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Alsugeir D, John M, Tillyer E, Wei L, Brauer R. Antidepressant medications in women aged 40 and older and the risk of fragility fractures: a systematic literature review and meta-analysis. Expert Opin Pharmacother 2024:1-10. [PMID: 39329177 DOI: 10.1080/14656566.2024.2409316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 09/12/2024] [Accepted: 09/23/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Antidepressants and menopause are risk factors which are independently associated with an increased risk of fractures. This review aims to investigate the risk of fragility fractures in women aged 40 and older and prescribed antidepressants. METHODS A literature search was conducted using PubMed, Ovid Embase, Ovid PsychINFO, Web of Science, and Scopus from inception to 1 June 2024. Relevant citations were identified and screened against our inclusion/exclusion criteria. The study population comprised women over 40 years. The risk of fragility fractures was compared between users and non-users of antidepressants. Risk of bias assessment was carried out using the ROBINS-I tool. A meta-analysis of cohort studies was performed to assess fracture risk associated with prescribing of any antidepressant agents, and SSRIs specifically. RESULTS Of the 3,676 articles retrieved, five observational studies were found eligible for inclusion (n = 1,240,354). In a meta-analysis of 4 studies, an increased risk of fractures in women was associated with the prescribing of antidepressants (HR = 1.62, 95% CI: 1.15-2.28; I2 = 96.50%) and SSRIs in particular (HR = 1.36, 95% CI: 1.20-1.55; I2 = 40.32%). CONCLUSIONS Findings from this review suggest that prescribing of antidepressants is associated with an increased risk of fractures in women aged 40 and older. Substantial heterogeneity between studies may have affected the results of the meta-analysis.
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Affiliation(s)
- Dana Alsugeir
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Merit John
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Emma Tillyer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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2
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Tan SM, Rawtaer I. Social health and cognition: the mediating role of depression and inflammation. THE LANCET. HEALTHY LONGEVITY 2024; 5:e312-e313. [PMID: 38705150 DOI: 10.1016/s2666-7568(24)00065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Shian Ming Tan
- Department of Psychiatry, Sengkang General Hospital, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Iris Rawtaer
- Department of Psychiatry, Sengkang General Hospital, SingHealth Duke-NUS Academic Medical Centre, Singapore.
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3
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Escobar LE, Liew M, Yirdong F, Mandelos KP, Ferraro-Diglio SR, Abraham BM, Polanco-Roman L, Benau EM. Reduced attentional control in individuals with a history of suicide attempts compared to those with suicidal ideation: Results from a systematic review and meta-analysis. J Affect Disord 2024; 349:8-20. [PMID: 38169241 DOI: 10.1016/j.jad.2023.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Neurocognitive profiles may be especially useful to identify factors that facilitate transitioning from contemplating suicide to attempting suicide. Generally, those who attempt suicide show greater disruptions in neurocognitive ability compared to those who think about suicide but do not proceed to attempt. The goal of this systematic review and meta-analysis is to test whether this pattern is observed with attentional control. METHODS We systematically searched PubMed, PsychINFO, CINAHL, and Google Scholar to find pertinent studies. All included studies compared attentional functioning using neutral stimuli. Each sample featured adults with a history of suicidal ideation (SI) and no history of suicide attempts (SA) compared to those with a history of SA. RESULTS We identified 15 studies with 32 effect sizes (N = 931; n = 506 with SI only; n = 425 with SA). SA groups, compared to SI groups, exhibited worse accuracy yet similar reaction time, suggesting a comparatively blunted speed-accuracy tradeoff. Relative to SI, SA groups performed worse on Stroop-like and Go/NoGo tasks. SA performed better than SI on Trail Making Test B, but not A. LIMITATIONS There were few available studies. Most samples were small. We did not differentiate current vs. past SI or high vs. low lethality SA. Only English and Spanish language articles were included. CONCLUSIONS Disrupted attentional control may convey risk for transitioning to SA from SI. More work is needed to determine which components of attention are most associated with suicide risk.
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Affiliation(s)
- Lesly E Escobar
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | - Megan Liew
- Department of Psychology, SUNY Stony Brook, Stony Brook, NY, USA; Department of Psychology, University of Missouri, Columbia, MO, USA
| | - Felix Yirdong
- Department of Psychology, CUNY Graduate Center, New York, NY, USA
| | | | | | - Blessy M Abraham
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | | | - Erik M Benau
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA.
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4
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Ahern E, White J, Slattery E. Change in Cognitive Function over the Course of Major Depressive Disorder: A Systematic Review and Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-023-09629-9. [PMID: 38315296 DOI: 10.1007/s11065-023-09629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024]
Abstract
Major depressive disorder (MDD) is associated with significant cognitive deficits during the acute and remitted stages. The aim of this systematic review and meta-analysis was to examine the course of cognitive function whilst considering demographic, treatment, or clinical features of MDD that could moderate the extent of cognitive change. Databases were searched to identify studies that reported on cognitive function in MDD with a ≥12-week test-retest interval. Relevant studies were pooled using random effects modelling to generate an inverse-variance, weighted, mean effect size estimate (Hedges' g) of cognitive change for each cognitive variable and for an overall composite cognitive domain. Of 6898 records, 99 eligible studies were identified from which 69 were meta-analysed, consisting of 4639 MDD patients (agemean = 40.25 years, female% = 64.62%) across 44 cognitive variables. In over 95% of cognitive variables, improvements were either of non-significant, negligible, or of a small magnitude, and when compared to matched healthy controls, the possibility of practice effects could not be precluded. Depressive symptom improvement and the number of previous depressive episodes moderated the extent of cognitive change, demonstrating state- and scar-like features for one-quarter of the cognitive domains. Further longitudinal studies are required to elucidate the MDD cognitive trajectory from initial onset. Findings nonetheless suggest that following pharmacological and non-pharmacological treatment, cognitive change in MDD is typically small, but the capacity for change may be less with episode recurrence. Targeting cognition early in the course of illness may facilitate better prognosis and support a more complete functional recovery.
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Affiliation(s)
- Elayne Ahern
- School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland.
- Department of Psychology, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland.
| | - Jessica White
- School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Eadaoin Slattery
- Department of Applied Social Sciences, Technological University of the Shannon Midwest, Limerick, Ireland
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5
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Ronold EH, Myklebost SB, Hammar Å. Improvement in self-reported cognitive functioning but not in rumination following online working memory training in a two-year follow-up study of remitted major depressive disorder. Front Psychiatry 2023; 14:1163073. [PMCID: PMC10277740 DOI: 10.3389/fpsyt.2023.1163073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/16/2023] [Indexed: 06/21/2023] Open
Abstract
Self-reported subjective cognitive difficulties (subjective deficits) and rumination are central residual cognitive symptoms following major depressive disorder (MDD). These are risk factors for more a severe course of illness, and despite the considerable relapse risk of MDD, few interventions target the remitted phase, a high-risk period for developing new episodes. Online distribution of interventions could help close this gap. Computerized working memory training (CWMT) shows promising results, but findings are inconclusive regarding which symptoms improve following this intervention, and its long-term effects. This study reports results from a longitudinal open-label two-year follow-up pilot-study of self-reported cognitive residual symptoms following 25 sessions (40 min), five times a week of a digitally delivered CWMT intervention. Ten of 29 patients remitted from MDD completed two-year follow-up assessment. Significant large improvements in self-reported cognitive functioning on the behavior rating inventory of executive function-adult version appeared after two-years (d = 0.98), but no significant improvements were found in rumination (d < 0.308) measured by the ruminative responses scale. The former showed moderate non-significant associations to improvement in CWMT both post-intervention (r = 0.575) and at two-year follow-up (r = 0.308). Strengths in the study included a comprehensive intervention and long follow-up time. Limitations were small sample and no control group. No significant differences between completers and drop-outs were found, however, attrition effects cannot be ruled out and demand characteristics could influence findings. Results suggested lasting improvements in self-reported cognitive functioning following online CWMT. Controlled studies with larger samples should replicate these promising preliminary findings.
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Affiliation(s)
- Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | | | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Skåne, Sweden
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6
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Chen P, Feng Y, Li XH, Li JX, Wang YY, Zheng WY, Su Z, Cheung T, Ungvari GS, Ng CH, Sha S, Xiang YT. Systematic reviews and meta-analyses on major depressive disorder: a bibliometric perspective. Front Psychiatry 2023; 14:1136125. [PMID: 37181891 PMCID: PMC10169641 DOI: 10.3389/fpsyt.2023.1136125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background There is a vast amount of evidence-based medicine research on the major depressive disorder (MDD) available in the literature, however, no studies on the overall performance, productivity and impact of such research have been published to date. This study explored and mapped the research outputs of MDD-related systematic reviews and meta-analyses (SR/MA) from a bibliometric perspective. Methods Relevant data were retrieved with search terms on MDD, systematic review and meta-analysis. Results A total of 4,870 papers with 365,402 citations published from 1983 to 2022 were included in the analysis. The publication output has grown steadily over time with the most publications originating from the USA (1,020; 20.94%), the UK (516; 10.60%) and China (448; 9.20%). The research collaborations between countries were most frequent between the USA and UK (266; 5.46%). Journal of Affective Disorders (379; 7.78%) was the most productive journal, while Cuijpers P was the most productive author (121; 2.48%), and University of Toronto (569; 11.78%) was the most productive institution. The top 10 most cited articles on MDD-related SR/MA had citations ranging from 1,806 to 3,448. The high-frequency keywords were mainly clustered into four themes, including psychiatric comorbidities, clinical trials, treatment, and brain stimulation in MDD. Conclusion The rapid increase in the number of SR/MA of MDD in recent years highlights the importance of this research field. Psychiatric comorbidities, clinical interventions, and treatment of MDD have been identified as hot topics, while biological mechanisms in MDD are likely to be an emerging research priority.
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Affiliation(s)
- Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, Macao SAR, China
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiao-Hong Li
- Beijing Huilongguan Hospital, Huilongguan Clinical Medical School, Peking University, Beijing, China
| | - Jia-Xin Li
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, Macao SAR, China
| | - Yue-Ying Wang
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, Macao SAR, China
| | - Wan-Ying Zheng
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macau, Macao SAR, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Gabor S. Ungvari
- Section of Psychiatry, University of Notre Dame Australia, Fremantle, WA, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Chee H. Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, VC, Australia
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, Macao SAR, China
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7
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da Silva Machado R, Vieira IS, Scaini C, Molina ML, Barbosa LP, da Silva GDG, Ores L, de Mattos Souza LD, Jansen K, da Silva RA. Ego-defense mechanisms and brief psychotherapies for the management of major depressive disorder in adults: A longitudinal and quasi-experimental study. J Affect Disord 2023; 330:291-299. [PMID: 36871912 DOI: 10.1016/j.jad.2023.02.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To evaluate the effect of psychotherapies on ego defense mechanisms and the reduction of depressive symptoms in a 12-month follow-up period. METHODS This longitudinal and quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. Two models of psychotherapy were used: Supportive Expressive Dynamic Psychotherapy (SEDP) and Cognitive Behavioral Therapy (CBT). Defense Style Questionnaire 40 was used to analyze defense mechanisms and the Beck Depression Inventory was used to measure the depressive symptoms. RESULTS The total sample comprised 195 patients (113 SEDP and 82 CBT), with the mean age was 35.63 (11.44) years. After adjustments, increased mature defenses was significantly associated with reduced depressive symptoms at all follow-up times (p < 0.001) and the decrease in immature defenses was significantly associated with the reduction of depressive symptoms at all follow-up times (p < 0.001). While neurotic defenses were not associated with a reduction in depressive symptoms at any time of follow-up (p > 0.05). CONCLUSION Both models of psychotherapy were effective in increasing mature defenses and decreasing immature ones, as well as decreasing depressive symptoms at all evaluation times. With this, it is understood that a greater understanding of these interactions will allow a more adequate diagnostic and prognostic evaluation and the design of useful strategies that adapt to the patient's reality.
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Affiliation(s)
- Rosiene da Silva Machado
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Igor Soares Vieira
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Centro Universitário Estácio de Sergipe, SE, Brazil
| | - Carolina Scaini
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Mariane Lopez Molina
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Faculdade Anhanguera do Rio Grande, RS, Brazil
| | - Luana Porto Barbosa
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Giovana Del Grande da Silva
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | | | - Luciano Dias de Mattos Souza
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Karen Jansen
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Ricardo Azevedo da Silva
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil.
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8
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Sorkhou M, Rabin RA, Rabin JS, Kloiber S, McIntyre RS, George TP. Effects of 28 days of cannabis abstinence on cognition in major depressive disorder: A pilot study. Am J Addict 2022; 31:454-462. [PMID: 35690891 DOI: 10.1111/ajad.13305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cannabis is a widely used substance that may impair select cognitive domains, including attention and memory. Problematic cannabis use is a common clinical problem among patients with major depressive disorder (MDD). Few studies have investigated the effects of cannabis abstinence on cognition in MDD. Thus, our study aimed to determine whether a 28-day period of cannabis abstinence is associated with improvements in cognition in patients with MDD and comorbid cannabis use disorder (CUD). METHODS We evaluated the effects of 28 days of cannabis abstinence on cognition in MDD patients with comorbid CUD facilitated by contingency management, motivational interviewing, psychoeducation, and coping-skills training (N = 11). Primary outcomes included Baseline to Day 28 changes in verbal memory and learning, while secondary outcomes included Baseline to Day 28 changes in working memory, visuospatial working memory (VSWM), visual search speed, mental flexibility, response inhibition, attention, manual dexterity, and fine motor movement. RESULTS Eight participants (72.7%) met the pre-specified criteria for cannabis abstinence and three participants significantly reduced their cannabis use (≥90%). Visual search speed, selective attention, and VSWM improved over the study period. These improvements were not associated with changes in cannabis metabolite levels from baseline to endpoint. DISCUSSION AND CONCLUSIONS Our findings suggest that 28 days of cannabis abstinence may improve select cognitive domains in patients with MDD and comorbid CUD. SCIENTIFIC SIGNIFICANCE This is the first study to longitudinally examine the effects of cannabis on cognition in MDD. CLINICAL TRIAL Effects of Cannabis Abstinence on Symptoms and Cognition in Depression (NCT03624933; https://www. CLINICALTRIALS gov).
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Affiliation(s)
- Maryam Sorkhou
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Rachel A Rabin
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Adult Psychiatry and Health Systems Division, CAMH, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Mood Disorders Psychopharmacology Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Tony P George
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Addictions Divisions, Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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9
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Yang KC, Hsieh WC, Chou YH. Cognitive factor structure and measurement invariance between healthy controls and patients with major depressive disorder. J Psychiatr Res 2022; 151:598-605. [PMID: 35636038 DOI: 10.1016/j.jpsychires.2022.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023]
Abstract
Cognitive impairments are crucial in functional outcomes of major depressive disorder (MDD). The effectiveness of currently available treatment methods for cognitive deficits is suboptimal. A cognitive test battery is often applied to evaluate cognition with multiple interrelated and difficult-to-interpret outcomes. Generating cognitive factor scores after the confirmation of a common cognitive structure and measurement invariance between healthy controls (HCs) and patients may aid in understanding cognition further. This methodology has been applied for several neuropsychiatric disorders, but not for MDD. Therefore, we conducted a series of exploratory factor analyses (EFA), confirmatory factor analyses (CFA), and multiple groups CFA (MGCFA) for a cognitive test battery in HCs and patients with MDD. The initial EFA of 106 HCs yielded a three-factor model-comprising attention, memory, and executive function. The CFA confirmed the initial model in other 94 HCs with revisions, which reasonably fit the cognitive data of 54 patients with MDD. MGCFA supported the measurement invariance of the determined model between HCs and patients with MDD. The associations of cognitive factor scores with age or education and the effect sizes of group differences in cognitive factor scores externally validated the determined model. In conclusion, this is the first study to demonstrate the measurement invariance of a cognitive model between HCs and patients with MDD using MGCFA. The measurement invariance substantiated valid group comparisons of factor scores and their relationships with other markers. The current results may be applicable for the development of improved treatment strategies for cognitive impairments in MDD.
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Affiliation(s)
- Kai-Chun Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chih Hsieh
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Quality Management, Taipei Veterans General Hospital, Taipei, Taiwan.
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10
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Ronold EH, Joormann J, Hammar Å. Computerized Working Memory Training in Remission From Major Depressive Disorder: Effects on Emotional Working Memory, Processing Speed, Executive Functions, and Associations With Symptoms. Front Behav Neurosci 2022; 16:887596. [PMID: 35832292 PMCID: PMC9272008 DOI: 10.3389/fnbeh.2022.887596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Remission from major depressive disorder (MDD) is associated with residual symptoms related to reduced functioning, quality of life, and relapse risk. Previous studies have raised questions about mechanisms involved-in and affected by cognitive training. This study investigated the associations and changes among depressive symptoms, rumination, processing speed (PS), executive functioning (EF), and emotional working memory (e-WM) pre- post computerized working memory training (CWMT). Method Twenty-nine remitted participants were included in a pre- post pilot study of within-subject effects of online CWMT. A total of 20 participants completed the intervention and pre- post tests of EF and PS, e-WM, in addition to symptom and rumination measures. Associations between changes in symptoms and cognition were investigated pre- post. Associations between improvements in CWMT, depression history, and changes in cognition were explored. Hypotheses and statistics were preregistered before data were analyzed. Results Manipulation of negatively valanced stimuli in e-WM showed an inverse association with rumination pre-intervention, but the association disappeared post-intervention. Cognitive functioning improved in most conditions with largest effects in EF. Symptoms did not change in the remitted sample. CWMT improvements were related to improvements in some aspects of EF and PS, but also to worse self-reported attention. Depression history was related to less improvement in EF. Limitations Sample size was small and there was dropout from the study. There was no control group, thus precluding practice and placebo effects and causal relationships. Conclusions Computerized WM training improves cognitive functions and could influence associations between e-WM and rumination. This could counteract functional impairment following MDD.
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Affiliation(s)
- Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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11
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Hammar Å, Ronold EH, Rekkedal GÅ. Cognitive Impairment and Neurocognitive Profiles in Major Depression-A Clinical Perspective. Front Psychiatry 2022; 13:764374. [PMID: 35345877 PMCID: PMC8957205 DOI: 10.3389/fpsyt.2022.764374] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Increasingly, studies have investigated cognitive functioning from the perspective of acute state- to remitted phases of Major Depressive Disorder (MDD). Some cognitive deficits observed in the symptomatic phase persist in remission as traits or scars. The etiological origin and clinical consequences of the neurocognitive profiles reported in the literature are still unclear and may vary across populations. Deficits are suspected to influence the association between MDD and neurodegenerative disorders and could thus be of particular clinical consequence. The aim of this review is to describe the clinical neuropsychological profile in MDD and how it is related to research during the past decade on cognitive deficits in MDD from a state, trait, and scar perspective. This review, with a clinical perspective, investigates research from the past decade regarding cognitive functioning in MDD in a long-term perspective. We focus on the clinical manifestation of deficits, and the potential neurodegenerative consequences of the neurocognitive profile in MDD. Searches in Medline, PsycINFO and Embase were conducted targeting articles published between 2010 and 2020. Examination of the evidence for long-lasting neurocognitive deficits in major depression within the cognitive domains of Memory, Executive Functions, Attention, and Processing Speed was conducted and was interpreted in the context of the State, Scar and Trait hypotheses. Defining the neurocognitive profiles in MDD will have consequences for personalized evaluation and treatment of residual cognitive symptoms, and etiological understanding of mood disorders, and treatments could potentially reduce or delay the development of neurodegenerative disorders.
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Affiliation(s)
- Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Guro Årdal Rekkedal
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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12
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Tetsuka S. Depression and Dementia in Older Adults: A Neuropsychological Review. Aging Dis 2021; 12:1920-1934. [PMID: 34881077 PMCID: PMC8612610 DOI: 10.14336/ad.2021.0526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 01/23/2023] Open
Abstract
Depression and dementia are the most common neuropsychiatric disorders in the older adult population. There are a certain number of depressed patients who visit outpatient clinics because they suspect dementia due to similarities in the clinical symptoms in both disorders. Depressive symptoms associated with dementia may be diagnosed with depression, and treatment with antidepressants is continued for a long time. Depression and dementia differ in their treatment approaches and subsequent courses, and it is necessary to carefully differentiate between the two in the clinical practice of dementia treatment. In this review, I describe the similarities between depression and dementia and how to differentiate depression in dementia treatment based on the differences and emphasize that there is a significant potential to cure depression, in contrast to dementia, for which there is currently no fundamental therapy. Therefore, it is important to recognize that depression and dementia may present with common symptoms and to appropriately differentiate depressed patients who are suspected of having dementia. Dementia is a disorder in which cognitive dysfunction is caused by a variety of causative diseases and conditions, resulting in impairment of activities of daily living. However, current medical science has had difficulty finding a cure for the causative disease. Based on clinical findings, it has also been shown that the degree of symptoms for preexisting psychiatric disorders is alleviated as the brain ages. In the presence of dementia, the speed of the alleviation will increase. The importance of focusing on the positive aspects of aging is also discussed.
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Affiliation(s)
- Syuichi Tetsuka
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, 329-2763, Japan
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13
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Suciu BD, Păunescu RL, Micluţia IV. Assessment of cognitive performances in major depressed patients: a 6-month follow-up study. Int J Psychiatry Clin Pract 2021; 25:378-384. [PMID: 33118408 DOI: 10.1080/13651501.2020.1840595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Our study aimed to assess the longitudinal change of cognitive functions in depressed patients after a 6-month interval free of mood symptoms. METHODS In a longitudinal study, 65 patients diagnosed with recurrent major depressive disorder were evaluated twice with neurocognitive tests, during an acute depressed episode and after 6 months of euthymia. The cognitive dimension was assessed with neuropsychological tests of attention and processing speed, memory, verbal fluency, psychomotor speed and executive functions. The severity of depression was evaluated through Hamilton Depression Rating Scale - 17 items. All the results were compared with the outcomes of 35 healthy controls, both in depression and euthymia. RESULTS Depressed patients compared to controls displayed significant statistical differences for most cognitive tests applied, verbal and working memory being the most severely impaired. They were still impaired at the second evaluation. Significant differences were noted between the euthymic and control group, too. Between the depression phase and euthymia, patients obtained significant improvement for attention and processing speed, verbal fluency, motor speed and executive functions. CONCLUSIONS Results from the current study indicate that cognitive impairment is more severe for depressed patients, decreases for euthymic subjects, and lasts longer after depressive symptoms remit.
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Affiliation(s)
- Bianca Daniela Suciu
- Department of Neurosciences, Psychiatry and Pediatric Psychiatry Chair, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ramona Liana Păunescu
- Department of Neurosciences, Psychiatry and Pediatric Psychiatry Chair, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Psychiatric Clinic, Emergency County Hospital, Cluj-Napoca, Romania
| | - Ioana Valentina Micluţia
- Department of Neurosciences, Psychiatry and Pediatric Psychiatry Chair, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Psychiatric Clinic, Emergency County Hospital, Cluj-Napoca, Romania
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14
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Li D, Zhang H, Liu Y, Liang X, Chen Y, Zheng Y, Qiu S, Cui Y. Abnormal Functional Connectivity of Posterior Cingulate Cortex Correlates With Phonemic Verbal Fluency Deficits in Major Depressive Disorder. Front Neurol 2021; 12:724874. [PMID: 34512534 PMCID: PMC8427063 DOI: 10.3389/fneur.2021.724874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Major depressive disorder (MDD) patients face an increased risk of developing cognitive impairments. One of the prominent cognitive impairments in MDD patients is verbal fluency deficit. Nonetheless, it is not clear which vulnerable brain region in MDD is interactively linked to verbal fluency deficit. It is important to gain an improved understanding for verbal fluency deficit in MDD. Methods: Thirty-four MDD patients and 34 normal controls (NCs) completed resting-state fMRI (rs-fMRI) scan and a set of verbal fluency tests (semantic VFT and phonemic VFT). Fourteen brain regions from five brain networks/systems (central executive network, default mode network, salience network, limbic system, cerebellum) based on their vital role in MDD neuropathology were selected as seeds for functional connectivity (FC) analyses with the voxels in the whole brain. Finally, correlations between the z-score of the FCs from clusters showing significant between-group difference and z-score of the VFTs were calculated using Pearson correlation analyses. Results: Increased FCs in MDD patients vs. NCs were identified between the bilateral posterior cingulate cortex (PCC) and the right inferior frontal gyrus (triangular part), in which the increased FC between the right PCC and the right inferior frontal gyrus (triangular part) was positively correlated with the z score of phonemic VFT in the MDD patients. Moreover, decreased FCs were identified between the right hippocampal gyrus and PCC, as well as left cerebellum Crus II and right parahippocampal gyrus in MDD patients vs. NCs. Conclusions: The MDD patients have altered FCs among key brain regions in the default mode network, the central executive network, the limbic system, and the cerebellum. The increased FC between the right PCC and the right inferior frontal gyrus (triangular part) may be useful to better characterize pathophysiology of MDD and functional correlates of the phonemic verbal fluency deficit in MDD.
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Affiliation(s)
- Danian Li
- Cerebropathy Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hanyue Zhang
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yujie Liu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xinyu Liang
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yaoping Chen
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanting Zheng
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Shijun Qiu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Cui
- Cerebropathy Center, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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15
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Schindler L, Stalder T, Kirschbaum C, Plessow F, Schönfeld S, Hoyer J, Trautmann S, Weidner K, Steudte-Schmiedgen S. Lifetime Trauma History and Cognitive Functioning in Major Depression and Their Role for Cognitive-Behavioral Therapy Outcome. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e4105. [PMID: 36398101 PMCID: PMC9667230 DOI: 10.32872/cpe.4105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background While cognitive-behavioral therapy (CBT) is the gold-standard psychological treatment for major depression (MD), non-response and lacking stability of treatment gains are persistent issues. Potential factors influencing treatment outcome might be lifetime trauma history and possibly associated primarily prefrontal-cortex- and hippocampus-dependent cognitive alterations. Method We investigated MD and healthy control participants with (MD+T+, n = 37; MD-T+, n = 39) and without lifetime trauma history (MD+T-, n = 26; MD-T-, n = 45) regarding working memory, interference susceptibility, conflict adaptation, and autobiographical memory specificity. Further, MD+T+ (n = 21) and MD+T- groups (n = 16) were re-examined after 25 CBT sessions, with MD-T- individuals (n = 34) invited in parallel in order to explore the stability of cognitive alterations and the predictive value of lifetime trauma history, cognitive functioning, and their interaction for treatment outcome. Results On a cross-sectional level, MD+T+ showed the highest conflict adaptation, but MD+T- the lowest autobiographical memory specificity, while no group differences emerged for working memory and interference susceptibility. Clinical improvement did not differ between groups and cognitive functioning remained stable over CBT. Further, only a singular predictive association of forward digit span, but no other facets of baseline cognitive functioning, lifetime trauma history, or their interaction with treatment outcome emerged. Discussion These results indicate differential roles of lifetime trauma history and psychopathology for cognitive functioning in MD, and add to the emerging literature on considering cognitive, next to clinical remission as a relevant treatment outcome.
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Affiliation(s)
- Lena Schindler
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Tobias Stalder
- Department Erziehungswissenschaften und Psychologie, Universität Siegen, Siegen, Germany
| | | | - Franziska Plessow
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sabine Schönfeld
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Psychology, Lund University, Lund, Sweden
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sebastian Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Susann Steudte-Schmiedgen
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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16
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Bernhardt M, Schwert C, Aschenbrenner S, Weisbrod M, Schröder A. Subjective cognitive and neurocognitive functions over the course of CBT. Psychiatry Res 2021; 300:113895. [PMID: 33799194 DOI: 10.1016/j.psychres.2021.113895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
The aim of the study was to investigate changes in both subjectively and objectively measured cognitive functions as well as their discrepancy in outpatients with major depression disorder in the course of cognitive-behavioural therapy (CBT). A neuropsychological test battery with cognitive tests measuring the domains of attention, memory, and executive functions as well as a questionnaire for the self-assessment of cognitive functions (FLei) in these domains were administered to depressed outpatients (n = 46) at the beginning of CBT, post-treatment after on average 40 sessions, as well as six months after the end of treatment. We found that subjectively as well as objectively measured cognitive functions did not change. The discrepancy between subjective and objective cognitive functions found at the beginning of therapy was no longer significant at post-treatment and six months later. The results indicate, that self-perceived and neuropsychologically measured cognitive impairments show stability despite improved depression. Specific interventions such as cognitive remediation therapy should be additionally applied to depressed patients who suffer from cognitive deficits.
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Affiliation(s)
- Maren Bernhardt
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Germany.
| | - Christine Schwert
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Germany
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Germany; Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Germany
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17
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Landry M, Moreno A, Patry S, Potvin S, Lemasson M. Current Practices of Electroconvulsive Therapy in Mental Disorders: A Systematic Review and Meta-Analysis of Short and Long-Term Cognitive Effects. J ECT 2021; 37:119-127. [PMID: 33009218 DOI: 10.1097/yct.0000000000000723] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) remains one of the most effective treatments for major depressive disorder, but uncertainties persist regarding the cognitive tests to include in ECT follow-up. The current study is a systematic review and meta-analysis of the most frequent cognitive side effects after ECT. We also discuss the most common cognitive tests in ECT follow-up. We searched studies published from 2000 to 2017 in English and French language in Pubmed, EBM Reviews, EMBASE, and PsycINFO. Standardized cognitive tests were separated into 11 cognitive domains. Comparisons between cognitive measures included pre-ECT baseline with post-ECT measures at 3 times: PO1, immediately post-ECT (within 24 hours after last ECT); PO2, short term (1-28 days); and PO3, long term (more than 1 month). A total of 91 studies were included, with an aggregated sample of 3762 individuals. We found no significant changes in global cognition with Mini-Mental State Examination at PO1. Hedges g revealed small to medium effect sizes at PO2, with individuals presenting a decrease in autobiographical memory, verbal fluency, and verbal memory. Verbal fluency problems showed an inverse correlation with age, with younger adults showing greater deficits. At PO3, there is an improvement on almost all cognitive domains, including verbal fluency and verbal memory. There is a lack of standardization in the choice of cognitive tests and optimal cognitive timing. The Mini-Mental State Examination is the most common screening test used in ECT, but its clinical utility is extremely limited to track post-ECT cognitive changes. Cognitive assessment for ECT purposes should include autobiographical memory, verbal fluency, and verbal memory.
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18
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Bernhardt M, Schwert C, Aschenbrenner S, Weisbrod M, Schröder A. Longitudinal Changes of Cognitive Deficits and Treatment Outcome of Cognitive Behavioral Therapy for Major Depression. J Nerv Ment Dis 2021; 209:336-342. [PMID: 33555821 DOI: 10.1097/nmd.0000000000001301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The current study examined neuropsychological changes over the course of cognitive behavioral therapy (CBT) in outpatients with major depressive disorder and the influence of cognitive deficits as predictors of clinical outcome in depression. A neuropsychological test battery was carried out on depressed outpatients (N = 54) at the beginning and at the end of CBT. Small improvements were found in divided attention, figural memory, and processing speed from pre- to posttreatment. Cognitive deficits in executive functions before treatment predicted the clinical outcome at the end of CBT. The present study reveals that attention and memory deficits are most likely to improve over the course of treatment, whereas executive functions remain stable in the long term. Depressed patients with worse executive functions at the beginning of treatment seem to benefit more from long-term CBT therapy.
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Affiliation(s)
- Maren Bernhardt
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
| | - Christine Schwert
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad
| | | | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
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19
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Cheng CH, Chang CC, Chao YP, Lu H, Peng SW, Wang PN. Altered mismatch response precedes gray matter atrophy in subjective cognitive decline. Psychophysiology 2021; 58:e13820. [PMID: 33792049 DOI: 10.1111/psyp.13820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 02/03/2023]
Abstract
The cross-sectional identification of subjective cognitive decline (SCD) in cognitively normal adults is particularly important for the early effective prevention or intervention of the future development of mild cognitive impairments (MCI) or Alzheimer's disease (AD). A pre-attentive neurophysiological signal that reflects the brain's ability to detect the changes of the environment is called mismatch negativity (MMN) or its magnetic counterpart (MMNm). It has been shown that patients with MCI or AD demonstrate reduced MMN/MMNm responses, while the exact profile of MMN/MMNm in SCD is substantially unknown. We applied magnetoencephalographic recordings to interrogate MMNm activities in healthy controls (HC, n = 29) and individuals with SCD (n = 26). Furthermore, we analyzed gray matter (GM) volumes in the MMNm-related regions through voxel-based morphometry and performed apolipoprotein E4 (APOE4) genotyping for all the participants. Our results showed that there were no significant differences in GM volume and proportions of APOE4 carriers between HC and SCD groups. However, individuals with SCD exhibited weakened z-corrected MMNm responses in the left inferior parietal lobule and right inferior frontal gyrus (IFG) as compared to HC. Based on the regions showing significant between-group differences, z-corrected MMNm amplitudes of the right IFG significantly correlated with the memory performance among the SCD participants. Our data suggest that neurophysiological changes of the brain, as indexed by MMNm, precede structural atrophy in the individuals with SCD compared to those without SCD.
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Affiliation(s)
- Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsinjie Lu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Peng
- Division of General Neurology, Department of Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Pei-Ning Wang
- Division of General Neurology, Department of Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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20
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Schmid M, Hammar Å. First-Episode Patients Report Cognitive Difficulties in Executive Functioning 1 Year After Initial Episode of Major Depressive Disorder. Front Psychiatry 2021; 12:667238. [PMID: 34135786 PMCID: PMC8200526 DOI: 10.3389/fpsyt.2021.667238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Major Depressive Disorder (MDD) is associated with cognitive impairment in general, and Executive Functioning (EF) in particular, even in remitted phase of the disorder, suggesting residual cognitive symptoms. The aim of the present study was to investigate self-reported EF 1 year after the first episode of MDD and to explore this in relation to depressive mood symptoms, remission and relapse. Method: The study included data from 24 patients and 23 healthy control subjects 1 year after the patients' initial first episode of MDD. All participants completed the Behavior Rating Inventory of Executive Functioning-Adult version (BRIEF-A), a standardized self-report measure of perceived EF in everyday life, measuring nine different EF. Total index scores for metacognitive functions, behavior/emotional regulation functions and a global EF score is also calculated. Results: The patient group in total, independent of symptom status, reported significantly lower EF in all indexes compared to the healthy controls 1 year after the initial episode. However, higher depressive mood symptom load correlated with self-reported difficulties in metacognitive functions and poor global EF scores. Regulatory control of behavior and emotional responses did not show such strong association with mood symptoms, but low self-report scores on this measure was associated with relapse during the first year after the initial episode. Conclusion: First-episode patients report significant lower executive functioning in everyday life compared to individually matched healthy controls, 1 year after onset, independent of symptom load. Residual cognitive symptoms seem to be evident and associated with risk of relapse and should be targeted in treatment and prevention of recurrence in MDD.
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Affiliation(s)
- Marit Schmid
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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21
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Ronold EH, Schmid MT, Oedegaard KJ, Hammar Å. A Longitudinal 5-Year Follow-Up Study of Cognitive Function After First Episode Major Depressive Disorder: Exploring State, Scar and Trait Effects. Front Psychiatry 2020; 11:575867. [PMID: 33364989 PMCID: PMC7750430 DOI: 10.3389/fpsyt.2020.575867] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
Major depression (MDD) is associated with cognitive deficits in processing speed and executive function (EF) following first episode (FE). It is unclear whether deficits are state or trait related. Studies following FE MDD over longer periods are lacking, making it uncertain how cognition and symptoms develop after the initial episode. The present study assessed cognitive function and symptoms 5 years following FE MDD. In addition, the study explored relationships between MDD symptoms, rumination, and cognitive deficits with regards to the trait, state, and scar perspective. Twenty-three participants with previous FE MDD, and 20 matched control participants were compared on Delis-Kaplan Executive Function System measures of processing speed and EF, in a 5-year longitudinal follow-up study. Correlations between current symptoms- and history of MDD, rumination, cognition were investigated. Findings indicated that cognitive deficits persisted with no clear signs of exacerbation after initial episode. Inhibition appeared independent of current and previous symptoms of depression. Processing speed was related to depressive- symptoms and rumination. In conclusion, results indicated persisting, stable deficits in both EFs and processing speed. Findings further suggest that depressive symptoms could be related to deficits in processing speed, indicating state effects. There was limited support for worsening of cognition after initial episode. Some aspects of EF like Inhibition could show persistent deficits independent of depressive symptoms indicating trait effects.
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Affiliation(s)
- Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Marit Therese Schmid
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Ketil Joachim Oedegaard
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
- Department of Psychiatry, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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22
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Abstract
Patients diagnosed with unipolar disorder usually experience impaired cognitive functioning during an acute depressive episode. The purpose of the current study was to investigate the association of specific clinical factors with cognitive dysfunction in a group of major depressed patients. 65 subjects diagnosed with recurrent major depressive disorder were evaluated during an acute episode. The cognitive functions were assessed with neuropsychological tests for attention and processing speed, memory, verbal fluency, psychomotor speed and executive functions. Hamilton Depression Rating Scale - 17 items was used to quantify the severity of depression. Clinical variables consisted in age at onset, number of previous depressive episodes, presence of psychotic symptoms or suicide attempts. The group had a mean age of 48.48 years, with predominance of females, with a history of 5.43 episodes and associated psychotic symptoms (23.1%) and suicide attempts (20%). Cognitive domains for which we found significant results (p < 0.05) were executive functions and attention, being associated with the number of previous depressive episodes. Psychomotor speed was significantly associated with the severity of depression. Also, patients with psychotic symptoms obtained altered results for psychomotor speed and verbal memory. For almost all cognitive domains we found significant statistical association with different clinical aspects, such as number of depressive episodes, severity of depression, presence of psychotic symptoms and suicide attempts. Since each of them had an influence over cognition, further studies involving larger samples are necessary to establish if there is a direct relationship between cognitive impairment and clinical variables.
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Affiliation(s)
- Bianca Daniela Suciu
- Department of Neurosciences, Psychiatry and Pediatric Psychiatry Chair, "Iuliu Hațieganu", University of Medicine and Pharmacy, 43 Victor Babeș Street, Cluj-Napoca, Romania.
| | - Ioana Valentina Micluţia
- Department of Neurosciences, Psychiatry and Pediatric Psychiatry Chair, "Iuliu Hațieganu", University of Medicine and Pharmacy, 43 Victor Babeș Street, Cluj-Napoca, Romania.,Psychiatric Clinic, Emergency County Hospital, Cluj-Napoca, Romania
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23
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Rubin LH, Xu Y, Norris PJ, Wang X, Dastgheyb R, Fitzgerald KC, Keating SM, Kaplan RC, Maki PM, Anastos K, Springer G, Benning L, Kassaye S, Gustafson DR, Valcour VG, Williams DW. Early Inflammatory Signatures Predict Subsequent Cognition in Long-Term Virally Suppressed Women With HIV. Front Integr Neurosci 2020; 14:20. [PMID: 32390808 PMCID: PMC7193823 DOI: 10.3389/fnint.2020.00020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/23/2020] [Indexed: 12/16/2022] Open
Abstract
Immunologic function is an important determinant of cognition. Here we examined the contribution of early immune signatures to cognitive performance among HIV-infected, virally suppressed women (HIV+VS) and in HIV-uninfected (HIV-) women. Specifically, we measured serum inflammatory markers, developed combinatory immune signatures, and evaluated their associations with cognition. Forty-nine HIV+VS women in the Women’s Interagency HIV Study (WIHS) who achieved viral suppression shortly after effective antiretroviral therapy (ART) initiation, and 56 matched HIV− women were selected. Forty-two serum inflammatory markers were measured within 2 years of effective ART initiation for HIV+VS women, and at an initial timepoint for HIV− women. The same inflammatory markers were also measured approximately 1, 7, and 12 years later for all women. Of the 105 women with complete immune data, 83 (34 HIV+VS, 49 HIV−) also had cognitive data available 12 years later at ≥1 time points (median = 3.1). We searched for combinatory immune signatures by adapting a dynamic matrix factorization analytic method that builds upon Tucker decomposition followed by Ingenuity® Pathway Analysis to facilitate data interpretation. Seven combinatory immune signatures emerged based on the Frobenius residual. Three signatures were common between HIV+VS and HIV− women, while four signatures were unique. These inflammatory signatures predicted subsequent cognitive performance in both groups using mixed-effects modeling, but more domain-specific associations were significant in HIV+VS than HIV− women. Leukocyte influx into brain was a major contributor to cognitive function in HIV+VS women, while T cell exhaustion, inflammatory response indicative of depressive/psychiatric disorders, microglial activity, and cytokine signaling predicted both global and domain-specific performance for HIV− women. Our findings suggest that immune signatures may be useful diagnostic, prognostic, and immunotherapeutic targets predictive of subsequent cognitive performance. Importantly, they also provide insight into common and distinct inflammatory mechanisms underlying cognition in HIV− and HIV+VS women.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States.,Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States.,Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States
| | - Philip J Norris
- Department of Laboratory Medicine, Vitalant Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Xuzhi Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | | | - Sheila M Keating
- Department of Laboratory Medicine, Vitalant Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Deborah R Gustafson
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - Victor G Valcour
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University, Baltimore, MD, United States.,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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