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Göke K, McClintock SM, Mah L, Rajji TK, Lee HH, Nestor SM, Downar J, Noda Y, Daskalakis ZJ, Mulsant BH, Blumberger DM. Cognitive Profiles in Treatment-Resistant Late-Life Depression and their Impact on Treatment Outcomes. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00197-6. [PMID: 39053577 DOI: 10.1016/j.bpsc.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Late-life depression (LLD) is associated with cognitive impairment, yet substantial heterogeneity exists among patients. Data on the extent of cognitive impairments is inconclusive, particularly in patients with treatment-resistant depression (TRD). We investigated the cognitive profiles of patients with treatment-resistant vs. nonresistant LLD and aimed to identify distinct cognitive subgroups. Additionally, we examined whether cognitive subgroups differentially responded to treatment with bilateral repetitive transcranial magnetic stimulation (rTMS). METHODS 165 patients with LLD were divided into treatment-resistant and nonresistant groups and compared to healthy controls (HC) on measures of executive function, information processing speed, verbal learning, and memory. Cluster analysis identified subgroups based on cognitive scores. Demographic and clinical variables, as well as outcomes with bilateral rTMS, were compared between cognitive subgroups. RESULTS Patients with LLD, particularly TRD, exhibited significantly worse cognitive performance than HC. A three-cluster solution was found, including "Cognitively Intact" (n = 89), "Cognitively Diminished" (n = 29), and "Impaired Memory" (n = 47) subgroups. Both the "Cognitively Diminished" and "Impaired Memory" subgroups had more anxiety symptoms and a higher proportion of patients with TRD than the "Cognitively Intact" group, though the latter did not survive multiple comparison correction. No significant differences were observed in outcomes to rTMS treatment. CONCLUSIONS Patients with LLD exhibited impairments across cognitive domains, which were more pronounced in TRD. Three identified cognitive subgroups responded similarly to rTMS treatment, indicating its effectiveness across cognitive profiles, especially when medications are not tolerated. Future research should examine the relationship among cognitive subgroups, cognitive decline, and neurodegeneration.
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Affiliation(s)
- Katharina Göke
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Linda Mah
- Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Hyewon H Lee
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sean M Nestor
- Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Faculty of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California, San Diego Health, California, United States
| | - Benoit H Mulsant
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Marawi T, Zhukovsky P, Brooks H, Bowie CR, Butters MA, Fischer CE, Flint AJ, Herrmann N, Lanctôt KL, Mah L, Pollock BG, Rajji TK, Voineskos AN, Mulsant BH. Heterogeneity of Cognition in Older Adults with Remitted Major Depressive Disorder: A Latent Profile Analysis. Am J Geriatr Psychiatry 2024; 32:867-878. [PMID: 38403532 DOI: 10.1016/j.jagp.2024.01.225] [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: 09/12/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES To identify data-driven cognitive profiles in older adults with remitted major depressive disorder (rMDD) with or without mild cognitive impairment (MCI) and examine how the profiles differ regarding demographic, clinical, and neuroimaging measures. DESIGN Secondary cross-sectional analysis using latent profile analysis. SETTING Multisite clinical trial in Toronto, Canada. PARTICIPANTS One hundred seventy-eight participants who met DSM-5 criteria for rMDD without MCI (rMDD-MCI; n = 60) or with MCI (rMDD + MCI; n = 118). MEASUREMENTS Demographic, clinical, neuroimaging measures, and domain scores from a neuropsychological battery assessing verbal memory, visuospatial memory, processing speed, working memory, language, and executive function. RESULTS We identified three latent profiles: Profile 1 (poor cognition; n = 75, 42.1%), Profile 2 (intermediate cognition; n = 75, 42.1%), and Profile 3 (normal cognition; n = 28, 15.7%). Compared to participants with Profile 3, those with Profile 1 or 2 were older, had lower education, experienced a greater burden of medical comorbidities, and were more likely to have MCI. The profiles did not differ on the severity of residual symptoms, age of onset of rMDD, number of depressive episodes, psychotropic medication, cerebrovascular risk, ApoE4 carrier status, or family history of depression, dementia, or Alzheimer's disease. The profiles differed in cortical thickness of 15 regions, with the most prominent effects for left precentral and pars opercularis, and right inferior parietal and supramarginal. CONCLUSION Older patients with rMDD can be grouped cross-sectionally based on data-driven cognitive profiles that differ from the absence or presence of a diagnosis of MCI. Future research should determine the differential risk for dementia of these data-driven subgroups.
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Affiliation(s)
- Tulip Marawi
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute (TM, PZ, HB, CRB, BGP, TKR, ANV, BHM), Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Zhukovsky
- Campbell Family Mental Health Research Institute (TM, PZ, HB, CRB, BGP, TKR, ANV, BHM), Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Heather Brooks
- Campbell Family Mental Health Research Institute (TM, PZ, HB, CRB, BGP, TKR, ANV, BHM), Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Christopher R Bowie
- Campbell Family Mental Health Research Institute (TM, PZ, HB, CRB, BGP, TKR, ANV, BHM), Centre for Addiction and Mental Health, Toronto, ON, Canada; Departments of Psychology and Psychiatry (CRB), Queen's University, Kingston, ON, Canada
| | - Meryl A Butters
- Department of Psychiatry (MAB), University of Pittsburgh, Pittsburgh, PA
| | - Corinne E Fischer
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science (CEF), St. Michaels Hospital, Toronto, ON, Canada
| | - Alastair J Flint
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Centre for Mental Health (AJF), University Health Network, Toronto, ON, Canada
| | - Nathan Herrmann
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Department of Psychiatry (NH, KLL), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology (NH, KLL), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Department of Psychiatry (NH, KLL), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology (NH, KLL), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Linda Mah
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Department of Psychiatry (LM), Baycrest Health Services, Rotman Research Institute, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute (TM, PZ, HB, CRB, BGP, TKR, ANV, BHM), Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute (TM, PZ, HB, CRB, BGP, TKR, ANV, BHM), Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance (TKR, BHM), University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute (TM, PZ, HB, CRB, BGP, TKR, ANV, BHM), Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Institute of Medical Science (TM, CEF, AJF, NH, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute (TM, PZ, HB, CRB, BGP, TKR, ANV, BHM), Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine (CEF, AJF, NH, KLL, LM, BGP, TKR, ANV, BHM), University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance (TKR, BHM), University of Toronto, Toronto, ON, Canada.
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Forbes M, Lotfaliany M, Mohebbi M, Reynolds CF, Woods RL, Orchard S, Chong T, Agustini B, O'Neil A, Ryan J, Berk M. Depressive symptoms and cognitive decline in older adults. Int Psychogeriatr 2024:1-12. [PMID: 38623851 DOI: 10.1017/s1041610224000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Few studies have examined the impact of late-life depression trajectories on specific domains of cognitive function. This study aims to delineate how different depressive symptom trajectories specifically affect cognitive function in older adults. DESIGN Prospective longitudinal cohort study. SETTING Australia and the United States of America. PARTICIPANTS In total, 11,035 community-dwelling older adults with a mean age of 75 years. MEASUREMENTS Depressive trajectories were modelled from depressive symptoms according to annual Centre for Epidemiological Studies Depression Scale 10 (CES-D-10) surveys. Four trajectories of depressive symptoms were identified: low ("nondepressed"), consistently mild ("subthreshold depression"), consistently moderate ("persistent depression"), and initially low but increasing ("emerging depression"). Global cognition (Modified Mini-Mental State Examination [3MS]), verbal fluency (Controlled Oral Word Association Test [COWAT]), processing speed (Symbol Digit Modalities Test [SDMT]), episodic memory (Hopkins Verbal Learning Test - Revised [HVLT-R]), and a composite z-score were assessed over a subsequent median 2 years. RESULTS Subthreshold depression predicted impaired performance on the SDMT (Cohen's d -0.04) and composite score (-0.03); emerging depression predicted impaired performance on the SDMT (-0.13), HVLT-R (-0.09), 3 MS (-0.08) and composite score (-0.09); and persistent depression predicted impaired performance on the SDMT (-0.08), 3 MS (-0.11), and composite score (-0.09). CONCLUSIONS Depressive symptoms are associated with later impaired processing speed. These effects are small. Diverse depression trajectories have different impacts on cognitive function.
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Affiliation(s)
- Malcolm Forbes
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Mojtaba Lotfaliany
- School of Medicine, Barwon Health, Deakin University, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, VC, Australia
| | - Mohammadreza Mohebbi
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Trevor Chong
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Bruno Agustini
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Adrienne O'Neil
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
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