Neuropsychology is all about understanding the brain and how it affects our cognition – our thinking and memory and those sorts of domains – and also how it affects our feelings and our behaviour.
Neuropsychologists work to try to understand and improve cognition, emotion regulation and behaviour in patients who have neurological disorders such as Alzheimer's disease, or who have psychiatric disorders such as attention deficit hyperactivity disorder (ADHD) or who have traumatic brain injury.
With my psychiatrist colleagues, I was one of the first people to set up a memory clinic for the early detection of memory problems in the elderly. And with my psychiatry colleagues we also went on to do clinical trials with patients with Alzheimer's disease.
Some years ago, I published with my psychiatrist colleagues in the Lancet about our discovery that certain drugs that we use could improve attention and memory in patients with Alzheimer's disease. Now, these drugs are called cholinesterase inhibitors – drugs such as Aricept or Ddonepezil – and they are now used within the NHS as effective treatments for the cognitive symptoms of Alzheimer's disease.
However, in order to detect these early memory problems, I had to develop new tests. One of the tests I developed was the CANTAB-PAL test. CANTAB was one of the first set of tests to use touchscreen technology and to run on computers. CANTAB is now used in over 100 different countries and over 1700 hospitals, universities and institutes.
The CANTAB-PAL studies learning and memory, because this is one of the first problems that patients with Alzheimer's disease have, even in the very earliest stages of Alzheimer's which is called amnestic mild cognitive impairment, or MCI. CANTAB measures episodic memory, an everyday type of memory. It's a sort of memory we use when we're trying to remember where we left our mobile phones in the house, or where we left our car in a multistorey car park.
In the brain, the hippocampus helps us with our episodic memory, and the hippocampus is one of the first areas in the brain to be affected in Alzheimer's disease. And that's why the CANTAB-PAL test is so sensitive.
In one example of a CANTAB-PAL test, you would see six white boxes presented on the screen. They will open in a random order and in some of the boxes patterns will be located. You would need to remember where the pattern is located in each of those boxes. If you make a mistake, the task will re-show you each of the boxes and it will help you to try and remember where that pattern was located. The task starts off very easy to make sure that you know exactly what you're doing, and it becomes progressively more difficult.
In addition to CANTAB-PAL, there are many other CANTAB tests. One of them is a test of cognitive flexibility. Cognitive flexibility is important for learning and also for decision-making and its impaired in obsessive compulsive disorder, and also in Parkinson's disease and Huntington's disease. We also develop tests of attention and concentration, which are very important for assessing and looking at treatments for young people and adults with ADHD.
Most psychiatric disorders, such as anxiety and depression, have associated cognitive problems, and these cognitive problems must be fully treated so that when people go back to university or work, they are successful within that environment. We also have tests of risky decision making, and these are very important for assessing such things as harmful gambling or substance misuse disorders. These tests can also look at whether there are treatments that are effective for these disorders.
In addition, we have tests that we use with ‘healthy’ people –for example, to assess psychopharmacological ‘smart drugs’ to see whether these smart drugs really do make people smarter. Do they improve attention, learning, memory and planning?
An area that I've been working on recently is cognitive training or brain training. This is applied to games to see whether we can improve learning, memory and attention in people, both in ‘healthy’ adults and also in patients. We've used these tests with patients with stroke, schizophrenia and MCI.
Two of these games, ‘Decoder’ and ‘Wizard’, have been technology-transferred to the games company Peak and also PopReach and now they are available to download as apps for mobile phones to Apple App Store or Google Play. When I co-invented these games, I worked with a games developer, Tom Piercy, to make sure that the games are really fun and easy to use for people.
One of the key games is ‘Wizard’ for improving memory. In the ‘Wizard’ game you're a wizard and there's another wizard. In order to move ahead in the game, you have to remember where runes are in different chests. And if you do this well and you're successful, then you get potions for spells that you can cast at the other wizard, and so you can go on to win. There's lots of reward along the way to winning.
If you can improve patient's cognition and daily functioning, they will have that better quality of life and better well-being.
Barbara Sahakian FBA is Professor of Clinical Neuropsychology, Department of Psychiatry and MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute at University of Cambridge
