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Original Research

The THINC-Integrated Tool (THINC-it) Screening Assessment for Cognitive Dysfunction: Validation in Patients With Major Depressive Disorder

Roger S. McIntyre, MD, FRCPC; Michael W. Best, MSc; Christopher R. Bowie, PhD, CPsych; Nicole E. Carmona, HBSc; Danielle S. Cha, HBSc, MSc; Yena Lee, BSc; Mehala Subramaniapillai, MSc; Rodrigo B. Mansur, MD; Harry Barry, MD; Bernhard T. Baune, PhD, MD, MPH, FRANZCP; Larry Culpepper, MD, MPH; Philippe Fossati, MD; Tracy L. Greer, PhD; Catherine Harmer, DPhil, MA, DipLATHE; Esther Klag, PhD; Raymond W. Lam, MD; Hans-Ulrich Wittchen, PhD; and John Harrison, PhD, CSci, CPsychol

Published: August 23, 2017

Article Abstract

Objective: To validate the THINC-integrated tool (THINC-it)—a freely available, patient-administered, computerized screening tool integrating subjective and objective measures of cognitive function in adults with major depressive disorder (MDD).

Methods: Subjects aged 18 to 65 years (n = 100) with recurrent MDD experiencing a major depressive episode of at least moderate severity were evaluated and compared to age-, sex-, and education-matched healthy controls (n = 100). Between January and June 2016, subjects completed the THINC-it, which includes variants of the Choice Reaction Time Identification Task (IDN), One-Back Test, Digit Symbol Substitution Test, Trail Making Test-Part B, and the Perceived Deficits Questionnaire for Depression-5-item (PDQ-5-D).

Results: The THINC-it required approximately 10 to 15 minutes for administration and was capable of detecting cognitive deficits in adults with MDD. A total of 44.4% of adults with MDD exhibited cognitive performance at ≥ 1.0 SD below that of healthy controls on standardized mean scores of the THINC-it. Concurrent validity of the overall tool, based on a calculated composite score, was acceptable (r = 0.539, P < .001). Concurrent validity of the component tests ranged from −0.083 (IDN) to 0.929 (PDQ-5-D). Qualitative survey results indicated that there was a high level of satisfaction and perceived value in administering the THINC-it regarding its impact on the appropriateness and quality of care being received.

Conclusions: The THINC-it is a valid and sensitive tool for detecting cognitive dysfunction in adults with MDD that is free, easy to use, and rapidly administered. The THINC-it should be incorporated into the assessment and measurement of all patients with MDD, particularly among those with enduring functional impairment.

Trial Registration: identifier: NCT02508493

Volume: 78

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