Neuropsychological deficits among older depressed patients with predominantly psychological or vegetative symptoms

The impact of comorbid depression-diabetes on proteomic outcomes among community-dwelling Mexican Americans with mild cognitive impairment

BACKGROUND

Mexican Americans suffer from a disproportionate burden of modifiable risk factors, which may contribute to the health disparities in mild cognitive impairment (MCI) and Alzheimer's disease (AD).

OBJECTIVE

The purpose of this study was to elucidate the impact of comorbid depression and diabetes on proteomic outcomes among community-dwelling Mexican American adults and elders.

METHODS

Data from participants enrolled in the Health and Aging Brain among Latino Elders study was utilized. Participants were 50 or older and identified as Mexican American (N = 514). Cognition was assessed via neuropsychological test battery and diagnoses of MCI and AD adjudicated by consensus review. The sample was stratified into four groups: Depression only, Neither depression nor diabetes, Diabetes only, and Comorbid depression and diabetes. Proteomic profiles were created via support vector machine analyses.

RESULTS

In Mexican Americans, the proteomic profile of MCI may change based upon the presence of diabetes. The profile has a strong inflammatory component and diabetes increases metabolic markers in the profile.

CONCLUSION

Medical comorbidities may impact the proteomics of MCI and AD, which lend support for a precision medicine approach to treating this disease.

The double burden of age and major depressive disorder on the cognitive control network

Poor cognitive control (CC) is common among older individuals with major depressive disorder (OMDD). At the same time, studies of CC in OMDD with fMRI are relatively limited and often have small samples. The present study was conducted to further examine poor CC in OMDD with early onset depression, as well as to investigate the interactive effects of MDD and aging on cognitive control. Twenty OMDD, 17 older never-depressed comparisons (ONDC), 16 younger adults with MDD (YMDD), and 18 younger never-depressed comparisons (YNDC) participated. All participants completed the Go level of the Parametric Go/No-Go Test, which requires sustained attention and inhibitory control while undergoing functional MRI (fMRI). YNDC were faster in reaction times (RTs) to go targets relative to the other 3 groups, and the YMDD group was faster than the OMDD group. fMRI effects of both age and diagnosis were present, with greater activation in MDD, and in aging. Additionally, the interaction of age and MDD was also significant, such that OMDD exhibited greater recruitment of fronto-subcortical regions relative to older comparisons. These results are consistent with prior research reporting that OMDD recruit more fronto-striatal regions in order to perform at the same level as their never-depressed peers, here on a task of sustained attention and inhibitory control. There may be an interaction of cognitive aging and depression to create a double burden on the CC network in OMDD, including possible fronto-striatal compensation during CC that is unique to OMDD, as younger MDD individuals do not show this pattern.

Cognitive Rehabilitation with Older Adults

The proportion of older adults seeking rehabilitation services are certain to rise as the population ages. Cognitive rehabilitation techniques can be successfully adapted and used with older adults with a range of clinical diagnoses. An understanding of cognitive changes which could be expected as a result of “normal” (non-disease-related) aging is essential for both assessment and treatment planning for this group. Age-related changes in attention, memory and executive functioning are briefly noted. Common cognitive sequelae of head-injury, depression and dementia are discussed, and useful assessment and rehabilitation strategies described. Case illustrations are used to illustrate major points.

A depressive endophenotype of poorer cognition among cognitively healthy community-dwelling adults: results from the Western Australia memory study

OBJECTIVE

The objective was to evaluate in a cognitively normal population the utility of an endophenotype of the depression-cognition link previously shown to be related to cognitive functioning in mild cognitive impairment and Alzheimer's disease.

METHODS

The data of 460 cognitively normal adults aged 32-92 years (M = 63.5, standard deviation = 9.24) from the Western Australian Memory Study with the Cross-national comparisons of the Cambridge Cognitive Examination-revised (CAMCOG-R) scores and 30-item Geriatric Depression Scale (GDS) scores were analyzed to determine the relationship between the five-item depressive endophenotype (DepE) scale drawn from the GDS and level of performance on a measure of cognitive functioning.

RESULTS

For the entire sample, there was a nonsignificant trend toward a negative relationship between DepE and CAMCOG-R scores. When analyzed for those 65 years and older, there was a significant negative relationship between the two measures (p = 0.001) with DepE scores significantly increasing the risk for performing more poorly on the CAMCOG-R (odds ratio = 1.53). Analysis of data for those 70 years and older showed that DepE was the only predictor significantly related to poorer CAMCOG-R performance (p = 0.001). For the 70 years and older group, DepE scores significantly increased the risk of poorer CAMCOG-R scores (odds ratio = 2.23). Analysis of the entire sample on the basis of ApoEε4 carrier status revealed that DepE scores were significantly negatively related only to ApoEε4 noncarrier regardless of age.

CONCLUSIONS

Elevated DepE scores are associated with poor neuropsychological performance among cognitively normal older adults. Use of the DepE may allow for the identification of a subset of older adults where depression is a primary factor in cognitive decline and who may benefit from antidepressant therapies.

Saccadic eye movements in depressed elderly patients

The primary aim of this study was to characterize oculomotor performances in elderly depressed patients. The second aim was to investigate whether cognitive inhibition measured by the antisaccade task was associated with a psychomotor retardation or rather with a more specific cognitive-motor inhibition deficit. Twenty patients with a major depressive disorder and forty-seven healthy subjects performed two eye movement tasks. Saccadic reaction time and error rates were analyzed in the prosaccade task to obtain basic parameters of eye movements. Saccade latency, error rates and correction rates were evaluated in the antisaccade task to investigate inhibition capacities. Performances were impaired in patients, who exhibited a higher reaction time and error rates compared to controls. The higher time cost of inhibition suggested that the reaction time was not related to global psychomotor retardation alone. The higher time cost of inhibition could be explained by a specific alteration of inhibition processes evaluated by the antisaccade task. These changes were associated with the severity of depression. These findings provide a new perspective on cognitive inhibition in elderly depressed patients and could have important clinical implications for our understanding of critical behaviors involving deficits in inhibitory processes in the elderly.

Correlates of cognitive impairment in older Vietnamese

OBJECTIVES

This study examined correlates of cognitive functioning and possible cognitive impairment among older adults living in Da Nang, Vietnam and surrounding rural areas.

METHODS

The analytic sample consisted of 489 adults, 55 and older stratified by gender, age, and residence in a rural or urban area. The sample was 46% rural, 44% women, with a mean age of 69.04. Interviews were conducted in individuals' homes by trained interviewers. The dependent variable was a Vietnamese version of the mini mental status examination (MMSE). A multiple linear regression was run with the MMSE continuous scores reflecting cognitive functioning, while a binary logistic regression was conducted with an education-adjusted cut-off score reflecting possible cognitive impairment. Age, gender, education, material hardship, depressive symptoms Center for Epidemiologic Studies - Depression Scale, war injury, head trauma, diabetes, cardiovascular and cerebrovascular disease conditions served as correlates, controlling for marital status and rural/urban residence.

RESULTS

About 33% of the sample scored below the standard cutoff of 23 on the MMSE. However, only 12.9% of the sample would be considered impaired using the education-adjusted cut-off score. Cognitive functioning and possible cognitive impairment as indicated by MMSE scores were significantly associated with being older, completing fewer years of education, and material hardship. Gender, depressive symptoms, and cerebrovascular disease were associated with cognitive functioning, but not cognitive impairment.

CONCLUSION

These results show that social characteristics, physical illness, and mental health are associated with cognitive functioning. The study also raises questions about the need for standardization of screening measures on Vietnamese populations.

Cognitive differences among depressed and non-depressed MCI participants: a project FRONTIER study

OBJECTIVE

Depression is the most commonly reported psychiatric symptom in patients with mild cognitive impairment (MCI). However, more research is needed examining the impact of depression on cognitive functioning in MCI patients. The purpose of this study was to examine differences in cognitive functioning in a sample of community- based, depressed, and non-depressed MCI patients.

METHODS

One hundred and five participants with MCI were included in this study. Participants were recruited from Project FRONTIER, a study of rural health. Depression was assessed via the Geriatric Depression Scale (GDS-30), and cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status.

RESULTS

The results indicated that depressed MCI participants performed significantly worse than their non-depressed counterparts on several cognitive measures. MCI participants with depression scored significantly lower on immediate memory (t = 3.4, p < 0.01) and delayed memory (t = 2.8, p < 0.01) indices than their non-depressed counterparts.

CONCLUSIONS

The results of this study indicated that MCI participants with depression experienced greater deficits in cognitive functioning than their non-depressed counterparts. Depressed MCI participants exhibited greater deficits in both immediate and delayed memory. Thus, identifying and treating depression in individuals with MCI may improve memory and cognitive functioning.

Investigating the relationship between cognitive change and antidepressant response following rTMS: a large scale retrospective study

BACKGROUND

The use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression has been studied extensively over the last 15 years. In this time the vast majority of trials included assessment of cognition to determine whether the technique is cognitively safe. However, recent evidence suggests that the assessment of cognition could also have an important role to play in the prediction of antidepressant response.

OBJECTIVES

The current study conducted a post hoc analysis of the cognitive data from four clinical trials of rTMS for treatment resistant depression, with an aim to investigate the relationship between early cognitive changes and eventual depression improvement.

METHOD

Data from 137 patients were included in the analysis (62 male and 75 female, mean ages 41.86 ± 11.68 years). The primary outcome measure for all four studies was the Montgomery Asberg Depression Rating Scale (MADRS). Clinical and cognitive assessments were undertaken at baseline, a midtime point, and at endpoint after 4 or 6 weeks of treatment.

RESULTS

There was no cognitive deterioration after a treatment course of rTMS across the four depression trials. Initial improvements in performance on immediate visuospatial memory were significantly related to eventual reduction of depression severity, with visuospatial improvement being a significant predictor of degree of eventual improvement in a near significant regression model.

CONCLUSIONS

Traditionally cognitive batteries in rTMS trials are designed to provide a broad assessment of neuropsychological functioning across numerous cognitive domains; however, there is growing evidence that cognition may have a very important role to play as an early indicator of antidepressant response.

The relation between depressive symptoms and semantic memory in amnestic mild cognitive impairment and in late-life depression

Semantic deficits have been documented in the prodromal phase of Alzheimer's disease, but it is unclear whether these deficits are associated with non-cognitive manifestations. For instance, recent evidence indicates that cognitive deficits in elders with amnestic mild cognitive impairment (aMCI) are modulated by concomitant depressive symptoms. The purposes of this study were to (i) investigate if semantic memory impairment in aMCI is modulated according to the presence (aMCI-D group) or absence (aMCI group) of depressive symptoms, and (ii) compare semantic memory performance of aMCI and aMCI-D groups to that of patients with late-life depression (LLD). Seventeen aMCI, 16 aMCI-D, 15 LLD, and 26 healthy control participants were administered a semantic questionnaire assessing famous person knowledge. Results showed that performance of aMCI-D patients was impaired compared to the control and LLD groups. However, in the aMCI group performance was comparable to that of all other groups. Overall, these findings suggest that semantic deficits in aMCI are somewhat associated with the presence of concomitant depressive symptoms. However, depression alone cannot account solely for the semantic deficits since LLD patients showed no semantic memory impairment in this study. Future studies should aim at clarifying the association between depression and semantic deficits in older adults meeting aMCI criteria. (JINS, 2011, 17, 865-874).

Depressive symptom clusters and neuropsychological performance in mild Alzheimer's and cognitively normal elderly

Objectives. Determine the relationship between depressive symptom clusters and neuropsychological test performance in an elderly cohort of cognitively normal controls and mild Alzheimer's disease (AD). Design. Cross-sectional analysis. Setting. Four health science centers in Texas. Participants. 628 elderly individuals (272 diagnosed with mild AD and 356 controls) from ongoing longitudinal study of Alzheimer's disease. Measurements. Standard battery of neuropsychological tests and the 30-item Geriatric Depression Scale with regressions model generated on GDS-30 subscale scores (dysphoria, apathy, meaninglessness and cognitive impairment) as predictors and neuropsychological tests as outcome variables. Follow-up analyses by gender were conducted. Results. For AD, all symptom clusters were related to specific neurocognitive domains; among controls apathy and cognitive impairment were significantly related to neuropsychological functioning. The relationship between performance and symptom clusters was significantly different for males and females in each group. Conclusion. Findings suggest the need to examine disease status and gender when considering the impact of depressive symptoms on cognition.

The differential impact of depressive symptom clusters on cognition in a rural multi-ethnic cohort: a Project FRONTIER study

OBJECTIVE

To examine the differential impact of depressive symptom clusters on neuropsychological functioning in a rural-dwelling, multi-ethnic cohort.

METHODS

Data were analyzed for 184 participants (70% female, 46% Hispanic) who are part of an ongoing rural healthcare study, Project FRONTIER. Previously published factor scores of dysphoria, meaninglessness, apathy, and cognitive impairment from the GDS-30 were entered as predictor variables in linear regression models with RBANS Index raw scores as outcome variables.

RESULTS

In the total sample, Dysphoria, Meaninglessness, and Cognitive Impairment were significantly associated with Immediate Memory, Language, Attention and Delayed Memory; Dysphoria was also significantly related to Visuospatial skills. When examined by gender and ethnicity, however, the findings varied with dysphoria being most related to cognitive status among men and dysphoria, meaninglessness, and cognitive impairment being most significantly related to cognitive status among women. When examined by ethnicity, dysphoria, meaninglessness, and cognitive impairment were most strongly associated with immediate and delayed memory in Hispanics.

CONCLUSIONS

In this study of rural-dwelling adults and elders, depressive symptom clusters were differentially associated with poorer cognition with the most consistent findings being between depressive symptoms of dysphoria and meaninglessness and the cognitive domains of immediate and delayed memory.

Cognitive and daily functioning in older adults with vegetative symptoms of depression

OBJECTIVES

In primary care 50-95% of patients with depression present with vegetative symptoms (VS). Based on the extant literature, older adults showing VS (but no dysphoria) may show functional impairment but this hypothesis has not been empirically tested. The goal of this study was to examine neurocognitive and daily functioning of elderly patients showing exclusively VS in comparison with patients presenting with VS and dysphoria.

METHODS

Seven hundred and eighty-seven primary care patients received measures of neurocognition and daily functioning. Neurocognition was measured with the repeatable battery for the assessment of neuropsychological status (RBANS). Three groups were compared: (1) patients with two or more VS of depression without dysphoria (VS - D), (2) patients with at least one VS and dysphoria (VS + D), and (3) comparison patients without multiple VS or dysphoria.

RESULTS

Nearly one third of the sample (31%) fell into the VS - D group, whereas 15% fell into the VS + D group. Both VS groups showed poorer neurocognition and activities of daily living than comparisons. Only one subtest of the RBANS (i.e., picture naming) showed a significant difference between VS + D and VS - D, and there was no significant difference on daily functioning. VS - D patients reported less frequent past history of depression and endorsed less anxiety compared to VS + D.

CONCLUSIONS

Elderly patients presenting with clusters of VS with or without dysphoria show poorer neurocognitive and functional performance. Relative poorer cognition and daily functioning in VS - D are potential harbingers of further decline and consistent with under-reporting of sadness in older age.

How late-life depression affects cognition: neural mechanisms

Late-life depression is a major health problem and a significant cause of dysfunction that warrants closer evaluation and study. In contrast to younger depressed patients, most depressed older adults suffer more severe variants of the disorder, including significant cognitive impairments. These cognitive changes add to the severity of symptoms and disability that older depressed patients face and likely reflect compromise of certain neural circuits, linking cognitive impairment to late-life depression. Studies examining clinical correlates, neuropsychological testing, and functional and anatomic imaging have yielded a clearer understanding of the neural mechanisms underlying cognitive deficits in late-life depression. This article discusses cognitive impairment in geriatric depression and how developing a better understanding of its neural correlates may lead to improved understanding and outcome of this specific disorder.

Mood, cognition and in vivo protein imaging: the emerging nexus in clinical neuroscience

INTRODUCTION

Disorders of mood and cognition overlap in the elderly and there is an emerging consensus that both groups of disorders share neurobiological substrates.

METHODS

Salient peer reviewed articles focusing on late-life depression, structural neuroimaging and recent developments in positron emission tomography based in vivo protein imaging.

RESULTS

Epidemiological and clinical evidence indicates that mood and cognition in the elderly are clinically inter-related and common neurobiological mechanisms may underlie both groups of disorders. Degenerative, vascular and related mechanisms like genetically programmed abnormal protein deposition may provide the underlying neurobiological links between these disorders.

CONCLUSIONS

Modern neuroimaging approaches such as positron emission tomography (PET) based in vivo protein binding may help further elucidate common pathophysiological mechanisms and assist in the early identification of patients at risk for developing dementia over time. These developments have important mechanistic and public health significance in the elderly.

Neuropsychological and hypothalamic-pituitary-axis function in female patients with melancholic and non-melancholic depression

BACKGROUND

Executive function deficits in depression implicate involvement of frontal-striatal circuits. However, studies of hypothalamic-pituitary-axis (HPA) function suggest that stress-related brain changes of hippocampus may also implicate prefrontal-hippocampal circuits, which may explain the profile of both executive dysfunction and memory deficits. In this study we examined the performance of patients with major depressive disorder (MDD) on tasks of memory and executive function in relation to melancholic features and to cortisol levels. Our hypothesis was that raised cortisol levels in melancholic patients would correlate with these deficits.

METHOD

Forty female MDD patients, 20 having melancholic features (MEL vs. Non-MEL), and 20 sex-age- and education-matched normal controls were investigated using the Cambridge neuropsychological test automated battery (CANTAB), to assess memory (paired associative learning, PAL; short-term recognition memory, SRM) and executive (intradimensional/extradimensional set-shifting, ID/ED; Stockings of Cambridge, SOC) functions. Plasma and salivary cortisol levels were measured.

RESULTS

The MDD patients performed worse than controls on PAL and both executive tasks. The MEL group differed from controls on all tests, and differed from the non-MEL only at the ED stage of the ID/ED task. Patient cortisol levels were within the normal range and did not correlate with neuropsychological performance for any group.

CONCLUSIONS

MDD patients showed neuropsychological deficits on tasks of executive function and memory, supporting the model of frontal-temporal dysfunction. MEL vs. non-MEL performed worse overall and demonstrated a qualitative difference in set shifting, perhaps implicating more extensive prefrontal involvement. Cortisol levels did not correlate with depression severity or the observed deficits.

Geriatric depression and cognitive impairment

Cognitive impairment is common in geriatric depression, and depressed individuals with co-morbid cognitive impairment are at increased risk for a number of adverse medical, psychiatric and cognitive outcomes. This review focuses on clinical issues surrounding the co-occurrence of these two conditions within the context of current research. We (1) review the clinical criteria and prevalence of depression, as well as co-morbid cognitive impairment, (2) discuss factors associated with persistent cognitive impairment in depression, including dementia, and (3) review research relevant to the assessment and treatment of cognitive impairment and dementia in the context of depression. We conclude that current research on depression and cognition can inform clinical decisions that reduce the occurrence of adverse outcomes. Clinicians are encouraged to develop proactive approaches for treatment, which may include combinations of pharmacological and psychotherapeutic interventions.

Symptoms of depression and cognitive functioning in older American Indians

Depression and lower cognitive functioning are common conditions in older populations. While links between psychopathology and neuropsychological performance have been studied in the white majority population, little is known about such links in the American Indian population. American Indians aged 60 and older (n=140) completed structured interviews that included a depression screener and two cognitive screening measures, the Mini-Mental State Examination (MMSE) and the Mattis Dementia Rating Scale (MDRS). Participants had mean values of 26.7/30 on the MMSE and 125.8/144 on the MDRS. The depression screen was not associated with the MMSE or MDRS total scores. However, older American Indians who screened positive for depression scored lower than did those American Indians who screened negatively for depression (27.7 versus 29.8 respectively) on the MDRS conceptualization subscale after adjusting for sociodemographic and health variables. The combined effects of psychopathology and cognitive impairment are likely to adversely impact the health and welfare of American Indians and their families. More research is needed to provide a better understanding of the relationship between psychopathology and cognition that will help inform clinical treatment for psychopathology in older ethnic minorities.

Education did not interact with major depression on performance of memory tests in acute southern Brazilian in patients

The relationship of cognitive function to depression in older adults has become a topic of extensive clinical interest and research.

OBJECTIVE

To analyze association between cognitive/memory performance,Major Depression, and education in 206 inpatients from the Psychiatry and Internal Medicine Departments.

METHODS

Patients were evaluated by the Mini Mental State Examination, a battery of memory tests, and the Montgomery-Åsberg Depression Rating Scale. Depression patients comprised 45 severe and 42 mild/moderate, according to the Montgomery-Asberg scale. The effect of psychoactive drugs was recorded (30% drug-free). Education was measured in years. Cognitive/memory tests assessed five domains: general mental functioning, attention, sustained attention/working memory, learning memory (verbal), and remote memory. An index for memory impairment was created (positivity: 50% of tests below cutoff).

RESULTS

The chief effect on worse performance was Major Depression for the domains (age and education adjusted) of attention, learning, remote memory, and general functioning. For the domain "sustained attention and working memory", only severely depressed patients differed from the medical controls (p=.008). Education showed an independent effect on test performances. No interaction between depression and educational status was observed.We also observed an independent effect of psychoactive drugs on some cognitive/memory domains. Logistic Regression showed Major Depression as the main risk for cognitive impairment.

CONCLUSIONS

These data demonstrated association of Major Depression with impaired cognitive performance independent of educational attainment or psychiatric medications.

The association between depressive mood and cognitive performance in an elderly general population - the MEMO Study

The aim of this study was to analyse the influence of the severity of depressive symptoms on different domains of cognitive function in the elderly. In a population-based cross-sectional study, 385 participants aged 65-83 years were interviewed with the Center for Epidemiologic Studies Depression Scale (CES-D) and performed a standardized neuropsychological test assessing attention, memory, cognitive speed and motor function. Multivariate linear regression analyses revealed a significant effect of depressive symptoms on a single test (Stroop test 1) and two summary scores (memory and motor function). After full adjustment for education and Mini Mental State Examination, the memory score was partly attenuated. Stratified analysis showed that an increase in CES-D scores led to a larger decline of cognitive test results in participants with mild to moderate depressive symptoms, compared to those with a high degree of depressive symptoms. Our results suggest that depressive mood in older adults is primarily associated with decreased processing speed and motor functioning, but not executive control functions. According to our results depressive mood is not necessarily associated with memory deficits in older adults. Changes in depressive symptoms in milder forms of depressive mood are associated with a larger decline in cognitive function than in severer forms of depressive mood.

Types of information physicians provide when prescribing antidepressants

BACKGROUND

Providing antidepressant information to patients may foster greater adherence to therapy.

OBJECTIVE

To assess physician information-giving while prescribing antidepressants, and to identify factors that influence the provision of information.

DESIGN

Randomized experiment using standardized patients (SPs). Standardized patients roles were generated by crossing 2 clinical conditions (major depression or adjustment disorder) with 3 medication request types (brand-specific, general, or none).

PARTICIPANTS

One hundred and fifty-two general internists and family physicians recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%.

MEASUREMENTS

We assessed physician information-giving by analyzing audio-recordings of interactions between physicians and SPs, and collected physician background information by survey. Generalized estimating equations were used to examine the influence of patient and physician factors on physicians' provision of information.

RESULTS

One hundred and one physicians prescribed antidepressants, accounting for 131 interactions. The mean age of physicians was 46.3 years; 69% were males. Physicians mentioned an average of 5.7 specific topics of antidepressant-related information (of a possible maximum of 11). The most frequently mentioned topic was purpose (96.1%). Physicians infrequently provided information about the duration of therapy (34.9%) and costs (21.4%). Standardized patients who presented with major depression received less information than those with adjustment disorder, and older and solo/private practice physicians provided significantly less information to SPs.

CONCLUSIONS

Physicians provide limited information to patients while prescribing antidepressants, often omitting critical information that may promote adherence. Mechanisms are needed to ensure that patients receive pertinent antidepressant information.

Set shifting deficits in melancholic vs. non-melancholic depression: preliminary findings

Twenty-two patients with major depressive disorder, 11 of them with melancholic features, and 11 controls were investigated with CANTAB subtests focusing in visual memory/learning and executive functions. Melancholic patients performed worse than the other groups in all tasks and manifested a significant impairment in set shifting. The results are discussed in association with prefrontal dysfunction.

[Place and role of neuropsychological exam in elderly depression]

PURPOSE

Neuropsychology provides essential information to all participants (physicians, psychologists, occupational therapists) involved in the treatment of the elderly. When treating depressed elderly patients, a comprehensive neuropsychological examination is required for diagnosis, prognosis and to control the effectiveness of antidepressant treatment.

KEY MESSAGE AND RECENT FACTS

Depression in elderly people is frequent and difficult to diagnose. Some forms of depression usher in or are associated with a neurodegenerative disease. In the case of diagnosis, the neuropsychological examination should furnish useful information to guide the clinician. The qualitative analysis of results (strategies used and type of errors) and the weakening of cognitive processes efficiency provides supplementary information and increases the reliability of the diagnosis. It also gives information about the long term evolution of cognitive deficits. It should reveal the presence of characteristics which help to distinguish patients who are developing dementia (predictive power of certain tests). Finally, it enables the clinician to evaluate the outcome of antidepressant treatment, to adjust the prescription according to the performance and to adapt an holistic treatment.

PERSPECTIVE AND PROJECTS

A neuropsychological examination may provide new perspectives, such as the possibility of predicting the outcome of dementia which are accompanied by affective disorders, such as Alzheimer's disease, vascular dementia and frontotemporal dementia. Neuropsychology may thus improve the treatment of these patients by providing information to a better understanding of their deficits and their impact on daily living abilities.

Executive deficits in elderly patients with major unipolar depression

Several studies have evaluated executive function in depressed patients, and the results vary from significant impairment relative to controls to virtually intact performances. To better comprehend executive impairment in elderly patients with major unipolar depression, the performance of 21 elderly depressed patients was compared with that of 19 elderly normal controls on executive tasks. The relationships between memory deficits and depression severity and between memory deficits and executive dysfunction were also examined. Depressed patients' performance was significantly worse than that of controls on almost all executive tasks. Their score for logical memory was significantly correlated with that for several executive tasks. Executive performance was also correlated with depression severity. Unipolar depressed patients present executive deficits. Memory failure in these patients may reflect impairment in retrieval processes, which in turn depends on executive function. Executive deficits are associated with depression severity. These results may be useful in the differential diagnosis between depression and early Alzheimer's disease.

Neurocognitive profiles in elderly patients with frontotemporal degeneration or major depressive disorder

Major depressive disorder (MDD) and frontotemporal dementia (FTD) are both disorders in elderly populations that involve the prefrontal cortex and appear to have similar neurocognitive deficits. This review examined whether there are testable deficits in cognition that are consistent across individuals within the same neuropathological condition that could be used to facilitate early diagnoses. Medline and PsychInfo databases were searched for cognitive studies of depressed and FTD patients that used a matched control group and reported findings with means and standard deviations (N = 312). Effect sizes for FTD patients with mild and moderately advanced disease were compared to effect sizes within subgroups of depressed patients, such as inpatients, outpatients and community volunteers. Moderately advanced FTD patients were more impaired than depressed patients over all domains, particularly in language ability, although depressed inpatients appeared similar to FTD patients in some domains. Effect sizes for FTD patients who were in the mild, or early, stage of the disease (MMSE = 28) were similar to those of depressed outpatients but slightly worse than those of community volunteers in all domains except semantic memory and executive ability. In the latter two domains, even mild FTD patients had notably large deficits. All FTD patients showed more severe deficits in some domains relative to other domains. In contrast, depressed patients tended to vary by clinical presentation or disease severity, but the magnitude of impairment for each subgroup remained relatively consistent across domains and they did not have the severe focal deficits in one or two domains demonstrated by FTD patients.

Residual cognitive impairment in late-life depression after a 12-month period follow-up

OBJECTIVES

This study investigated cognitive impairment in late-life depression in a follow-up design. The main objective was to assess the most important cognitive domains implicated in late-life depression, in patients who underwent pharmacological treatment, in the acute phase and twelve months after.

METHODS

Neuropsychological and clinical data were used from the baseline of patients and controls, to determine the cognitive impairment in the acute phase. Patients repeated the neuropsychological assessment at twelve months.

RESULTS

There were significant differences between patients and controls at baseline. But in the patients there was no change over twelve months. There were no differences between remitted and non-remitted patients on neuropsychological scores.

CONCLUSIONS

The cognitive impairment seen in the elderly depressed patients seems to be a trait characteristic of this mental disease, even when the depressive episode has remitted.

Working memory and prefrontal cortex dysfunction: specificity to schizophrenia compared with major depression

BACKGROUND

A large number of studies suggest the presence of deficits in dorsolateral prefrontal cortex function during performance of working memory tasks in individuals with schizophrenia. However, working memory deficits may also present in other psychiatric disorders, such as major depression. It is not clear whether people with major depression also demonstrate impaired prefrontal activation during performance of working memory tasks.

METHODS

We used functional magnetic resonance imaging to assess the patterns of cortical activation associated with the performance of a 2-back version of the N-Back task (working memory) in 38 individuals with schizophrenia and 14 with major depression.

RESULTS

We found significant group differences in the activation of dorsolateral prefrontal cortex associated with working memory performance. Consistent with prior research, participants with schizophrenia failed to show activation of right dorsolateral prefrontal cortex in response to working memory tasks demands, whereas those with major depression showed clear activation of right and left dorsolateral prefrontal cortex as well as bilateral activation of inferior and superior frontal cortex.

CONCLUSIONS

During performance of working memory tasks, deficits in prefrontal activation, including dorsolateral regions, are more severe in participants with schizophrenia (most of whom were recently released outpatients) than in unmedicated outpatients with acute nonpsychotic major depression.

Influence of age and executive functioning on verbal memory of inpatients with depression

BACKGROUND

Despite many studies demonstrating memory and executive impairments in young and old depressed patients, the relationships between age, executive functioning and memory have not been evaluated in depression. The aim of this study was to investigate if older patients were more vulnerable than younger patients to the impact of depression on memory and if the differences between young and old depressed could be related to executive functioning.

METHODS

Forty-nine inpatients, with unipolar and bipolar depression, ranging in age from 19 to 72 years were compared with 70 controls on a verbal memory task. Age cut-off of 45 years was used as a categorical variable to divide subjects into subgroups. A subset of patients (n=41) was also evaluated with the modified version of the Wisconsin Card Sorting Test and separated into a non-dysexecutive group and a group of patients with mild-executive impairment.

RESULTS

Depressed patients exhibited memory deficits with a pattern of memory failure -- impaired free recall and normal cued recall and recognition -- interpreted as a retrieval problem. Both age and executive function influenced memory performance in depression, however neither group x age interaction nor age x executive status interaction were significant. Multiple regression analysis showed that free recall scores were related to age and psychomotor retardation in depressed patients.

CONCLUSION

Age and executive functioning have different influences on the memory performance of depressed patients. Our findings support an 'executive memory decline hypothesis' in young as well as old depressed patients. The memory deficits in depression may be associated with both trait and state factors and raise questions about the long-term cognitive functioning of patients with recurrent affective disorders.

Problem-solving abilities in unipolar depressed patients: comparison of performance on the modified version of the Wisconsin and the California sorting tests

Problem solving relies on such abilities as decision-making, planning, initiation and hypothesis testing. Although problem-solving deficits have been consistently reported in depression, the specific nature of these deficits is not fully elucidated. In order to assess and isolate cognitive processes underlying problem-solving impairments in depression, depressed patients and normal controls were evaluated with the modified version of the Wisconsin Card Sorting Test (WCST) and the California Card Sorting Test (CCST). The California Card Sorting Test, unlike the modified WCST, provides several different measures of concept generation, concept identification and concept execution. Compared with controls, depressed patients did not show any deficits on all the measures of the modified WCST. In contrast, depressed patients evidenced mild impairment on the CCST with a specific deficit on concept generation but no major problems in concept identification and concept execution. The deficit in concept generation may be rooted in multiple factors such as hypothesis-testing deficits, a loss of cognitive flexibility and a conservative style of response. Since a positive relation between problem-solving deficits and the mean duration of the depressive episode was observed, problem-solving abilities might be predictive of poorer outcome in patients with unipolar affective disorders.

Cognitive disturbance in outpatient depressed younger adults: evidence of modest impairment

BACKGROUND

Investigations of cognitive disturbances among patients with mood disorders have yielded inconsistent results. Although marked neuropsychologic deficits have been reported in elderly patients and in midlife patients with severe depression, the severity of cognitive impairments in medically healthy younger ambulatory adults with depression has not been well characterized.

METHODS

A comprehensive battery of standard neuropsychologic tests and experimental computerized measures of cognitive functioning were administered to unmedicated ambulatory younger adults with mild to moderate nonbipolar depression and to a group of age- and gender-equated healthy subjects.

RESULTS

Patients demonstrated a notable absence of widespread cognitive impairment. Deficits in executive functions were observed on the Wisconsin Card Sort Test but not on several other tests. Despite the absence of significant impairment on tests of attention, memory, and motor performance in the total sample, symptom severity and age of illness onset were correlated with poorer performance on some tests of cognitive functioning even after correction for age.

CONCLUSIONS

These findings, derived from a large sample of unmedicated depressed outpatients, indicate that major depressive disorder in healthy younger ambulatory adults does not cause appreciable impairments in cognitive functioning in the absence of clinical and course-of-illness features.

Cognitive deficits in depression: possible implications for functional neuropathology

BACKGROUND

While depression is known to involve a disturbance of mood, movement and cognition, its associated cognitive deficits are frequently viewed as simple epiphenomena of the disorder.

AIMS

To review the status of cognitive deficits in depression and their putative neurobiological underpinnings.

METHOD

Selective computerised review of the literature examining cognitive deficits in depression and their brain correlates.

RESULTS

Recent studies report both mnemonic deficits and the presence of executive impairment--possibly selective for set-shifting tasks--in depression. Many studies suggest that these occur independent of age, depression severity and subtype, task 'difficulty', motivation and response bias: some persist upon clinical 'recovery'.

CONCLUSIONS

Mnemonic and executive deficits do no appear to be epiphenomena of depressive disorder. A focus on the interactions between motivation, affect and cognitive function may allow greater understanding of the interplay between key aspects of the dorsal and ventral aspects of the prefrontal cortex in depression.

Selective serotonin reuptake inhibitors in affective disorders--II. Efficacy and quality of life

Since their introduction, the selective serotonin reuptake inhibitors (SSRIs) have become one of the most widely used classes of medication in psychiatry. Their popularity is based on apparent efficacy over a wide range of disorders and a favorable side-effect profile. However, as with any psychotropic medication, considerable data are required to define where a drug works and where it does not. There is now a wealth of evidence demonstrating that SSRIs may differ in their efficacy profiles in certain depressive symptoms, in different subtypes of depression, with respect to their ability to maintain efficacy over time, on broader outcomes such as quality of life, and in the consistency of the usually effective minimum therapeutic dose across the age spectrum and across indications. Although this review includes data on all SSRIs, it focuses on fluoxetine and sertraline, which in addition to being the most widely used SSRIs are also the most widely studied. The relative quantity and quality of data on these two SSRIs means that it is possible to make relatively firm inferences regarding their differential effects on affective symptoms and quality of life.