1. Cognition Workshop Dr Jill Rasmussen Dr Amy Chappell

2. 2 Declaration of Interests  NHS:  East Surrey CCG Commisisioning Lead for Mental Health, Learning Disability and Dementia  Strategic Clinical Network Lead Dementia SE Coast  Co-developer of Depression Anxiety Pathway  Royal College of General Practitioners  Chair Learning Disability Special Interest Group  Clinical Champion Dementia  Consultancy/ Advisory Boards / Speakers Bureau  Chair Lewy Body Society, GP Advisor to Alzheimer’s Society  Autism Therapeutics, Chronos, Lilly, Lundbeck, Napp, Novartis, Otsuka, Pfizer, Roche, Servier, Targacept, TauRX.

3. 3 Overview  7.30 – 7.35 Welcome and Introduction  Jill Rasmussen  7.35 am – 7.55 am  Designing a Battery for Clinical Trials: The MATRICS Project for Schizophrenia  Richard Keefe, PhD, Duke University Medical Center  7.55 am – 8.20 am  The Problem of Cognitive Dysfunction/Decline in Epilepsy  Kimford Meador, MD, Stanford University School of Medicine  8.20 to 8.40  Regulatory Considerations  Philip Sheridan Div Neurology Products FDA  8.40 am – 9.00 am Panel Discussion

4. Cognition Workshop – The Issue  Cognitive impairment is a feature of many psychiatric and neurological disorders and is a major cause of poor functioning for patients.  Compounding this problem many treatments for these disorders are also associated with cognitive impairment.  There is a growing interest in developing treatments for cognitive impairment but a major obstacle to the field has been the lack of an accepted standard for measuring cognitive change.

5. Cognitive Impairment in Epilepsy Factors Seizure type, frequency, duration severity AED Side-effects Psychosocial factors Cerebral function During ictal / post- Ictal phases Age of Onset of Epilepsy Cerebral Damage Prolonged seizures Status, surgery 5

6. Cognitive Impairment in Epilepsy – Issues & Examples of Domains Affected  Adults newly diagnosed epilepsy:  Pts under-report cognitive problems  75% have deficits in attention, executive function, memory Attentional and executive function 49.4% Memory deficits 47.8%  Chr Temporal Lobe Epilepsy – 20% patients  Pts with lower baseline IQ, longer epilepsy duration, older age, and smaller baseline lt hippocampal volume were most susceptible to cognitive decline.  Domains most adversely affected over time - memory, psychomotor speed, executive function, naming. Ref: Rudzinski and Meador Continuum (Minneap Minn) 2013;19(3):682–696

7. Cognitive Impairment in Epilepsy – Challenges  The discrepancy between subjective perception and objective measures of cognitive performance in epilepsy patients requires a different approach is needed when evaluating patients.  Need to evaluate cognition at initial presentation and over the course of the disorder to detect:  Detect Improvement / Deterioration  Intervene as appropriate

8. 8 Cognitive Impairment in Epilepsy - Questions  How should we be addressing the issue of cognitive impairment in epilepsy:  Identification  Ongoing evaluation  Management  Rationale for standardisation in approach?  Impact of AEDs on developing / mature brain  Risk / benefit current treatments  New treatments – drug / non-drug  What can we learn from others?  MATRICS

9. 9 Overview  7.30 – 7.35 Welcome and Introduction  Jill Rasmussen  7.35 am – 7.55 am  Designing a Battery for Clinical Trials: The MATRICS Project for Schizophrenia  Richard Keefe, PhD, Duke University Medical Center  7.55 am – 8.20 am  The Problem of Cognitive Dysfunction/Decline in Epilepsy  Kimford Meador, MD, Stanford University School of Medicine  8.20 to 8.40  Regulatory Considerations  Philip Sheridan Div Neurology Products FDA  8.40 am – 9.00 am Panel Discussion