Application of CMINDS® in the FBIRN Study

 

Study Objective

The Function BIRN (FBIRN) Test Bed is employing functional neuroimaging to explore the underlying causes of schizophrenia and to subsequently assess the impact of new treatments on functional brain abnormalities.

The FBIRN’s aim is to develop initial multi-site, imaging calibration methods and a shared data storage infrastructure as well as create imaging analysis and calibration tools for high quality fMRI data that can be openly shared with the scientific community. In completing these goals, FBIRN will provide a large, multi-site, publicly available data repository rich in fMRI, structural imaging, and clinical data so that the research community can develop and test novel hypotheses.

Today, the same person’s brain scan taken at different MRI centers across the country will not produce the same image (Figure 1).

  Figure 1 Figure 1

The FBIRN Test Bed is developing a suite of tools and methods to allow multi-site functional MRI studies to become a regular practice. These tools and methods involve the calibration and collection of data across diverse environments; the storage and management of data in a standardized format; the analysis of multi-site data; and sharing the results in a permanent location. For more information on FBIRN methods and tools, please see the FAQ and these video explanations: http://www.fbirntutorials.org/.


Participating Sites

CMINDS® is being utilized at these eight participating sites: 1) University of Iowa, 2) University of Minnesota, 3) University of New Mexico, 4) San Francisco VA, 5) University of California, Irvine, 6) University of California, Los Angeles, 7) University of California, San Diego, and 8) University of North Caroline.


CMINDS® Computerized Neuropsychological Evaluations

The battery of tests utilized for this study consists of 19 computerized tests and includes the CMINDS® 1) PRE, 2) NAART, 3) SVLT, 4) VST, 5) Trails A, 6) Trails B, 7) Finger Tapping, 8) SDAT, 9) Maze Solving, 10) VFLT, 11) Delay SVLT, 12) Letter Number Ordering, 13) Letter Fluency, 14) Category Fluency, 15) Emotional Discrimination, 16) Stroop, 17) Delay VFLT, 18) CPT-IP, and 19) Card Sorting.

Perception-Response Evaluation (PRE)

The CMINDS® Perception-Response Evaluation (PRE) is a brief test utilized to evaluate a subject’s ability to perceive and respond to the auditory and visual tasks involved in the administration of a CMINDS battery, as well as a means of orienting the subject to CMINDS. The PRE assesses the subject’s ability to read aloud, follow simple instructions, draw and write on the screen using the electronic pen, and press buttons in response to stimuli presented on the screen.

Perception-Response Evaluation (PRE)

The CMINDS® Perception-Response Evaluation (PRE) is a brief test utilized to evaluate a subject’s ability to perceive and respond to the auditory and visual tasks involved in the administration of a CMINDS battery, as well as a means of orienting the subject to CMINDS. The PRE assesses the subject’s ability to read aloud, follow simple instructions, draw and write on the screen using the electronic pen, and press buttons in response to stimuli presented on the screen.

North American Adult Reading Test (NAART)

The CMINDS® North American Adult Reading Test (NAART) is utilized to estimate premorbid intellectual functioning based upon word reading ability. In this test, phonetically irregular words are visually displayed on the subject’s screen. The subject is instructed to say each word aloud as it appears.

Semantic Verbal Learning Test (SVLT)

The CMINDS® Semantic Verbal Learning Test (SVLT) is a word list-learning task utilized to evaluate new learning, short-term and long-term memory, and recognition memory for words. The use of a semantic word list-learning test provides information about how efficiently the subject can employ semantic organizational strategies in learning verbal material. The SVLT is divided into two parts. The first part consists of three immediate “free recall” trials of a list of 12 high-frequency, aurally presented nouns. Within the word list, three semantic categories are defined. Thus, there are four words in each of three categories. The second part consists of the delay and recognition trials, which are outlined under Delay SVLT (below).

Visuospatial Sequencing Test (VST)

The CMINDS® Visuospatial Sequencing Test (VST) assesses a subject’s ability to hold a visual-spatial sequence in working memory. As the name implies, the content is nonverbal. In this test, an array of squares is displayed on the screen. In each trial, squares light up in a spatially-defined sequence that the subject is required to memorize. Upon verbal prompt, the subject uses the electronic pen to tap the squares in the same order that was just presented.

The CMINDS® Trail Making Test part A is widely applied to evaluate attention, visual scanning, visuomotor coordination and sequencing. In this test the subject is required to draw a compound line connecting 25 circles using an electronic pen.

Trail Making Test part B

The CMINDS® Trail Making Test part B is routinely used to assess attention, visual scanning and visuomotor coordination. In addition to attention and visual scanning, Trails B is sensitive to deficits in executive function. Trails B requires the subject to draw a line connecting 13 circled numbers and 12 circled letters in an alternating sequence with an electronic pen.

Finger Tapping

The CMINDS® Finger Tapping Test is utilized in the assessment of motor efficiency, fine motor function, disparity between right and left motor functions, and sustained motor response. During the test, the subject is instructed to place his or her right index finger on the red response button. Aural instructions then prompt: “Ready, Go”. The subject repeatedly taps the response button as many times as they can for 10 seconds.

Symbol Digit Association (SDAT)

In the CMINDS® Symbol Digit Association Test (SDAT), a symbol-digit test “key” appears at the top of the display and is comprised of two rows of matched symbols and numbers. The subject’s task is to verbally match each number listed in a row with its corresponding symbol, as quickly as possible, going from left to right. Performance on the SDAT invokes several functions including scanning, tracking, visual attention, perceptual speed, processing speed, and memory.

Maze Solving

The CMINDS® Maze Solving Test is utilized in the assessment of executive function and evaluates a subject’s planning, foresight, and visuomotor control. During the test, the subject’s task is to trace a path through mazes of varying difficulties, while attempting to avoid dead ends.

Visual Figure Learning Test (VFLT)

The CMINDS® Visual Figure Learning Test (VFLT) is utilized to evaluate multiple facets of visuospatial memory including, immediate, delayed and recognition memory, visuospatial learning and visuomotor skills. The VFLT can be divided into two parts. The first part consists of three immediate “free recall” trials. In the immediate “free recall” trials a set of six geometric figures arranged in a 2x3 order is displayed for ten seconds, after which the subject uses the electronic pen to accurately draw as many of the figures as they can remember, in their original locations. The second part consists of the delay and recognition trials, which are outlined under Delay VFLT (below).

Letter Number Ordering

The CMINDS® Letter Number Ordering Test is utilized to evaluate a subject’s working memory. In each trial, the subject listens to a string of aurally-presented letters and numbers. They must then reorganize them mentally and repeat them back with all the numbers first, in ascending order, followed by all of the letters, in alphabetical order.

 

Delay Semantic Verbal Learning (Delay SVLT)

The CMINDS® Delay Semantic Verbal Learning Test (Delay SVLT) is the second part of the SVLT assessment (outlined above). After a 20 minute delay this second part of the SVLT is administered. It consists of a delayed free recall trial of the original list, in which the original list is not presented. This is immediately followed by a Recognition Trial. In the Recognition Trial a list of 24 words is aurally presented, and the subject must use the response buttons to select ‘Yes’ or ‘No’ indicating whether they recognize the word as having been part of the original list, or not.. The Recognition Trial word list consists of the 12 words presented in the earlier recall trials, plus 12 “new” words. Six of the new words are from the same three semantic categories as the original word list, with the remaining six words being semantically unrelated.

Letter Fluency

The CMINDS® Letter Fluency Test is utilized to assess semantic knowledge, executive functioning, and associated retrieval ability. In this test, the subject’s task is to spontaneously produce as many words as possible that begin with a specified letter. There are three specific letters for each of the separate, 60-second trials.

Category Fluency

The CMINDS® Category Fluency test assesses spontaneous word production in response to a semantic category cue. In this test, the subject’s task is to spontaneously produce as many words as possible from each given category. There are three specific categories: “animals”, “vegetables” and “fruits”, each administered in separate 60-second trials.

Emotion Discrimination Test

In the CMINDS® Emotion Discrimination Test, the subject is instructed that they will see pictures of human faces, two at a time, on the screen, and they must decide whether the two faces pictured are displaying the same or different emotional expressions. For each of the 30 pairs, the subject will enter their response (indicating whether the emotion is the ‘Same’ or ‘Different’) by pressing, with the pen, the appropriate control buttons at the bottom of their screen.

Stroop Test

The CMINDS® Stroop Test is utilized to assess executive functioning and evaluates a subject’s cognitive flexibility, selective attention, and inhibitory processes. The Stroop Test is composed of four sections. In the first section, names of colors are printed in black lettering inside a grid displayed on the subject’s screen. The program provides the subject with verbal instructions to read each word out loud as quickly as possible, starting at the top from left to right. In the second section, coloured squares are displayed on the subject’s screen. The program instructs the subject to name out loud the colors of squares, again starting at the top from left to right. In the third section, coloured words are displayed inside a grid on the subject’s screen. The subject is instructed not to read the words, but to say the color each word is printed in. In the fourth and final section, coloured words are again displayed inside a grid on the subject’s screen. The subject is instructed to say out loud the color that each word is printed in. This section differs from the preceding section because the words spell-out a color that is not congruent with the color the words are printed in. This section tests the subject’s ability to inhibit the intrusion of the actual word.

Delay Visual Figure Learning Test (Delay VFLT)

The CMINDS® Delay Visual Figure Learning Test (Delay VFLT) is the second part of the VFLT assessment (outlined above). Approximately 20 minutes after the three immediate “free recall” trials, the delayed “free recall” trial, is given. In this trial the subject is not shown the figure set, but is only asked to recall, from memory, as many of the figures as they can remember in their original locations. This trial is immediately followed by the Recognition trial. In the Recognition trial, the subject is shown twelve geometric figures, one at a time, and must use the response buttons to select ‘Yes’ or ‘No’ indicating whether they recognize a figure as having been part of the original set of six geometric figures, or not.

CPT Identical Pairs Test (CPT-IP)

The CMINDS® CPT Identical Pairs Test (CPT-IP) is utilized in the assessment of executive function and evaluates a subject’s inhibitory control, or impulsivity, as well as measuring attention and concentration. During the CPT-IP, the subject watches as a sequence of numbers appear in the middle of their screen. The subject’s task is to retain the current digits being presented, in order to compare it with the digits that immediately follow. The subject is instructed to press the response button as quickly as possible when they see a set of numbers repeat itself in succession.

Card Sorting Test

The CMINDS® Card Sorting Test is utilized in the assessment of executive functioning and evaluates aspects such as working memory, the ability to flexibly shift cognitive processes, and perseveration. In the Card Sorting Test, the subject is presented with 4 stimulus cards on their screen. These cards remain on the screen throughout the entire test. Each card contains: a geometric shape that is different from the others, a different number of shapes (1, 2, 3, or 4 shapes), and a different color. The appearance of the stimulus cards does not change during testing. A 5th card is displayed on the screen, which represents the card the subject must correctly match to one of the 4 stimulus cards. The matching task is primarily based upon the shape, color, or number of shapes. The subject uses the electronic pen to select the stimulus card to be matched. After each matching trial, subjects are informed that their response was either correct or incorrect and a new 5th card is then displayed. Depending on the feedback from the program, the subject must continue with the correct strategy or develop a new strategy in order to make a correct match.