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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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Liu X, Wang X, Liu Y, Gao F, Xia J, Fan J, Zhu X. The abnormal implicit memory to positive and negative stimuli in patients with current and remitted major depressive disorder: A systematic review and meta-analysis. Front Psychiatry 2022; 13:1043987. [PMID: 36704726 PMCID: PMC9871490 DOI: 10.3389/fpsyt.2022.1043987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION In patients with current major depressive disorder (cMDD) a general abnormal implicit memory has been reported. However, the elaborate function of implicit memory when processing stimuli with different emotions (i.e., positive, neutral, and negative) in current and remitted (rMDD) patients is unclear. The present review examines implicit memory's general and elaborate in cMDD and rMDD patients. METHODS We conducted meta-analyses based on published studies meeting criteria in Web of Science, PubMed, and EMBASE databases between 1990 and July 2022. The full sample patients included cMDD = 601 and rMDD = 143. RESULTS Initial analysis of cMDD patients revealed a general implicit memory deficit. Subsequent subgroup analyses showed that the implicit memory performance to neutral stimuli is poorer in cMDD patients than controls, but recovered in rMDD patients; the deficient implicit memory to positive stimuli existed in cMDD and rMDD patients; the implicit memory performance to negative stimuli in cMDD patients is similar to controls but poorer in rMDD patients. CONCLUSION These findings indicate that the negative bias in cMDD patients might compensate for the general implicit memory deficit. Together, the implicit memory to neutral stimuli could recover with remission, whereas still abnormal in processing positive and negative stimuli. These results suggested that the abnormal implicit memory to positive and negative information might be relevant to depression pathogenesis. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero, identifier CRD42020205003.
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Affiliation(s)
- Xingze Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Yao Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Feng Gao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Jie Xia
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Jie Fan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
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Zaremba D, Schulze Kalthoff I, Förster K, Redlich R, Grotegerd D, Leehr EJ, Meinert S, Dohm K, Bürger C, Enneking V, Böhnlein J, Repple J, Opel N, Jörgens S, Yüksel D, Schmitt S, Stein F, Kircher T, Krug A, Nenadić I, Zwitserlood P, Baune BT, Arolt V, Dannlowski U. The effects of processing speed on memory impairment in patients with major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:494-500. [PMID: 30831198 DOI: 10.1016/j.pnpbp.2019.02.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Learning and memory performance have been reported to be impaired in patients with Major Depressive Disorder (MDD). Impairments are associated with diminished psychosocial functioning. Based on the processing-speed theory, we aimed to examine whether processing speed mediates the relationship between depression status and verbal, visuo-spatial and working memory impairment. METHODS A neuropsychological test-battery was administered to 106 patients with current MDD, 119 patients with remitted MDD and 120 healthy controls to assess processing speed, learning and memory performance. To examine the impact of diagnosis status and processing speed on learning and memory performance, simple mediation models were computed. RESULTS Currently depressed patients with MDD showed partially slowed processing speed, impaired short-term verbal and visuo-spatial memory performance compared to healthy controls. A basic deficit in processing speed mediated the relationship between depression status and verbal, visuo-spatial, and working memory impairment. However, there was no processing speed or memory impairment in patients with remitted MDD. CONCLUSION Processing speed is an important factor regarding learning and memory impairment in patients with current MDD. Thereby, our results highlight novel targets for treatment of diminished learning and memory performance via enhancement of processing speed using pharmacological as well as therapeutic interventions.
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Affiliation(s)
- Dario Zaremba
- Department of Psychiatry, University of Münster, Germany
| | | | | | - Ronny Redlich
- Department of Psychiatry, University of Münster, Germany
| | | | | | | | - Katharina Dohm
- Department of Psychiatry, University of Münster, Germany
| | | | | | | | | | - Nils Opel
- Department of Psychiatry, University of Münster, Germany
| | - Silke Jörgens
- Department of Psychiatry, University of Münster, Germany
| | - Dilara Yüksel
- Department of Psychiatry, University of Marburg, Germany
| | - Simon Schmitt
- Department of Psychiatry, University of Marburg, Germany
| | | | - Tilo Kircher
- Department of Psychiatry, University of Marburg, Germany
| | - Axel Krug
- Department of Psychiatry, University of Marburg, Germany
| | - Igor Nenadić
- Department of Psychiatry, University of Marburg, Germany
| | | | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Germany; Department of Psychiatry, University of Melbourne, Australia
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Germany.
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Abstract
OBJECTIVE Deficits in explicit learning and memory have consistently been reported in adult ADHD, but it is less clear whether these deficits reflect deficient attentional processes or specific dysfunctions in memory processes. Studies on implicit learning and memory, which are less dependent on the allocation of attention, have rarely been conducted on adult ADHD. METHOD We implemented a modified serial reaction-time task that involves distracting stimuli to investigate implicit sequence learning in 32 adult participants with ADHD and in 32 matched healthy control participants. RESULTS The participants with ADHD revealed unimpaired implicit learning performance, but they made significantly more errors than the control participants. There was no evidence for impaired error monitoring in the participants with ADHD reflected by a comparable degree of double errors and post-error slowing in the two groups. CONCLUSION Reduced efficiency of the inhibition of incorrect responses in implicit sequence learning supports previous findings of impaired behavioral inhibition in adult ADHD.
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Cléry-Melin ML, Gorwood P. A simple attention test in the acute phase of a major depressive episode is predictive of later functional remission. Depress Anxiety 2017; 34:159-170. [PMID: 27781337 DOI: 10.1002/da.22575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/22/2016] [Accepted: 09/23/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Functional recovery after a major depressive episode (MDE) requires both clinical remission and preservation of cognitive skills. As attentional deficit may persist after remission, leading to functional impairment, its role as a prognosis marker needs to be considered. METHODS Five hundred eight depressed outpatients (DSM-IV) were assessed at baseline for clinical symptoms (QIDS-SR), social functioning (Sheehan Disability Scale, SDS) and attention through the d2 test of attention and the trail making test, simple tests, respectively, requiring to quote or to interconnect relevant items. All patients were treated by agomelatine, and examined 6 to 8 weeks after baseline to assess clinical remission (QIDS-SR ≤ 5) and/or functional remission (SDS ≤ 6). RESULTS At follow up, 154 patients (31%) were in clinical and functional remission. Shorter cumulative duration of prior depression, shorter present MDE, and two parameters of the d2 test of attention were predictive of such positive outcome, the number of omission mistakes (F1) being the only one still significantly predictive (P < .05) with a multivariate approach. F1 was unchanged after remission, patients with less than 11 mistakes had a 2.27 times increased chance to reach full remission, and a dose-response relationship was observed, with a regular increase of positive outcome for less mistakes. CONCLUSIONS The number of omission mistakes (F1) of the d2 test of attention was a stable marker, being predictive of, and with a dose-effect for, clinical plus functional remission. It may constitute a specific marker of attentional deficit, involved in the resilience process that enables individuals to develop more adequate strategies to cope with everyday functional activities.
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Affiliation(s)
- Marie-Laure Cléry-Melin
- CMME (Groupe Hospitalier Sainte-Anne), Université Paris Descartes, Paris, France.,INSERM U894, Centre of Psychiatry and Neurosciences, Paris, France
| | - Philip Gorwood
- CMME (Groupe Hospitalier Sainte-Anne), Université Paris Descartes, Paris, France.,INSERM U894, Centre of Psychiatry and Neurosciences, Paris, France
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Woo YS, Rosenblat JD, Kakar R, Bahk WM, McIntyre RS. Cognitive Deficits as a Mediator of Poor Occupational Function in Remitted Major Depressive Disorder Patients. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:1-16. [PMID: 26792035 PMCID: PMC4730927 DOI: 10.9758/cpn.2016.14.1.1] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/21/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023]
Abstract
Cognitive deficits in major depressive disorder (MDD) patients have been described in numerous studies. However, few reports have aimed to describe cognitive deficits in the remitted state of MDD and the mediational effect of cognitive deficits on occupational outcome. The aim of the current review is to synthesize the literature on the mediating and moderating effects of specific domains of cognition on occupational impairment among people with remitted MDD. In addition, predictors of cognitive deficits found to be vocationally important will be examined. Upon examination of the extant literature, attention, executive function and verbal memory are areas of consistent impairment in remitted MDD patients. Cognitive domains shown to have considerable impact on vocational functioning include deficits in memory, attention, learning and executive function. Factors that adversely affect cognitive function related to occupational accommodation include higher age, late age at onset, residual depressive symptoms, history of melancholic/psychotic depression, and physical/psychiatric comorbidity, whereas higher levels of education showed a protective effect against cognitive deficit. Cognitive deficits are a principal mediator of occupational impairment in remitted MDD patients. Therapeutic interventions specifically targeting cognitive deficits in MDD are needed, even in the remitted state, to improve functional recovery, especially in patients who have a higher risk of cognitive deficit.
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Affiliation(s)
- Young Sup Woo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto
| | - Ron Kakar
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto
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Bora E, Harrison BJ, Yücel M, Pantelis C. Cognitive impairment in euthymic major depressive disorder: a meta-analysis. Psychol Med 2013; 43:2017-2026. [PMID: 23098294 DOI: 10.1017/s0033291712002085] [Citation(s) in RCA: 352] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is evidence to suggest that cognitive deficits might persist beyond the acute stages of illness in major depressive disorder (MDD). However, the findings are somewhat inconsistent across the individual studies conducted to date. Our aim was to conduct a systematic review and meta-analysis of existing studies that have examined cognition in euthymic MDD patients. METHOD Following a systematic search across several publication databases, meta-analyses were conducted for 27 empirical studies that compared euthymic adult MDD patients (895 participants) and healthy controls (997 participants) across a range of cognitive domains. The influence of demographic variables and confounding factors, including age of onset and recurrent episodes, was examined. RESULTS Compared with healthy controls, euthymic MDD patients were characterized by significantly poorer cognitive functions. However, the magnitude of observed deficits, with the exception of inhibitory control, were generally modest when late-onset cases were excuded. Late-onset cases demonstrated significantly more pronounced deficits in verbal memory, speed of information processing and some executive functions. CONCLUSIONS Cognitive deficits, especially poor response inhibition, are likely to be persistent features, at least of some forms, of adult-onset MDD. More studies are necessary to examine cognitive dysfunction in remitted psychotic, melancholic and bipolar spectrum MDD. Cognitive deficits overall appear to be more common among patients with late-onset depression, supporting the theories suggesting that possible vascular and neurodegenerative factors play a role in a substantial number of these patients.
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Affiliation(s)
- E Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia.
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Hasselbalch BJ, Knorr U, Hasselbalch SG, Gade A, Kessing LV. The cumulative load of depressive illness is associated with cognitive function in the remitted state of unipolar depressive disorder. Eur Psychiatry 2012; 28:349-55. [PMID: 22944336 DOI: 10.1016/j.eurpsy.2012.03.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 03/28/2012] [Accepted: 03/29/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate whether the cumulative number, duration and subtypes (severity and presence of psychotic features) of previous episodes of depression in patients with unipolar depressive disorder in a remitted state are associated with decreased global cognitive function. METHODS Via the Danish registers individuals between 40 and 80 years of age were identified: (1) patients with a diagnosis of unipolar disorder at their first discharge from a psychiatric hospital in the period 1994 to 2002, and (2) gender and age matched control individuals. The participants were assessed with the Cambridge Cognitive Examination (CAMCOG), which provides a composite measure of global cognitive function. RESULTS A total of 88 patients and 50 controls accepted our invitation to participate, fulfilled the selection criteria and were included in the study. The cumulative duration of depressive episodes was associated with a decreased CAMCOG score adjusted for age, gender, education, premorbid IQ and residual depressive symptoms (B=-0.14, 95% C.I. (-0.26, -0.02), R(2)adj=0.31, P=.02). Significant associations were also found between CAMCOG score and the cumulative duration and total number of depressive episodes with psychotic features, respectively. CONCLUSION Our findings suggest that cognitive dysfunction is associated with the cumulative duration of depressive episodes, and that, in particular, depressive episodes with psychotic features in the course of illness may be a significant predictor of future impairment of cognitive function.
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Affiliation(s)
- B J Hasselbalch
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
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Self-Discrepancies Among Individuals with a History of Depression: The Role of Feared Self-Guides. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-011-9433-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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