/extra-dimensional set-shifting (IED)
Cognitive flexibility:
Attentional set-shifting (IED)

# Errors
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Reversal
EDS
The Executive CANTAB
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Planning – SOC
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Decision-making – CGT
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Motor/response control –
AGN & IED
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Cognitive flexibility – IED
RESULTS
Sample characteristics
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Groups matched on:
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IQ
Basic education (yrs)
Number of PDs other than ASPD
Mood stabilisers
Age: non-ASPD>ASPD
SRD: ASPD>non-ASPD
Antidepressants: non-ASPD>ASPD
Planning (SOC): Perfect solutions
ASPD & N-ASPD<HC but not different
compared to each other.
12
10
Perfect solutions

8
6
4
2
0
ASPD
N-ASPD
Group
HC
Planning (SOC): Mean moves

ASPD & N-ASPD<HC but not different
compared to each other
Moves
6.8
5.8
4.8
ASPD
3.8
N-ASPD
2.8
HC
1.8
2
3
4
Problem difficulty (minimum moves to solution)
5
Decision-making (CGT): Quality
of decision-making


ASPD & N-ASPD<HC
Group x increment interaction
Decision-making
1
0.95
0.9
ASPD
0.85
N-ASPD
0.8
HC
0.75
Ascending
Descending
Bet increment
Decision-making (CGT): Quality
of decision-making

Decision-making

ASPD & N-ASPD<HC
Group x odds interaction
1
0.95
0.9
0.85
0.8
0.75
0.7
0.65
ASPD
N-ASPD
HC
9:1
8:2
7:3
Betting odds
6:4
Response inhibition (AGN):
Commission errors

ASPD>HC
14
Number of errors
12
10
8
6
4
2
0
ASPD
N-ASPD
Group
HC
Response reversal & Attentional
set-shifting (IED): # errors

Reversal: ASPD>N-ASPD & HC
EDS: ASPD>HC
16
14
12
Errors

10
ASPD
8
6
N-ASPD
4
HC
2
0
Reversal
EDS
Error type
Results summary
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Non-characteristic deficits:
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Planning
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Broadly agreed with Dolan & Park (2002)
Quality of decision-making
Characteristic deficits (?):

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Response inhibition
Response reversal & Attentional set-shifting

Some agreement with Dolan & Park (2002)
Limitations

Unable to place N-ASPD
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Effect of substance abuse

Confounding of offending
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Limited power for AGN and particularly CGT
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