Cited by 172Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesHistorical and Modern Theater Studies

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

McIntyre, Roger S., Best, Michael W., Bowie, Christopher R., Carmona, Nicole E., Cha, Danielle S., Lee, Yena, Subramaniapillai, Mehala, Mansur, Rodrigo B., Barry, Harry, Baune, Bernhard T., Culpepper, Larry, Fossati, Philippe, Greer, Tracy L., Harmer, Catherine, Klag, Esther, Lam, Raymond W., Wittchen, Hans-Ulrich, Harrison, John·2017·The Journal of Clinical Psychiatry

DOI 10.4088/jcp.16m11329

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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: ClinicalTrials.gov identifier: NCT02508493.

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Cha, D. S., Carmona, N. E., Rodrigues, N. B., Mansur, R. B., Lee, Y. L., Subramaniapillai, M., Phan, L., Cha, R. H., Pan, Z., Lee, J. H., et al. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.05.006 · Cited by 16
Self-citation
Further validation of the THINC‐it tool and extension of the normative data set in a study ofn = 10.019 typical controls
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“The THINC‐it tool has been validated and reported as a method of detecting caseness in a cohort of individuals living with Major Depressive Disorder (MDD) (McIntyre et al., 2017).”
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Characterizing mood disorders in the AFFECT study: a large, longitudinal, and phenotypically rich genetic cohort in the US
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Autonomic dysregulation, cognition and fatigue in people with depression and in active and healthy controls: observational cohort study
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Making remote measurement technology work in multiple sclerosis, epilepsy and depression: survey of healthcare professionals
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Epigenetic modification related to cognitive changes during a cognitive training intervention in depression
Assche, E. V., Hohoff, C., Zang, J. C. S., Knight, M. J., & Baune, B. T. (2023) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2023.110835 · Cited by 12
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The role of threat anticipation in the development of psychopathology in adolescence: findings from the SIGMA Study
Paetzold, I., Gugel, J., Schick, A., Kirtley, O. J., Achterhof, R., Hagemann, N., Hermans, K. S. F. M., Hiekkaranta, A. P., Lecei, A., Myin‐Germeys, I., et al. (2022) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-022-02048-w · Cited by 10
“In addition, the THINC-it application [41] was used to screen for impairments in cognitive functioning.”
Method
Practical pathway for the management of depression in the workplace: a Canadian perspective
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“THINC-integrated tool (THINC-it) (62) Patient • Computerized cognitive battery assessing both objective and subjective cognitive deficits in MDD • 10–15 min, digital administration of 5 subtests: DSST, CRT, TMT-B, PDQ-D-5, and one-back working memory tool”
MethodSelf-citation
Relationship between objective cognitive functioning and work performance among Japanese workers
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Immune gene co-expression signatures implicated in occurence and persistence of cognitive dysfunction in depression
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Baseline characteristics of a European patient population with difficult-to-treat depression (RESTORE-LIFE) treated with adjunctive vagus nerve stimulation
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Transcranial temporal interference stimulation for treating bipolar disorder with depressive episodes: a feasibility Study
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“…(THINC-it) toassessthe changes in cognitivefunctioning, which includes variants of the Choice Reaction Time Identi ﬁ cation Task (IDN), One-Back Test, Digit Symbol Substitution Test (DSST), Trail Making Test-Part B, and the Perceived De ﬁ cits Questionnaire for Depression-5-item (PDQ-5-D) [26].”
Psychological training to improve psychosocial function in patients with major depressive disorder: A randomised clinical trial
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The impact of depressive symptomology, rumination and objective memory performance on subjective cognitive complaints
Szyszkowska, J., & Bala, A. (2023) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2023.05.351 · Cited by 11
Neurocognition Function of Patients With Bipolar Depression, Unipolar Depression, and Depression With Bipolarity
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Decreased hemodynamic response to fearful faces relative to neutral faces in the medial frontal cortex of first-episode drug-naïve major depressive disorder
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Three Virtual Reality Environments for the Assessment of Executive Functioning Using Performance Scores and Kinematics: An Embodied and Ecological Approach to Cognition
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“19,20 Each test gives one global score of performance.”
Long-term follow-up of brain regional changes and the association with cognitive impairment in quarantined COVID-19 survivors
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“Prior to the analysis, Spotter and Trails test scores were transformed into standard Z scores and multiplied by -1 to ensure a higher score indicated better cognitive function, following guidelines by McIntyre et al. [29].”
The Relationship Between Cognitive Dysfunction Through THINC-Integrated Tool (THINC-it) and Psychosocial Function in Chinese Patients With Major Depressive Disorder
Han, H., Hou, Y., Yao, S., Hu, S., Zhou, Q., Yu, X., McIntyre, R. S., & Shi, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.763603 · Cited by 11
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Cognitive Dysfunction in Major Depressive Disorder: Cause and Effect
Knight, M. J., Aboustate, N., & Baune, B. T. (2018) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-018-0160-y · Cited by 8
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A critical overview of tools for assessing cognition in bipolar disorder
Rossetti, M. G., Girelli, F., Perlini, C., Brambilla, P., & Bellani, M. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000555 · Cited by 7
Clinical Quest for Associated Cognitive Impairment in Major Depressed Patients
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Assessment of cognitive performances in major depressed patients: a 6-month follow-up study
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“During the last decade, cognition has become of large interest because of a question that has been disputed: is there clear evidence of cognitive deficits in both acute and remitted major depressed patients (McIntyre et al. 2017).”
Background
An App-Based Digit Symbol Substitution Test for Assessment of Cognitive Deficits in Adults With Major Depressive Disorder: Evaluation Study
McIntyre, R. S., Lipsitz, O., Rodrigues, N. B., Subramaniapillai, M., Nasri, F., Lee, Y., Fehnert, B., King, J., Chrones, L., Kratiuk, K., et al. (2022) · JMIR Mental Health · doi:10.2196/33871 · Cited by 7
“Many commonly used comprehensive neurocognitive tests are effective MBC assessment tools, but they are lengthy and cumbersome to administer and complete and often require professional interpretation, limiting their implementation outside of a clinical environment [13,14].”
MethodSelf-citation
Factors associated with objective and subjective cognitive impairment in Chinese patients with acute major depressive disorder
Zhu, N., Tong, J., Pei, Y., Zhang, J., & Sun, X. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04857-y · Cited by 8
Cognitive and Functional Assessment of Psychosis Stratification Study (CoFAPSS): Rationale, Design, and Characteristics
Clark, S. R., Schubert, K. O., Olagunju, A. T., Lyrtzis, E., & Baune, B. T. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00662 · Cited by 6
“It has been validated for use in major depression (72).”
BackgroundSelf-citation
Effects of Exercise on Functional Recovery in Patients with Bipolar Depression: A Study Protocol for a Randomized Controlled Trial
Hamada, F., Hori, H., Iida, H., Yokoyama, H., Sugawara, H., Hatanaka, A., Gotoh, L., Ogata, M., Kumagai, H., Yano, R., et al. (2023) · Metabolites · doi:10.3390/metabo13090981 · Cited by 16
“THINC-it ® [55] is a newly developed digital screening instrument for cognitive dysfunction in patients with MDD.”
Neuropsychological instruments for bipolar disorders: A systematic review on psychometric properties
Rossetti, M. G., Girelli, F., Perlini, C., Brambilla, P., & Bellani, M. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.026 · Cited by 7
A Machine-Learning-Based Analysis of Resting State Electroencephalogram Signals to Identify Latent Schizotypal and Bipolar Development in Healthy University Students
Gubics, F., Nagy, Á., Dombi, J. D., Pálfi, A., Szabó, Z., Viharos, Z. J., Hoang, A. T., Bilicki, V., & Szendi, I. (2025) · Diagnostics · doi:10.3390/diagnostics15040454 · Cited by 6
“…Anoma-lous Self-experiences (EASE) [45], Temperament and Character Inventory (TCI-R) [46], Morningness Eveningness Questionnaire (MEQ-SA) [47], The Behavioral Inhibition and Activation System Scales (BIS/BAS scale) [48], Leuven Affect and Pleasure Scale (LAPS) [49], Raven test [50], and THINC [51].”
Validation of the THINC-It Tool for Assessment of Cognitive Impairment in Patients with Bipolar Depression
Zhu, N., Zhang, W., Huang, J., et al. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s401095 · Cited by 6
“Data for the questionnaire items were transformed using an integrated z-score according to a method described by Mclntyre.19 https://doi.org/10.2147/NDT.S401095 DovePress Neuropsychiatric Disease and Treatment 2023:19 446 Powered by TCPDF (www.tcpdf.org) Cronbach’s α coefficient was used to calculate the internal cons…”
MethodResultInfluential
Association of Major Depressive Disorder with remotely administered measures of cognition and subjective report of cognitive difficulties across the adult age spectrum
Mackin, R. S., Jin, C., Burns, E. M., Kassel, M. T., Rhodes, E., Nosheny, R. L., Ashford, M. T., Banh, T., Eichenbaum, J., Knight, K., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.12.045 · Cited by 5
“…in the clinic have shown association of MDD and cognitive dysfunction in the domains of memory, attention, information processing speed, and executive functioning (Hammar et al., 2003; Rock et al., 2014; Weiland-Fiedler et al., 2004; McIntyre et al., 2017; Davis et al., 2017; Chen et al., 2018).”
Web-based cognitive screening in bipolar disorder: validation of the Internet-based Cognitive Assessment Tool in remote administration settings
Petersen, J. Z., Bruun, C. F., Christiansen, S. H., Krogh, H. B., Kuchinke, O. V., Bernsen, C. L., Jespersen, A. E., Bardram, J. E., Kessing, L. V., & Miskowiak, K. W. (2024) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2024.2434601 · Cited by 5
“In keeping with this, key advantages of ICAT, as compared to existing web-based screening tools, e.g. CANTAB and THINC-it [21–23], are its short administration time and the integration of advanced ASR-based algorithms to assess the domain of verbal learning and memory.”
Assessment of current clinical practices for major depression in Japan using a web-based questionnaire
Hori, H., & Yamato, K. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s217098 · Cited by 6
Using early changes in cold cognition to predict response to vortioxetine in major depressive disorder
Park, C., Zuckerman, H., Subramaniapillai, M., Mansur, R. B., Rosenblat, J. D., Cao, B., Iacobucci, M., Lee, Y. L., Levitan, R. D., Blumberger, D. M., et al. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112767 · Cited by 5
Self-citation
The Assessment of Cognition in Translational Medicine: A Contrast Between the Approaches Used in Alzheimer's Disease and Major Depressive Disorder
Harrison, J., & Hendrix, S. B. (2019) · Handbook of behavioral neuroscience · doi:10.1016/b978-0-12-803161-2.00021-7 · Cited by 5
Self-citation
Gender-specific associations of blood immune markers with symptoms and cognitive function in major depressive disorder: a cross-sectional observational study
Yang, D., Zhan, X., Fan, Y., Gao, Y., Ma, Q., Ma, X., & Jia, M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07277-2 · Cited by 6
“Previous studies have demonstrated good test-retest reliability and moderate-to-strong correlations with standard neuropsychological tests [18].”
Measurement-Based Care in Youth: An Opportunity for Better Clinical Outcomes?
Frontini, R., da Costa, C. S., Baptista, S., Garcia, C. D. C., & Vian-Lains, A. (2024) · Healthcare · doi:10.3390/healthcare12090910 · Cited by 4
“To complete the protocol, a screening of cognitive dysfunction is performed through a tablet utilizing the program THINC-IT [29,30].”
Method
Procognitive Effects of Adjunctive D-Cycloserine to Intermittent Theta-Burst Stimulation in Major Depressive Disorder: Effets procognitifs de la D-cyclosérine en traitement complémentaire par la stimulation thêta-burst intermittente dans le trouble dépressif caractérisé
DeMayo, M. M., Cole, J., Sohn, M. N., Bray, S., Harris, A. D., Patten, S. B., & McGirr, A. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241293984 · Cited by 5
“Participants completed the THINC-it, a computerized cognitive battery developed as a cognitive screening tool focused on domains impacted in MDD. 14 The THINC-it has been validated against established cognitive tests, 15 demonstrated to be sensitive to the cognitive de ﬁ cits seen in MDD, 14 and to…”
Influential
Risk Factors Influencing Cognitive Function in Elderly Patients With Late‐Life Depression: A Scoping Review
Jiang, P., Gao, Y., Wang, L., Shao, X., Zhang, L., Zhu, G., & Duan, L. (2025) · Brain and Behavior · doi:10.1002/brb3.70265 · Cited by 4
Clinical practice guidelines on cognitive impairment in bipolar disorders – Assessment and management
Kesavan, M., Rathi, L., Sinha, N., Reddy, P. V., & Bhaskar, M. (2025) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_696_24 · Cited by 4
“2017) [39] web-based, patient-administered cognitive screening tool Uses gamified cognitive tasks to engage patients in completing the tests.”
Effectiveness of rTMS compared to SSRI as early treatment of depression – study protocol of a randomized controlled trial (Early-TMS)
Becker-Sadzio, J., Brendel, B., Weller, S., Bornheimer, E., Mehlig, U., Padberg, F., Vogelmann, U., Kammer, T., Strube, W., Martus, P., et al. (2025) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-025-01975-4 · Cited by 6
Attention-Dominated Cognitive Dysfunction May Be a Biological Marker for Distinguishing SA from SI in Adolescents: A Network Analysis Study Based on Adolescent Depression
Wang, Q., Wen, M., Fan, S., Liu, J., Wang, X., Guo, W., Hu, J., Zhang, J., Li, B., Zhang, L., et al. (2024) · Psychology Research and Behavior Management · doi:10.2147/prbm.s448904 · Cited by 4
“22 Few studies have conducted comprehensive reviews of adolescents’ cognitive function in a brief time.”
BackgroundMethodInfluential
Tablet-Based Cognitive and Eye Movement Measures as Accessible Tools for Schizophrenia Assessment: Multisite Usability Study
Morita, K., Miura, K., Toyomaki, A., Makinodan, M., Ohi, K., Hashimoto, N., Yasuda, Y., Mitsudo, T., Higuchi, F., Numata, S., et al. (2024) · JMIR Mental Health · doi:10.2196/56668 · Cited by 4
“The reliability and stability of the THINC-it have been validated [33,34]; it has also been used in patients with schizophrenia in previous studies [35].”
Method

Authors: McIntyre, R. S., Best, M. W., Bowie, C. R., Carmona, N. E., Cha, D. S., Lee, Y., Subramaniapillai, M., Mansur, R. B., Barry, H., Baune, B. T., Culpepper, L., Fossati, P., Greer, T. L., Harmer, C., Klag, E., Lam, R. W., Wittchen, H.-U., & Harrison, J.
Affiliations: University Health Network (CA)
Queen's University (CA)
Centre for Addiction and Mental Health (CA)
The University of Adelaide (AU)
Boston University (US)
Centre National de la Recherche Scientifique (FR)
The University of Texas Southwestern Medical Center (US)
Warneford Hospital (GB)
University of British Columbia (CA)
King's College London (GB)
ORCID: McIntyre, Roger S.
Best, Michael W.
Bowie, Christopher R.
Carmona, Nicole E.
Lee, Yena
Subramaniapillai, Mehala
Mansur, Rodrigo B.
Baune, Bernhard T.
Culpepper, Larry
Fossati, Philippe
Greer, Tracy L.
Harmer, Catherine
Lam, Raymond W.
Harrison, John
Venue: The Journal of Clinical Psychiatry
Publisher: Physicians Postgraduate Press, Inc
Published: 2017-08-23
Volume: 78
Issue: 7
Pages: 873-881
ISSN: 0160-6689 (ISSN-L)
DOI: 10.4088/jcp.16m11329
OpenAlex: W2747517649
Cited by: 172
References: 0
Citations by year: 2026: 21 · 2025: 20 · 2024: 17 · 2023: 22 · 2022: 26 · 2021: 16 · 2020: 15 · 2019: 16 · 2018: 15 · 2017: 4
FWCI: 9.54
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Psychiatry (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
Keywords: cognitive impairment, major depressive disorder, screening tool, computerized cognitive assessment, concurrent validity, Trail Making Test, Digit Symbol Substitution Test, functional disability
MeSH terms: Adolescent, Adult, Aged, Cognition Disorders, Major Depressive Disorder, Diagnosis, Computer-Assisted, Female, Humans, Male, Mass Screening, Middle Aged, Neuropsychological Tests, Psychometrics, Recurrence, Reference Values, Reproducibility of Results, Young Adult

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

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