November 15, 2017

THINC-it: Measuring Cognition in MDD

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Roger S. McIntyre, MD, FRCPC

Mood Disorders Psychopharmacology Unit, University Health Network; Brain and Cognition Discovery Foundation; and the University of Toronto, Toronto, Canada​


Patients, families, health care providers, and other stakeholders are highly familiar with the fact that therapeutic outcomes in major depressive disorder (MDD) are not acceptable. In other words, most people who are diagnosed and treated with conventional treatment for MDD do not experience full symptom resolution and/or functional recovery. During the past few decades, results from convergent lines of research indicate that cognitive problems intrinsic to MDD are a common reason for failure to achieve the desired therapeutic objectives.

Historically, disturbance in a person’s mood (eg, sadness and/or difficulty experiencing pleasure) has been the primary focus in MDD from a diagnostic and treatment perspective. What has emerged during the past decades, however, is that MDD is a multidimensional syndrome with disturbances in mood, affect regulation, sleep and biological rhythm, and cognitive processes as well as physical functions. Moreover, antidepressant medications have been studied with an aim to reduce overall depression symptoms. However, a fine-grained look at the data indicates that most antidepressants are not capable of offering clinically relevant improvements in measures of cognitive function.

Research shows that measuring depressive symptoms in MDD is associated with both better treatment outcomes and a greater overall satisfaction with care. Unfortunately, most available scales that measure depressive symptoms (eg, the Patient Health Questionnaire [PHQ-9]) do not sufficiently evaluate the cognitive domain of symptoms. Furthermore, screening tools for dementia (eg, Mini-Mental Status Examination [MMSE]) are not sufficiently sensitive for detecting cognitive function in individuals with MDD.

The clinical relevance of cognitive symptoms in MDD as well as the absence of a sufficient tool provided the impetus to validate the THINC-integrated tool (THINC-it) in adults aged 18–65 years diagnosed with DSM-5–defined MDD. The THINC-it was found to be a reliable tool for detecting cognitive deficits in individuals with MDD. It also demonstrated convergent validity with other cognitive tests (eg, Trail Making Test-B).

The THINC-it is a free, patient-administered, easy-to-use, fully-computerized tool presented in gamified form, and it takes only 10 minutes to complete. Using tools like the THINC-it to evaluate cognitive function is believed to provide a more refined assessment of MDD, leading to determination of why some patients are not able to functionally recover. It is also believed that having information regarding patients’ cognitive performance will assist in treatment selection and refining therapeutic objectives.

The THINC-it tool may be downloaded free of charge from or

Financial disclosure:Dr McIntyre is a consultant and a member of the speakers/advisory boards for Shire, Purdue, Otsuka, Janssen-Ortho, Lundbeck, Pfizer, Neurocrine, Neuralstem, Sunovion, Takeda, and Allergan.

Category: Depression
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