Comorbid anxiety corresponds with neuropsychological dysfunction in unipolar depression

Determinants of semantic and episodic memory decline among older adults in Ghana: Evidence from the WHO study on global AGEing and adult health Ghana wave 2

Objective

Determined factors associated with semantic (SM) and episodic memory (EM) among older adults aged 50 years and older in Ghana.

Methods

Data from WHO Study on Global AGEing and Adult Health (SAGE) Ghana Wave 2 was used for this study. Semantic memory (SM) and Episodic memory (EM) were the main study outcomes separately. The study employed Nested Ordinary Least Square regression analysis by sequentially adding 6 blocks of variables and comparison tests between the nested models.

Results

The study involved 3575 adult Ghanaians aged 50 years and older with a mean ± standard deviation of 62.6 ± 18.4 years. The overall mean ± SD of EM and SM were 5.86 ± 2.51 and 11.69 ± 8.59 respectively. Overall, analysis from block 6 showed a significant variation in SM by approximately 16.9%(ΔR2 = 1.17%) where increasing age, never married (β = -1.55; 95% CI = -2.41-0.69), being resident in Greater Accra (regional disparity) (β = -3.45; 95% CI = -4.73-2.20), underweight (β = -0.81;95% CI = -1.34-0.27), and moderate self-rated health (SRH) (β = -0.98; 95% CI = -1.52-0.45) significantly decreased SM. Similarly, increasing age, separated/divorced (β = -0.22; 95% CI = -0.35-0.87), being resident in Greater Accra (β = -0.53; 95% CI = -0.80-0.26), and moderate SRH (β = -0.20; 95% CI = -0.36--0.04) significantly decrease EM with an overall significant variation of approximately 22.9%(ΔR2 = 2.7%).

Conclusions

Increasing age, sex, marital status, regional disparity, and poor SRH significantly decreased both Semantic memory and Episodic memory. Higher educational attainment and life satisfaction significantly influenced SM and EM. These provide pointers to important socio-demographic determinants of SM and EM with implications for the implementation of the Ghana national ageing policy 2010, 'ageing with security and dignity', and as a key consideration for healthy ageing towards 2030.

Compounding Effects of Domain-General Cognitive Weaknesses and Word Reading Difficulties on Anxiety Symptoms in Youth

This study examined whether domain-general cognitive weaknesses in processing speed (PS) or executive functioning (EF) moderate the relation between word reading scores and anxiety such that lower word reading scores in combination with lower cognitive scores are associated with higher anxiety symptoms. The sample consisted of 755 youth ages 8-16 who were recruited as part of the Colorado Learning Disabilities Research Center twins study. Lower scores on PS (R2 = .007, p = .014), EF (R2 = .009, p = .006), and word reading (R2 = .006-.008, p = .010-.032) were associated with higher anxiety scores. In addition, the word reading × cognitive interactions were significant such that lower scores on PS (R2 = .010, p = .005) or EF (R2 = .013, p = .010) combined with lower word reading were associated with higher-than-expected anxiety symptoms. Results suggest that weaknesses in PS, EF, and word reading are modestly associated with higher anxiety symptoms, and these anxiety symptoms may be compounded in youth with both PS or EF weaknesses and word reading difficulties. These findings can guide assessment approaches for identifying youth with word reading challenges who may be at increased risk for anxiety.

Features of cognitive impairment and related risk factors in patients with major depressive disorder: A case-control study

BACKGROUND

Cognitive impairment (CI) is a common symptom contributing to functional loss in major depressive disorder (MDD). However, the features of CI and its related risk factors in young and middle-aged MDD patients remain unclear.

METHODS

In this case-control study, 18- to 55-year-old acute-onset MDD patients and healthy controls (HCs) were recruited from nine centers in China. MDD patients were diagnosed based on the DSM-IV, the Mini-International Neuropsychiatric Interview, and a 17-item Hamilton Rating Scale for Depression score ≥ 14. Cognitive function, including attention/vigilance, learning, memory, processing speed and executive function, was assessed with a neuropsychological battery and compared between MDD patients and HCs. MDD patients scoring 1.5 SDs below the mean HC score in at least 2 domains were defined as having CI. Logistic regression analysis was used to identify risk factors for CI in MDD patients.

RESULTS

Compared with HCs (n = 302), MDD patients (n = 631) showed significant impairment in all cognitive domains (P < 0.001); 168 MDD patients (26.6%) had CI. Male sex (OR: 1.712; 95% CI: 1.165-2.514; P < 0.01) was positively correlated with CI; age of first onset (OR: 0.974; 95% CI: 0.957-0.991; P < 0.05) and comorbid anxiety disorders (OR: 0.514; 95% CI: 0.332-0.797; P < 0.01) were negatively correlated with CI.

LIMITATIONS

Biomarkers and neuroimaging were not used to investigate the possible biological mechanism and neural basis of CI in MDD.

CONCLUSIONS

CI was prominent in adults with acute-onset MDD; male sex and younger age of first onset were independent risk factors, and comorbid anxiety disorders were a protective factor.

High-School Football and Midlife Brain Health Problems

OBJECTIVE

To examine whether middle-aged men who played high-school football experience worse mental health or cognitive functioning than men who did not play high-school football.

DESIGN

Cross-sectional cohort study.

SETTING

Online survey completed remotely.

PARTICIPANTS

A total of 435 men between the ages of 35 and 55 completed the study, of whom 407 were included in the analyses after excluding participants who answered embedded validity items incorrectly (n = 16), played semiprofessional football (n = 2), or experienced a recent concussion (n = 10).

ASSESSMENT OF RISK FACTORS

Self-reported high school football participation, compared with those who played contact sports, noncontact sports, and no sports.

MAIN OUTCOME MEASURES

A lifetime history of depression or anxiety; mental health or cognitive problems in the past year; current depression symptoms, and post-concussion-like symptoms.

RESULTS

Middle-aged men who played high-school football did not have a higher prevalence of being prescribed medication for anxiety or depression or receiving treatment from a mental health professional. Similarly, there were no significant differences between groups on the rates in which they endorsed depression, anxiety, anger, concentration problems, memory problems, headaches, migraines, neck or back pain, or chronic pain over the past year. A greater proportion of those who played football reported sleep problems over the past year and reported being prescribed medication for chronic pain and for headaches.

CONCLUSIONS

Men who played high-school football did not report worse brain health compared with those who played other contact sports, noncontact sports, or did not participate in sports during high school.

Attentional networks in co-occurring generalized anxiety disorder and major depression disorder: Towards a staging approach to the executive control deficits

INTRODUCTION

Major Depression Disorder (MDD) and Generalized Anxiety Disorder (GAD) often co-occur, but the neurocognitive mechanisms of this co-occurrence remain unknown. Prominent views have pointed to attentional processes as potent mechanisms at play in MDD and GAD, respectively. Yet uncertainty remains regarding the very nature of attentional impairments in patients with co-occurring MDD and GAD.

METHODS

Inspired by contemporary models of attentional networks, we compared the three main attentional networks, namely the orienting, alerting, and executive networks of the Attention Network Task's model, in four groups of patients with, respectively, co-occurring DSM-5 MDD and GAD (n = 30), DSM-5 MDD only (n = 30), DSM-5 GAD only (n = 30), or free from any DSM-5 diagnosis (n = 30). To capture the multivariate nature of our data, we examined between-group differences in the attentional networks through a multivariate analysis of variance.

RESULTS

Patients with co-occurring MDD and GAD exhibited more severe impairments in the executive control network than those with only one of the disorders. Although patients with MDD or GAD solely did not differ in terms of attentional impairments, both groups showed significantly more impairments in the executive control network than those free from any DSM-5 diagnosis (all Bonferonni-corrected post-hoc ps < 0.05).

CONCLUSIONS

Our findings align with a longstanding staging approach to comorbidity whereby, via synergistic effects, co-occurring disorders produce more damages than the sum of each disorder. Here, for the first time, we extended this approach to the executive network of attention in the context of the co-occurrence between MDD and GAD.

Intensive Care-Related Cognitive Impairment: A Biopsychosocial Overview

Advancements in critical care medicine have improved survival rates for patients experiencing critical illness in intensive care units (ICUs). While mortality has declined, more than half of ICU survivors experience functional impairments that persist beyond discharge. Of particular concern is ICU-related cognitive impairment, which can extend across the care continuum, ranging from acute and transient presentations in the ICU (eg, delirium) to long-term impairments years after discharge. ICU-related cognitive impairment has received increased attention in the literature, particularly as it relates to ICU survivors who have received and survived critical care in the context of SARS-CoV-2 pandemic and are now experiencing post-acute sequelae of SARS-CoV-2 infection. The medical complexity and heterogeneity of ICU survivors, coupled with the multifactorial etiology of ICU-related cognitive impairments, lead to challenges in how to optimize care for ICU survivors at various stages of recovery. This review aims to provide an overview of cognitive outcomes associated with critical illness by integrating recent literature focused on etiology, assessment, and interventions in the context of ICU-related cognitive impairments. The narrative review employs a biopsychosocial framework to comprehensively evaluate the multifactorial nature of ICU-related cognitive outcomes. Authors also highlight multidisciplinary teams composed of key rehabilitation providers are likely best suited for optimizing recovery trajectories of ICU survivors. This article is protected by copyright. All rights reserved.

Set Shifting and Inhibition Deficits as Potential Endophenotypes for Depression

The etiology of Major Depressive Disorder (MDD) is poorly understood, and identifying endophenotypes, or intermediate processes implicated in pathophysiology, for MDD may inform treatment and identification/prevention efforts. Impaired set-shifting and inhibition are commonly observed in MDD; however, few studies have examined they are endophenotypes for MDD. Thus, the present study tested whether set-shifting and/or inhibition satisfy several endophenotype criteria: specifically, whether they were (1) impaired in current MDD, (2) impaired in remitted MDD, and (3) familial (i.e., correlated within sibling pairs). Set-shifting and inhibition were assessed using subtests from the Delis-Kaplan Executive Function System. Psychopathology was assessed using the Structured Clinical Interview for DSM-5. Results indicated set-shifting deficits were familial and present in both current MDD and in remitted MDD individuals who had no current disorders, suggesting they may be state-independent. Inhibition was familial, but was generally not impaired in current nor remitted MDD (although the remitted MDD group with no current disorders exhibited impairments on one of the two inhibition tasks). These findings indicate that impaired set-shifting is a promising endophenotype candidate for MDD. Findings are limited to young adults, and further research is needed to test generalizability to other populations, evaluate longitudinal relationships, and examine other endophenotype criteria.

Burnout and Cognitive Performance

The aim of this study was to investigate the relationship between burnout and cognitive functioning. The associations of depression, anxiety and family support with burnout and cognitive functioning were also examined both independently and as potential moderators of the burnout–cognitive functioning relationship. Seven different cognitive tasks were administered to employees of the general working population and five cognitive domains were assessed; i.e., executive functions, working memory, memory (episodic, visuospatial, prospective), attention/speed of processing and visuospatial abilities. Burnout, depression, anxiety and family support were assessed with the Maslach Burnout Inventory-General Survey, the Hospital Anxiety and Depression Scale and the Family Support Scale respectively. In congruence with the first and fourth (partially) Hypotheses, burnout and perceived family support are significantly associated with some aspects of cognitive functioning. Moreover, in line with the third Hypothesis, perceived family support is inversely related to burnout. However, in contrast to the second and fourth Hypotheses, depression, anxiety and perceived family support do not moderate the burnout–cognitive functioning relationship. Additional results reveal positive associations between burnout depression and anxiety. Overall findings suggest that cognitive deficits, depression and anxiety appear to be common in burnout while they underpin the role of perceived family support in both mental health and cognitive functioning. Implications for practice are discussed.

Using supervised machine learning on neuropsychological data to distinguish OCD patients with and without sensory phenomena from healthy controls

OBJECTIVES

While theoretical models link obsessive-compulsive disorder (OCD) with executive function deficits, empirical findings from the neuropsychological literature remain mixed. These inconsistencies are likely exacerbated by the challenge of high-dimensional data (i.e., many variables per subject), which is common across neuropsychological paradigms and necessitates analytical advances. More unique to OCD is the heterogeneity of symptom presentations, each of which may relate to distinct neuropsychological features. While researchers have traditionally attempted to account for this heterogeneity using a symptom-based approach, an alternative involves focusing on underlying symptom motivations. Although the most studied symptom motivation involves fear of harmful events, 60-70% of patients also experience sensory phenomena, consisting of uncomfortable sensations or perceptions that drive compulsions. Sensory phenomena have received limited attention in the neuropsychological literature, despite evidence that symptoms motivated by these experiences may relate to distinct cognitive processes.

METHODS

Here, we used a supervised machine learning approach to characterize neuropsychological processes in OCD, accounting for sensory phenomena.

RESULTS

Compared to logistic regression and other algorithms, random forest best differentiated healthy controls (n = 59; balanced accuracy = .70), patients with sensory phenomena (n = 29; balanced accuracy = .59), and patients without sensory phenomena (n = 46; balanced accuracy = .62). Decision-making best distinguished between groups based on sensory phenomena, and among the patient subsample, those without sensory phenomena uniquely displayed greater risk sensitivity compared to healthy controls (d = .07, p = .008).

CONCLUSIONS

Results suggest that different cognitive profiles may characterize patients motivated by distinct drives. The superior performance and generalizability of the newer algorithms highlights the utility of considering multiple analytic approaches when faced with complex data.

PRACTITIONER POINTS

Practitioners should be aware that sensory phenomena are common experiences among patients with OCD. OCD patients with sensory phenomena may be distinguished from those without based on neuropsychological processes.

Effects of mood episodes and comorbid anxiety on neuropsychological impairment in patients with bipolar spectrum disorder

OBJECTIVES

Cases of patients with bipolar disorder (BD) having neuropsychological impairment have been reported, although inconsistently. The possibility of comorbidity with anxiety disorder (AD) has been suggested. The association between mood episodes and AD comorbidity on neuropsychological performance is unclear and thus was investigated in the current study.

METHODS

All participants were informed about and agreed to participate in this study. Patients with BD were recruited from outpatient and inpatient settings, and healthy controls (HCs) were recruited as a comparison group. Six hundred and twenty-eight participants (175 HCs and 453 BD-56 BDI and 397 BDII) were studied based on their current mood episode, namely, depressive (BD_d ), manic/hypomanic (BDm), mixed (BDmix), and euthymic (BDeu), compared with/without AD comorbidity (164 with AD).

RESULTS

Compared to HCs, all BD groups had significantly more impaired neuropsychological profiles, but the BDeu group was found to have less impairment in memory and executive function than the episodic BD groups. The percentage of AD comorbidity in BDd, BDm, BDmix, and BDeu was 33.9%, 40.3%, 33.0%, and 35.6%, respectively (χ²  = 1.61, p > .05). The results show that AD plays a different role in neuropsychological impairment across various mood episodes in BD.

CONCLUSION

Memory impairment and executive dysfunction may be state-like cognitive phenotypes and are affected by AD comorbidity during mixed and depressive episodes in BD, while sustained attention deficiencies are more like trait markers, regardless of mood episodes, and persist beyond the course of the illness. The AD comorbidity effect on attentional deficit is greater when suffering from a manic episode.

Predictors of cognitive impairment in treatment-resistant depression

BACKGROUND

Cognitive impairment is a well-recognized symptom of major depressive disorder; however, contributing factors are not fully characterized. The present study examined the neurocognitive profiles and predictors of cognitive impairment in patients with treatment-resistant depression (TRD).

METHODS

Moderate to severely depressed TRD patients were compared to matched healthy volunteers (HV) in verbal learning and recall and executive functions. Based on cognitive scores, cluster analysis was performed to identify subsets within the TRD sample. Predictors of cognitive impairment were also investigated.

RESULTS

TRD patients showed worse performance in tests assessing verbal memory, executive attentional shifting, and inhibitory control. The cluster analysis revealed two groups: a cognitively impaired (CI) group that showed a generalized deficit across cognitive domains, and a relatively cognitively intact group that performed better than CI in all domains except attentional shifting. A logistic binomial regression of the two groups revealed three significant contributing risk factors for CI: 1) older age, 2) lower premorbid IQ, and 3) benzodiazepine use. Cognitive impairment and benzodiazepine use were associated with worse functioning.

CONCLUSIONS

Significant cognitive impairment is present in TRD and is associated with worse functioning. Age, lower premorbid IQ, and benzodiazepine use increased the likelihood of generalized cognitive impairment in TRD patients. The detrimental effect of benzodiazepine on cognitive impairment is independent of anxiety symptoms. Further research is needed to characterize the timeline of cognitive impairment in depression.

Depression, Anxiety, and Apathy in Mild Cognitive Impairment: Current Perspectives

Objective: Mild cognitive impairment (MCI) is an important risk state for dementia, particularly Alzheimer's disease (AD). Depression, anxiety, and apathy are commonly observed neuropsychiatric features in MCI, which have been linked to cognitive and functional decline in daily activities, as well as disease progression. Accordingly, the study's objective is to review the prevalence, neuropsychological characteristics, and conversion rates to dementia between MCI patients with and without depression, anxiety, and apathy. Methods: A PubMed search and critical review were performed relating to studies of MCI, depression, anxiety, and apathy. Results: MCI patients have a high prevalence of depression/anxiety/apathy; furthermore, patients with MCI and concomitant depression/anxiety/apathy have more pronounced cognitive deficits and progress more often to dementia than MCI patients without depression/anxiety/apathy. Conclusions and Implications: Depression, anxiety, and apathy are common in MCI and represent possible risk factors for cognitive decline and progression to dementia. Further studies are needed to better understand the role and neurobiology of depression, anxiety, and apathy in MCI.

Verbal memory predicts treatment outcome in syndromal anxious depression: An iSPOT-D report

BACKGROUND

Major Depressive Disorder (MDD), anxiety disorders, and high levels of anxious symptoms are associated with impaired cognitive functioning. However, little is known of how cognitive functioning is impaired in people with anxious depression. Here, we compared cognitive functioning between people with anxious depression, non-anxious depression, and healthy controls. We also tested whether anxious depression moderated the relationship between cognitive functioning and treatment outcome.

METHODS

1008 adults with MDD and 336 healthy controls completed IntegNeuro: a computerized cognitive functioning test battery. Participants were then randomised to one of three antidepressants and reassessed at 8 weeks using the 17-item Hamilton Depression Rating Scale (HRSD₁₇) and the 16-Item Quick Inventory of Depressive Symptomatology-Self-Rated for remission and response. Syndromal anxious depression was defined as MDD with a comorbid anxiety disorder. HRSD anxious depression was defined as MDD with a comorbid HRSD₁₇ anxiety/somatisation factor score ≥ 7.

RESULTS

Syndromal anxious depression was associated with better psychomotor functioning and poorer working memory, cognitive flexibility and information processing speed compared to their non-anxious counterparts. HRSD anxious depression was associated with better psychomotor functioning compared to their non-anxious counterparts. Syndromal anxious depression moderated the relationship between verbal memory and treatment outcome. In people with syndromal anxious depression, poorer baseline verbal memory predicted poorer treatment outcome.

LIMITATIONS

As DSM-IV criteria was used, the DSM-5 anxious distress specifier characterisation of anxious depression could not be assessed CONCLUSIONS: Syndromal anxious depression is characterised by impaired executive functions and moderates the relationship between verbal memory functioning and treatment outcome.

Influence of comorbid anxiety symptoms on cognitive deficits in patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) patients with comorbid anxiety symptoms showed obvious cognitive deficits. However, it remains unclear whether comorbid anxiety symptoms will make a specific contribution to cognitive deficits in MDD.

METHODS

Executive function, processing speed, attention and memory were assessed in 162 MDD patients, and 142 healthy controls (HCs) by a comprehensive neuropsychological battery. 14-item Hamilton Anxiety Rating Scale (HAM-A) was used for anxiety symptoms and MDD patients with HAM-A total score >14 were classified into MDD with comorbid anxiety (MDDA) group. A multivariate analysis of covariance and regression models was conducted to evaluate the effects of anxiety symptoms on cognitive deficits.

RESULTS

There were no significantly differences in all 4 cognitive domains between MDD alone and MDDA patients (all p < 0.05). In MDDA subgroup, HAM-A total score contributed to executive function and memory (both p < 0.05), while HAM-A psychic symptoms contributed to all 4 domains (all p < 0.05). Moreover, after controlling for the severity of depression, either anxiety symptoms shown as HAMA total score or psychic anxiety symptoms only contributed significantly to the executive function performance.

LIMITATIONS

The cross-sectional design made it hard to acquire a cognitive performance trajectory accompanied by the fluctuations in anxiety symptoms.

CONCLUSION

Our findings suggest that there is no significant difference in cognitive performance between MDD alone and MDDA patients. However, comorbid anxiety, especially psychic anxiety may contribute to extensive cognitive deficits in MDDA patients. Notably, anxiety symptoms only independently triggered executive dysfunction when eliminating effect of the severity of depression.

The effect of anxiety on cognition in older adult inpatients with depression: results from a multicenter observational study

Late-life depression is associated with reduced cognitive function beyond normal age-related cognitive deficits. As comorbid anxiety frequently occur in late-life depression, this study aimed to examine the association between anxiety symptoms and cognitive function among older inpatients treated for depression. We hypothesized that there would be an overall additive effect of comorbid anxiety symptoms on dysfunction across cognitive domains. The study included 142 patients treated for late-life depression in hospital, enrolled in the Prognosis of Depression in the Elderly study. Anxiety symptoms were measured at admission using the anxiety subscale of the Hospital Anxiety and Depression Scale. Patients completed cognitive tasks at admission and discharge. Linear mixed and generalized linear mixed models were estimated to investigate the effect of anxiety, on continuous and categorical cognitive scores, respectively, while controlling for depression. Anxiety severity at admission was not associated with performance in any of the cognitive domains. Patients with more symptoms of anxiety at admission demonstrated a significant improvement in immediate recall during the hospital stay. Patients with a score above cutoff indicating clinically significant symptoms on the anxiety subscale performed better on general cognitive function, as measured by the Mini Mental Status Examination at admission, than those below cutoff for anxiety. In conclusion, comorbid anxiety symptoms had no additive effect on cognitive dysfunction in late-life depression in our sample of inpatients.

Relationship Between Anxiety and Cognition in Multiple Sclerosis: Implications for Treatment

Background

Anxiety, which is very prevalent in multiple sclerosis (MS) but understudied, has been shown to negatively affect cognition in many different populations. Slowed information processing speed underlies most cognitive impairments in MS, including verbal learning. The aim of this study was to look at how anxiety influences cognition-specifically processing speed and verbal learning-in MS.

Methods

Eligibility criteria were adults (≥18 years) who had a diagnosis of clinically definite MS and had participated in neuropsychological research projects. A retrospective medical record review was conducted on the neuropsychological testing data. Two hierarchical multiple regressions were conducted to determine the unique contributions of processing speed and anxiety on verbal learning in MS, after adjusting for demographic and disability variables. Two separate mediation analyses were conducted to determine the relationship between processing speed, verbal learning, and anxiety.

Results

Participants (N = 141) ranged in age from 18-91 years. Based on the multiple regression analyses, processing speed (β = 0.55, ΔR ² = 0.27, P < .001) and anxiety (β = -0.34, ΔR ² = 0.11, P < .001) were uniquely significant predictors of verbal learning. Based on the mediation analyses, there was a significant indirect effect of anxiety on verbal learning through processing speed (ab = -0.31, 95% CI = -0.60 to -0.09). There was also a significant indirect effect of processing speed on verbal learning through anxiety (ab = -0.05, 95% CI = 0.01 to 0.12).

Conclusions

Results suggest a bidirectional relationship of anxiety and processing speed on verbal learning in MS. Anxiety has a significant effect on cognition and should not be overlooked. Interventions targeting anxiety may improve cognition in MS.

Cognitive impairment as measured by the THINC-integrated tool (THINC-it): The association with self-reported anxiety in Major Depressive Disorder

BACKGROUND AND OBJECTIVES

This study evaluated the association between self-reported anxiety and objective/subjective measures of cognitive performance in adults with Major Depressive Disorder (MDD).

METHODS

Acutely depressed subjects with recurrent MDD (n = 100) and age-, sex-, and education-matched healthy controls (HC; n = 100) between the ages of 18 and 65 completed the cross-sectional validation study of the THINC-integrated tool (THINC-it; ClinicalTrials.gov: NCT02508493). Objective cognitive performance was assessed using the THINC-it, and subjective cognitive impairment with the Perceived Deficits Questionnaire for Depression-5-item. Subjects also completed the Generalized Anxiety Disorder-7-item (GAD-7) questionnaire.

RESULTS

Subjects with MDD reported significantly more anxiety symptoms, as assessed by the GAD-7, compared to HC (p < 0.001). Linear regression analysis determined that anxiety symptoms significantly accounted for 70.4% of the variability in subjective cognitive impairment, adjusting for depression severity. Moreover, subjects' ratings of the difficulties caused by their anxiety were reported as significantly more severe among subjects with MDD when compared to HC (p < 0.001). Likewise, greater self-reported difficulties with anxiety significantly predicted 57.8% of the variability in subjective cognitive impairment, adjusting for depression severity. Neither anxiety symptoms nor impairment due to anxiety symptoms predicted objective cognitive performance.

LIMITATIONS

Subjects were not prospectively verified to have a clinical diagnosis of GAD. Rather, this study examined the relationships between symptoms of generalized anxiety, assessed using a brief screening tool, and subjective and objective cognitive function.

CONCLUSIONS

Results from the current study indicate that adults with MDD and high levels of self-reported anxiety are significantly more likely to report experiencing subjective cognitive dysfunction.

The association of anxiety, depression, and worry symptoms on cognitive performance in older adults

Emerging research suggests that a relationship exists between the cognitive aspects of anxiety (e.g. worry) and cognitive decline in older adults. The current study examined the association between anxiety, depressive, and worry symptoms on cognitive performance. Participants were 156 older adults enrolled in the Nathan Kline Institute-Rockland Sample Study (NKI-RS).  Hierarchical linear regression analysis was used to determine the unique associations of anxiety, depressive, and worry symptoms on cognitive performance as measured by the Penn Computerized Neurocognitive Battery (Penn CNB), the Delis-Kaplan Executive Function System (D-KEFS), and the Rey Auditory Verbal Learning Test (RAVLT). Worry symptoms were a significant predictor of Penn CNB social cognition, complex cognition, executive function, and episodic memory performance as well as RAVLT immediate and short-delay recall, but not of D-KEFS performance or RAVLT long-delay recall. In contrast, anxiety and depressive symptoms had few unique associations with cognitive performance. Given that worry symptoms have a negative impact on many aspects of neurocognitive performance, they may have utility in predicting and preventing cognitive decline in older adults.

Childhood adversity and cognitive functioning in patients with major depression

OBJECTIVE

Major depression is often accompanied by deficits in cognitive functioning and lowered executive functions. However, not all depressed patients show impairments in these domains. The aim of this study was to examine whether different kinds of childhood adversity might account for cognitive deficits in patients with major depression.

METHODS

Ninety-one patients with major depression (DSM-IV) and 40 healthy controls completed a neuropsychological test battery assessing memory, processing speed and executive functions. The Childhood Trauma Questionnaire (CTQ) was used to measure the severity and number of incidences of sexual, physical and emotional abuse and physical and emotional neglect.

RESULTS

Patients with major depression had a significantly higher number of traumas and reported more severe emotional abuse, emotional neglect and physical neglect than healthy controls. Patients performed less well in memory tasks, general knowledge and processing speed than healthy controls. Hierarchical regression analyses indicated that the overall number of traumas was significantly associated with poorer general knowledge, lower processing speed and impaired executive functions in patients with major depression. A second model including all CTQ-subscales simultaneously demonstrated an association between physical neglect and poorer verbal learning, and physical abuse and diminished executive functions.

CONCLUSION

A higher number of childhood adversities may influence general knowledge, processing speed and executive functions in patients with major depression. In addition, physical abuse and neglect seemed to be associated with verbal learning deficits and poorer executive functions.

Satisficing in Mental Health Care Patients: The Effect of Cognitive Symptoms on Self-Report Data Quality

Respondents may use satisficing (i.e., nonoptimal) strategies when responding to self-report questionnaires. These satisficing strategies become more likely with decreasing motivation and/or cognitive ability (Krosnick, 1991). Considering that cognitive deficits are characteristic of depressive and anxiety disorders, depressed and anxious patients may be prone to satisficing. Using data from the Netherland’s Study of Depression and Anxiety (N = 2,945), we studied the relationship between depression and anxiety, cognitive symptoms, and satisficing strategies on the NEO Five-Factor Inventory. Results showed that respondents with either an anxiety disorder or a comorbid anxiety and depression disorder used satisficing strategies substantially more often than healthy respondents. Cognitive symptom severity partly mediated the effect of anxiety disorder and comorbid anxiety disorder on satisficing. The results suggest that depressed and anxious patients produce relatively low-quality self-report data—partly due to cognitive symptoms. Future research should investigate the degree of satisficing across different mental health care assessment contexts.

Cognitive Dysfunction in Major Depressive Disorder: Assessment, Impact, and Management

Cognitive dysfunction is increasingly being recognized as an important clinical dimension in major depressive disorder. This review summarizes the existing data on the epidemiology, assessment, and treatment of cognitive dysfunction among nonelderly adults with the disorder. Overall, cognitive dysfunction is prevalent, persists through periods of symptom remission, and may be independently associated with functional outcomes. However, although the evidence increasingly suggests that clinicians should be heedful of their patients' cognitive functioning, there is as yet no consensus on how best to monitor cognition clinically. In addition, although most studies have reported improved cognition with antidepressant medications, psychotherapy, and neuromodulation, the clinical significance of these improvements is unclear, and high-level evidence to guide decision making is limited. Nonetheless, given the important functional implications, clinicians should assess and monitor cognition and optimize both medication and psychological treatments to mitigate cognitive dysfunction among patients with major depressive disorder.

Die Bedeutung kognitiver Beeinträchtigungen bei depressiven Patienten

Zusammenfassung. Beeinträchtigungen der Exekutivfunktionen, der Aufmerksamkeit und des Gedächtnisses sind einige der häufigsten und hartnäckigsten Symptome depressiver Störungen. Bisher konnte allerdings kein eindeutiges Profil dieser Defizite identifiziert werden, wahrscheinlich auch deshalb, weil die Defizite von verschiedenen klinischen und demografischen Faktoren, wie dem Depressionssubtypus, Grübeln, Komorbiditäten und Alter beeinflusst werden. Die kognitiven Beeinträchtigungen verbessern sich mit der Remission der Störung, häufig findet jedoch keine vollständige Rückbildung statt. Sie sind klinisch sehr relevant und gehen einher mit Suizidalität, reduzierten Therapieeffekten und negativen Auswirkungen auf Alltagsaktivitäten. Aus diesen Gründen ergibt sich für betroffene Patienten die Notwendigkeit einer neuropsychologischen Behandlung. Erste Ergebnisse lassen hoffen, dass die kognitiven Beeinträchtigungen mithilfe neuropsychologischer Therapie, Achtsamkeitstraining, psychopharmakologischer Therapie und weiteren neurobiologischen Behandlungen, wie z. B. der repetitiven transkraniellen Magnetstimulation, erfolgreich behandelt werden können.

Cognitive Deficits as a Mediator of Poor Occupational Function in Remitted Major Depressive Disorder Patients

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.

The neurocognitive profile of mood disorders - a review of the evidence and methodological issues

OBJECTIVES

Cognitive abnormalities are an established part of the symptomatology of mood disorders. However, questions still exist regarding the exact profile of these deficits in terms of the domains most affected, their origins, and their relationship to clinical subtypes. This review aims to examine the current state of the evidence and to examine ways in which the field may be advanced.

METHODS

Studies examining cognitive function in bipolar disorder (BD) and unipolar major depression (MDD) were examined. Given the number and variability of such studies, particular attention was paid to meta-analyses and to meta-regression analyses which examined the possible mediators of cognitive impairment.

RESULTS

Meta-analyses are available for MDD and BD in both depression and euthymia. Several analyses examine mediators. Results do not support the presence of domain specific deficits but rather a moderate deficit across a range of domains in BD and in MDD. The data on clinical mediators is inconsistent, even with regard to the effect of mood state.

CONCLUSIONS

A two-tiered approach, with the broad-based application of standardized measures on a large-scale, and the refined application of theoretically driven experimental development would significantly further our understanding of neurocognitive processing in mood disorder.

Influence of anxiety symptoms on improvement of neurocognitive functions in patients with major depressive disorder: A 12-week, multicenter, randomized trial of tianeptine versus escitalopram, the CAMPION study

BACKGROUND

Previous research has reported evidence that patients with major depressive disorder (MDD) show anxiety symptoms and neurocognitive impairments. However, the influence of anxiety on neurocognitive function in MDD patients during antidepressant treatment is unclear.

METHOD

MDD patients (n=164) completed a 12-week, multicenter, randomized trial assigned in a 1:1 ratio to either tianeptine or escitalopram. Changes of anxiety symptoms were assessed by the Hamilton Anxiety Rating Scale (HAM-A), and the Hamilton Depression Rating Scale (HAM-D), self-rated subjective cognitive impairment on memory and concentration, the Mini-Mental Status Examination (MMSE), Continuous Performance Test (CPT), Verbal Learning Test (VLT), and Raven's Progressive Matrices (RPM) were assessed every 4 weeks.

RESULTS

During 12 weeks of treatment, decrease in the HAM-A score was significantly associated with improvement of subjective cognitive impairments on memory (p<0.001) and concentration (p<0.001), and objective measures on delayed memory (p=0.006) and reasoning ability (p=0.002), after adjusting for covariates such as baseline HAM-A scores, time, sex, age, education years and assigned medication using the Mixed effects and Generalized Estimated Equation model analysis. However, the other cognitive outcome variables, immediate memory, commission error, and MMSE, which showed significant improvement through 12-week study period, showed no significant association with improvement of anxiety.

CONCLUSION

Improvement of anxiety symptoms was significantly associated with improvement in subjective and objective neurocognitive functions such as delayed memory and reasoning ability in elderly MDD patients during antidepressant treatment, but not significantly associated with improvement of immediate memory and commission error.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT01309776.

Cerebral Perfusion Pressure and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

BACKGROUND

Whether delayed cerebral ischemia (DCI) mediates the relationship between Hunt and Hess grade and outcomes after aneurysmal subarachnoid hemorrhage remains unknown.

OBJECTIVES

To investigate the relationship between cerebral perfusion pressure, DCI, Hunt and Hess grade, and outcomes after aneurysmal subarachnoid hemorrhage.

METHODS

DCI was defined as neurological deterioration due to impaired cerebral blood flow. Relationships between minimum cerebral perfusion pressure and onset and occurrence of DCI were tested by using logistic regression and the accelerated failure time model. The mediation effect of DCI on relationships between Hunt and Hess grade and outcomes was tested by using the bootstrap confidence interval. Outcomes at 3 and 12 months included mortality and neuropsychological, functional, and physical outcomes.

RESULTS

DCI occurred in 211 patients (42%). About one-third of the patients had poor functional outcome at 3 (32%) and 12 (30%) months. Impaired neuropsychological outcome was observed in 33% of patients at 3 months and 17% at 12 months. For every increase of 10 mm Hg in cerebral perfusion pressure, odds for DCI increased by 2.78 (95% CI, 2.00-3.87). High perfusion pressure was associated with earlier onset of DCI (P < .001).

CONCLUSIONS

DCI does not mediate the relationship of Hunt and Hess grade to functional outcome or death. The relationship between cerebral perfusion pressure and DCI was most likely due to induced hypertension and hypervolemia. Clinical guidelines may need to include limits for induced hypertension.

Memory for child sexual abuse information: simulated memory error and individual differences

Building on the simulated-amnesia work of Christianson and Bylin (Applied Cognitive Psychology, 13, 495-511, 1999), the present research introduces a new paradigm for the scientific study of memory of childhood sexual abuse information. In Session 1, participants mentally took the part of an abuse victim as they read an account of the sexual assault of a 7-year-old. After reading the narrative, participants were randomly assigned to one of four experimental conditions: They (1) rehearsed the story truthfully (truth group), (2) left out the abuse details of the story (omission group), (3) lied about the abuse details to indicate that no abuse had occurred (commission group), or (4) did not recall the story during Session 1 (no-rehearsal group). One week later, participants returned for Session 2 and were asked to truthfully recall the narrative. The results indicated that, relative to truthful recall, untruthful recall or no rehearsal at Session 1 adversely affected memory performance at Session 2. However, untruthful recall resulted in better memory than did no rehearsal. Moreover, gender, PTSD symptoms, depression, adult attachment, and sexual abuse history significantly predicted memory for the childhood sexual abuse scenario. Implications for theory and application are discussed.

Glucagon-like peptide-2-induced memory improvement and anxiolytic effects in mice

We investigated the effectiveness of glucagon-like peptide-2 (GLP-2) on memory impairment in lipopolysaccharide (LPS)-treated mice, and anxiety-like behavior in adrenocorticotropic hormone (ACTH)-treated mice. In the Y-maze test, LPS (10 µg/mouse, i.c.v.) significantly decreased spontaneous alternation, which was prevented by pretreatment with GLP-2 (0.01-0.3 µg/mouse, i.c.v.). The GLP-2 treatment just before the Y-maze test also improved LPS-induced memory impairment. Continuous treatment with GLP-2 (3 µg/mouse, i.c.v.) had no effect on the open-field test in saline-treated or ACTH-treated mice. Chronic ACTH treatment did not cause anxiogenic effects in the elevated plus-maze test. GLP-2 showed weak anxiolytic-like effects in the elevated plus-maze test in ACTH-treated, but not saline-treated mice. Moreover, GLP-2 increased 5-HT, but not 5-HIAA and tryptophan hydroxylase 2 levels in the amygdala of ACTH-treated mice. Pharmacological depletion of 5-HT prevented the anxiolytic effects of GLP-2. These results suggest that GLP-2 protected and improved memory function in LPS-treated mice, and also had anxiolytic effects due to changes in the 5-HT system.

Neuropsychological functioning in youth with obsessive compulsive disorder: an examination of executive function and memory impairment

Preliminary research suggests neuropsychological deficits in youth with obsessive-compulsive disorder (OCD) similar to those in adults; however, small samples and methodological confounds limit interpretation. We aimed to examine the rates and clinical correlates of cognitive sequelae in youth with OCD, focusing on executive functioning and memory abilities. Youth ages 7-17 years with OCD (N=96) completed a hypothesis-driven neuropsychological battery (including the Rey-Osterreith Complex Figure, California Verbal Learning Test, and subtests of the Delis-Kaplan Executive Function System and Wide Range Assessment of Memory and Learning) that primarily assessed executive functioning, memory and processing speed. Cognitive sequelae were identified in 65% of youth (37% using a more stringent definition of impairment). Magnitude of cognitive sequelae was not associated with OCD severity or age; however, greater neuropsychological impairments were found amongst youth prescribed atypical neuroleptics and those diagnosed with comorbid tic disorders. Comorbidity burden was associated with presence of neuropsychological impairment, but was not specific to any single test. Findings suggest that the presence of cognitive sequelae is prevalent amongst treatment-seeking youth with OCD. Deficits were found in executive functioning and non-verbal memory performance but these impairments were not associated with OCD severity.

Unique and interactive effect of anxiety and depressive symptoms on cognitive and brain function in young and older adults

OBJECTIVE

Depression and anxiety and are associated with cognitive deficits and brain changes, especially in older adults. Despite the frequent co-occurrence of these conditions, cognitive neuroscience studies examining comorbid depression and anxiety are limited. The goal of the present study was to examine the unique and combined effect of depressive and anxiety symptoms on cognitive and brain functioning in young and older adults.

METHODS

Seventy-one healthy, community-dwelling adults between the ages of 18 and 81 were administered a neuropsychological battery and completed the Center for Epidemiologic Studies Depression Scale (CES-D) and the trait form of the State-Trait Anxiety Inventory (STAI-T). A subset of 25 participants also underwent functional magnetic resonance imaging (fMRI) scanning while completing the n-back working memory task.

RESULTS

Total depressive symptoms, depressed mood symptoms, and somatic symptoms were associated with deficits in speed, working memory and executive functions, especially in older adults. Symptoms of lack of well-being were not associated with any neuropsychological test. Anxiety was associated with better attention and working memory. Moreover, anxiety modified the relationship between depressive symptoms and executive functioning in older adults, as elevated depressive symptoms were associated with worse performance at low levels of anxiety, but not at higher anxiety levels. Similarly, analysis of fMRI data showed that total depressive symptoms and depressed mood symptoms were associated with decreased activity in the superior frontal gyrus at low anxiety levels, but not at high anxiety levels.

CONCLUSION

Results confirm previous reports that subthreshold depression and anxiety impact cognitive and brain functioning and suggest that the interaction of depression and anxiety results in distinct cognitive and brain changes. Findings highlight the importance of assessing and controlling for symptoms of depression and anxiety in research studies of either condition.

Opposite effects of anxiety and depressive symptoms on executive function: the case of selecting among competing options

People constantly face the need to choose one option from among many, such as when selecting words to express a thought. Selecting between many options can be difficult for anyone, and can feel overwhelming for individuals with elevated anxiety. The current study demonstrates that anxiety is associated with impaired selection across three different verbal tasks, and tests the specificity of this finding to anxiety. Anxiety and depression frequently co-occur; thus, it might be assumed that they would demonstrate similar associations with selection, although they also have distinct profiles of symptoms, neuroanatomy and neurochemistry. Here, we report for the first time that anxiety and depressive symptoms counter-intuitively have opposite effects on selection among competing options. Specifically, whereas anxiety symptoms are associated with impairments in verbal selection, depressive symptoms are associated with better selection performance. Implications for understanding the mechanisms of anxiety, depression and selection are discussed.

Depressive symptoms, major depressive episodes and cognitive test performance-what is the role of physical activity?

BACKGROUND

Positive associations between physical activity and cognitive test performance in depressed subjects have been proposed in clinical studies. The contribution of severity and recency of depressive symptoms at the population level is not known.

AIMS

This study aims to examine whether regular physical activity associates with better verbal fluency and psychomotor speed in depressed subjects using a large population-based sample.

METHODS

Data was obtained from the population-based Finnish Health 2000 Study, gathered in 2000-2001. Depressive symptoms and depressive disorders were assessed by the Beck Depression Inventory (BDI) and the Composite International Diagnostic Interview (CIDI), correspondingly. Cognitive test performance was assessed by the animal naming test and psychomotor speed with a simple and multi-choice reaction time test. Physical activity (Gothenburg scale) was self-reported. Complete data were obtained from 3658 subjects aged 30-64 years. Socio-demographic factors, health behaviours and use of antidepressants and anxiolytics were used as covariates in the linear regression models. Adjusted means were calculated using the predictive margins method.

RESULTS

Regular physical activity associated with better performance in reaction time tests and better verbal fluency among men with depressive symptoms or with a major depressive episode. Physical activity also associated with cognitive test performance among non-depressed men and women, but among them the differences between the physical activity groups were smaller.

CONCLUSION

Regular physical activity may be a useful tool in supporting neurocognitive functioning among depressed subjects.

Cortical organization of inhibition-related functions and modulation by psychopathology

Individual differences in inhibition-related functions have been implicated as risk factors for a broad range of psychopathology, including anxiety and depression. Delineating neural mechanisms of distinct inhibition-related functions may clarify their role in the development and maintenance of psychopathology. The present study tested the hypothesis that activity in common and distinct brain regions would be associated with an ecologically sensitive, self-report measure of inhibition and a laboratory performance measure of prepotent response inhibition. Results indicated that sub-regions of DLPFC distinguished measures of inhibition, whereas left inferior frontal gyrus and bilateral inferior parietal cortex were associated with both types of inhibition. Additionally, co-occurring anxiety and depression modulated neural activity in select brain regions associated with response inhibition. Results imply that specific combinations of anxiety and depression dimensions are associated with failure to implement top-down attentional control as reflected in inefficient recruitment of posterior DLPFC and increased activation in regions associated with threat (MTG) and worry (BA10). Present findings elucidate possible neural mechanisms of interference that could help explain executive control deficits in psychopathology.

Neuropsychological correlates of symptom dimensions in inpatients with major depressive disorder

Symptoms of major depressive disorder (MDD) manifest variably across individuals. Accordingly, recent models of the disorder imply that MDD may be characterized according to independent symptom dimensions. In particular, several studies reveal that depression may be characterized along dimensions of negative affect, agitation and hostility, and lassitude and malaise. No research has examined the relationship between these dimensions and neuropsychological function. Towards this end, 133 in patients with unipolar MDD and 17 people without psychiatric illness were administered a brief battery of neuropsychological tests and the MMPI-2. Paralleling earlier research, principal component analysis of the MMPI-2 revealed symptom dimensions of negative affect, agitation, and lassitude and malaise. Multiple regression analyses showed that the negative affect and agitation dimensions accounted for significant variance on measures of executive function, speed of information processing, new learning, dexterity, and overall impairment. Lassitude and malaise failed to correspond with neuropsychological performance. Implications of these data for clinical practice and neural models of MDD are discussed.

Executive function in eating disorders: the role of state anxiety

OBJECTIVE

We examined the influence of depression and anxiety on executive function in individuals with a DSM-IV diagnosis of anorexia nervosa-restricting type, anorexia nervosa-binge-eating/purging type, bulimia nervosa, or eating disorder not otherwise specified.

METHOD

We assessed 106 women after their inpatient treatment in an eating disorders program. All participants were nutritionally stable at the time of testing.

RESULTS

Thirty percent of the total sample showed impaired performance on one or more tests of executive function. No differences in executive function were observed among diagnostic groups. Anxiety scores accounted for significant variance in performance for all groups.

DISCUSSION

Executive function deficits were found in a minority of our sample, with significant variance in performance accounted for by self-reported anxiety. State anxiety appears to contribute to diminished executive function in women with eating disorders.

Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review

Cognitive impairments are now widely acknowledged as an important aspect of major depressive disorder (MDD), and it has been proposed that executive function (EF) may be particularly impaired in patients with MDD. However, the existence and nature of EF impairments associated with depression remain strongly debated. Although many studies have found significant deficits associated with MDD on neuropsychological measures of EF, others have not, potentially due to low statistical power, task impurity, and diverse patient samples, and there have been no recent, comprehensive, meta-analyses investigating EF in patients with MDD. The current meta-analysis uses random-effects models to synthesize 113 previous research studies that compared participants with MDD to healthy control participants on at least one neuropsychological measure of EF. Results of the meta-analysis demonstrate that MDD is reliably associated with impaired performance on neuropsychological measures of EF, with effect sizes ranging from 0.32 to 0.97. Although patients with MDD also have slower processing speed, motor slowing alone cannot account for these results. In addition, some evidence suggests that deficits on neuropsychological measures of EF are greater in patients with more severe current depression symptoms, and those taking psychotropic medications, whereas evidence for effects of age was weaker. The results are consistent with the theory that MDD is associated with broad impairment in multiple aspects of EF. Implications for treatment of MDD and theories of EF are discussed. Future research is needed to establish the specificity and causal link between MDD and EF impairments.

The impact of depression heterogeneity on cognitive control in major depressive disorder

OBJECTIVE

Depressed patients display a variety of deficits in neuropsychological function, and contradictory findings in the literature may be due to disorder heterogeneity. The aim of this study was to examine the impact of severity, subtype and symptoms on cognitive control.

METHODS

Neuropsychological function across a range of cognitive control tasks was examined in melancholic (n = 65) and non-melancholic depressed patients (n = 59) relative to controls (n = 124). The relationship between subtype (melancholia vs non-melancholia) and anxiety was also examined.

RESULTS

Melancholia was characterised by attention and working memory deficits typically associated with the dorsolateral prefrontal cortex, while non-melancholia was characterised by verbal memory recall deficits indicative of left frontal lobe and medial temporal lobe function. The severity of anxious arousal and psychomotor disturbance contributed to cognitive impairment more than the severity of depression symptoms and anxious apprehension.

CONCLUSIONS

Findings highlight a differential impact of depression subtype and severity, and suggest that anxious arousal and psychomotor disturbance may contribute to poorer performance on neuropsychological tasks associated with dorsolateral prefrontal cortex function.

A meta-analysis of cognitive deficits in first-episode Major Depressive Disorder

BACKGROUND

Recurrent-episode Major Depressive Disorder (MDD) is associated with a number of neuropsychological deficits. To date, less is known about whether these are present in the first-episode. The current aim was to systematically evaluate the literature on first-episode MDD to determine whether cognition may be a feasible target for early identification and intervention.

METHODS

Electronic database searches were conducted to examine neuropsychological studies in adults (mean age greater than 18 years old) with a first-episode of MDD. Effect sizes were pooled by cognitive domain. Using meta-regression techniques, demographic and clinical factors potentially influencing heterogeneity of neuropsychological outcome were also investigated.

RESULTS

The 15 independent samples reviewed yielded data for 644 patients with a mean age of 39.36 years (SD=10.21). Significant cognitive deficits were identified (small to medium effect sizes) for psychomotor speed, attention, visual learning and memory, and all aspects of executive functioning. Symptom remission, inpatient status, antidepressant use, age and educational attainment, each significantly contributed to heterogeneity in effect sizes in at least one cognitive domain.

LIMITATIONS

Reviewed studies were limited by small sample sizes and often did not report important demographic and clinical characteristics of patients.

CONCLUSIONS

The current meta-analysis was the first to systematically demonstrate reduced neuropsychological functioning in first-episode MDD. Psychomotor speed and memory functioning were associated with clinical state, whereas attention and executive functioning were more likely trait-markers. Demographic factors were also associated with heterogeneity across studies. Overall, cognitive deficits appear to be feasible early markers and targets for early intervention in MDD.

Frontal brain asymmetry in depression with comorbid anxiety: a neuropsychological investigation

The approach-withdrawal model posits that depression and anxiety are associated with a relative right asymmetry in frontal brain activity. Most studies have tested this model using measures of cortical brain activity such as electroencephalography. However, neuropsychological tasks that differentially use left versus right frontal cortical regions can also be used to test hypotheses from the model. In two independent samples (Study 1 and 2), the present study investigated the performance of currently depressed individuals with or without a comorbid anxiety disorder and healthy controls on neuropsychological tasks tapping primarily left (verbal fluency) or right (design fluency) frontal brain regions. Across both samples, results indicated that comorbid participants performed more poorly than depressed only and control participants on design fluency, while all groups showed equivalent performance on verbal fluency. Moreover, comorbid participants showed "asymmetrical" performance on these two tasks (i.e., poorer design [right frontal] relative to verbal [left frontal] fluency), whereas depressed only and control participants showed approximately symmetrical profiles of performance. Results from these two samples suggest an abnormal frontal asymmetry in neurocognitive performance driven primarily by right frontal dysfunction among anxious-depressed individuals and highlight the importance of considering comorbid anxiety when examining frontal brain functioning in depression.

Choosing our words: retrieval and selection processes recruit shared neural substrates in left ventrolateral prefrontal cortex

When we speak, we constantly retrieve and select words for production in the face of multiple possible alternatives. Our ability to respond in such underdetermined situations is supported by left ventrolateral prefrontal cortical (VLPFC) regions, but there is active debate about whether these regions support (1) selection between competing alternatives, (2) controlled retrieval from semantic memory, or (3) selection and controlled retrieval in distinct subregions of VLPFC (selection in mid-VLPFC and controlled retrieval in anterior VLPFC). Each of these theories has been supported by some prior evidence but challenged by other findings, leaving the debate unresolved. We propose that these discrepancies in the previous literature reflect problems in the way that selection and controlled retrieval processes have been operationalized and measured. Using improved measures, we find that shared neural substrates in left VLPFC support both selection and controlled retrieval, with no dissociation between mid and anterior regions. Moreover, selection and retrieval demands interact in left VLPFC, such that selection effects are greatest when retrieval demands are low, consistent with prior behavioral findings. These findings enable a synthesis and reinterpretation of prior evidence and suggest that the ability to respond in underdetermined situations is affected by both selection and retrieval mechanisms for verbal material subserved by left VLPFC, and these processes interact in meaningful ways.

Cognitive Control Functions in Unipolar Major Depression with and without Co-Morbid Anxiety Disorder

BACKGROUND

Impaired cognitive control functions have been demonstrated in both major depression (MDD) and anxiety disorder (A), but few studies have systematically examined the impact of MDD with co-morbid A (MDDA), which is the main aim of this study.

METHOD

We compared patients with MDD with (MDDA; n = 24) and without co-morbid A (n = 37) to a group of healthy controls (HC; n = 92) on three subtests from the Cambridge Neuropsychological Test Automated Battery; intra-extra dimensional, stop signal task, and spatial working memory. These tasks correspond to a theoretical model consisting of three separable but interrelated executive control functions: Shifting, Inhibition, and Updating. A simple psychomotor speed measure was also included.

RESULTS

After controlling for age, gender, and education level, the results showed that the MDDA group displayed significantly impaired performance on the functions Shifting and Updating compared to HC. There emerged no significant differences between any of the patient groups and HC regarding Inhibition. The pure MDD group did not display dysfunctions relative to the HC group on the main executive control variables, but displayed slowed psychomotor speed. Contrary to expectation there were no significant differences between the MDDA and the MDD groups.

CONCLUSION

Co-morbid anxiety should be taken into account when studying cognitive control functions in major depression.

Neuropsychological function in unmedicated recurrent brief depression

BACKGROUND

Recurrent brief depression (RBD) is a mood disorder characterized by mild to severe depressive episodes lasting less than 2 weeks and occurring approximately once a month with complete recovery between episodes. The aim of this study was to describe neuropsychological impairments associated with RBD, relating cognitive performance to clinical features and comorbidity.

METHODS

Forty-six ICD-10 defined RBD patients (mean age 33.8) and 24 matched controls were assessed on working memory/attention tasks, executive functions, verbal/visual memory, and psychomotor speed.

RESULTS

Patients were significantly impaired across all domains of cognition except for verbal learning and non-semantic verbal fluency. Neuropsychological performance was not related to depression severity, duration of depressive episodes, interval duration, psychiatric or somatic comorbidity, or attributable to a general reduction in processing speed or effort. Patients reporting previous major depressive episodes were impaired on one measure of psychomotor speed. Previous episodes of hypomania were not related to neuropsychological performance.

LIMITATIONS

The relatively high number of self-referrals, high female-to-male ratio in the patient sample, and the relatively high level of education and intellectual capacity among participants may limit the possibility to generalize our results to the RBD population in general.

CONCLUSIONS

Unmedicated RBD patients demonstrate significant neuropsychological impairment that also may persist into euthymic states. Examining cognitive functions might be equally important in RBD as in major depression with consequences for functional diagnostics and treatment strategies.

Volumetric MRI changes, cognition and personality traits in old age depression

BACKGROUND

The presence of cognitive and structural deficits in euthymic elderly depressed patients remains a matter of debate. Integrative aetiological models assessing concomitantly these parameters as well as markers of psychological vulnerability such as persistent personality traits, are still lacking for this age group.

METHODS

Cross-sectional comparisons of 38 elderly remitted patients with early-onset depression (EOD) and 62 healthy controls included detailed neuropsychological assessment, estimates of brain volumes in limbic areas and white matter hyperintensities, as well as evaluation of the Five-Factor personality dimensions.

RESULTS

Both cognitive performances and brain volumes were preserved in euthymic EOD patients. No significant group differences were observed in white matter hyperintensity scores between the two groups. In contrast, EOD was associated with significant increase of Neuroticism and decrease of Extraversion facet scores.

LIMITATIONS

Results concern the restricted portion of EOD patients without psychiatric and physical comorbidities. Future longitudinal studies are necessary to determine the temporal relationship between the occurrence of depression and personality dimensions.

CONCLUSIONS

After remission from acute depressive symptoms, cognitive performances remain intact in elderly patients with EOD. In contrast to previous observations, these patients display neither significant brain volume loss in limbic areas nor increased vascular burden compared to healthy controls. Further clinical investigations on EOD patterns of vulnerability in old age will gain from focusing on psychological features such as personality traits rather than neurocognitive clues.

Current perspectives of the roles of the central norepinephrine system in anxiety and depression

Norepinephrine (NE) is a major monoamine neurotransmitter that has widespread effects across multiple brain areas to regulate arousal and stress responses. The underlying function of the NE cortical system is to balance vigilance/scanning behavior with focused attention on novel environmental stimuli and the state of arousal. The central NE system is involved intrinsically with the stress response system, and dysregulation within the NE system has been implicated in the pathogenesis of anxiety and depressive disorders. Central NE activity paradoxically has either anxiogenic or anxiolytic effects, depending on whether the time course of the stress is acute or chronic, whether the stress is predictable or unpredictable, and which underlying brain regions are affected. Under conditions of chronic stress, NE system activity dysregulation of the hypothalamic-pituitary-adrenal system may turn a homeostatic stress response into a pathological stress response. Data suggest that the NE interplay with the serotonin system may exert neurobiological normalization of the pathophysiological state of anxious depression. Accordingly, pharmacological interventions targeting the NE system can result in anxiolytic, rather than anxiogenic, outcomes when used to treat patients with anxiety and depression.