Cognitive Deficits in Euthymic Patients With Recurrent Depression

Developmental Psychiatry Section, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
The Journal of nervous and mental disease (Impact Factor: 1.69). 07/2010; 198(7):513-5. DOI: 10.1097/NMD.0b013e3181e4c5ba
Source: PubMed


Neurocognitive impairments are found in people recovered from major depression compared with never-depressed controls. A total of 20 patients in recovery from recurrent unipolar depression and 20 healthy controls were tested using a neuropsychological battery containing tasks of executive function (Wisconsin Card Sort Test), attention, visuomotor speed, and working memory. The recovered-depressed group performed poorly in comparison to healthy controls on the planning and problem solving aspects of the Wisconsin Card Sort Test, even after controlling for subclinical depressive symptoms. There was no significant difference between the 2 groups on set-shifting aspects of the task and the other tests. These specific deficits, even after controlling for subclinical depressive symptoms, were correlated with the number of previous episodes of depression. These findings support the hypothesis that impairments in executive function are present in recovery from unipolar depression, and so are not simply state markers. Further longitudinal research on samples free of history of depression is needed to determine whether these impairments are intermediate markers for recurrent unipolar depression, rather than "scars" caused by past episodes.

19 Reads
  • Source
    • "The relation between cognitive disturbances and the course of depression is a crucial question to understand the conceptual models of the disease (Bhardwaj et al., 2010; Preiss et al., 2009). New research is needed to analyze depression-related symptoms in cognitive impairment and to observe if they are reversible or not during clinical remission in patients with or without previous depressive episodes. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cognitive impairment is a core symptom of depressive disorders associated with poor social function. New research is needed to analyze depression-related symptoms in cognitive impairment and to observe if they are reversible or not during clinical remission in patients with or without previous episodes. None of the previous studies has analyzed the differences between first and recurrent episodes in a long-term follow-up study related with remission state. The aim of our study was to compare cognitive performance and assess the impact of previous depressive episodes in a sample of patients in acute phase and in remission six month later. 79 depressive patients were assessed at baseline. The instruments used for clinical and cognitive assessment were: Hamilton Depression Rating Scale, Mini-Mental State Examination and the Clinical Global Impression Rating Scales, Trail Making Test parts A and B, Digital Span subtest of WAIS, Stroop Colour Word Test, Tower of London, Controlled Verbal Fluency Task, Semantic Verbal Fluency and Finger Tapping Test. A repeated measures MANCOVA with education as covariate was used. No differences were found at baseline between first episode and recurrent depressive patients. At six month, remitted patients scored significant better in TMT-A, TMT-B, Animals and Tower of London total time. Remitted first depressive patients scored significant worse than remitted recurrent depressive patients. The main finding of the study is the effect of remission on cognitive function despite previous episodes. However first episode remitted patients seemed to have poor access to long term memory than recurrent remitted patients. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 08/2015; 25(11). DOI:10.1016/j.euroneuro.2015.07.020 · 4.37 Impact Factor
  • Source
    • "Memory impairment (Burt et al., 1995), atrophy of the hippocampus (Sheline et al., 1999), and higher risk for dementia (Kessing, 2012) have also been observed, raising the possibility that depressive episodes could be neurotoxic (Gorwood et al., 2008). Some neurocognitive deficits may constitute a core feature of major depressive disorder (MDD), as they have also been observed during clinical remission (Austin et al., 2001; Bhardwaj et al., 2010; Weiland-Fiedler et al., 2004) and predict a higher degree of follow-up symptoms over and above the initial symptoms (Sumner et al., 2010). The cognitive functions involved concern reduced memory capacity (Gorwood et al., 2008), decreased flexibility and psychomotor speed (Beats et al., 1996; Austin et al., 2001), attention and set-shifting deficits (Purcell et al., 1997; Austin et al., 2001), reduced vigilance, and psychomotor slowness (Den Hartog et al., 2003; Egeland et al., 2003; Arnett et al., 1994; Kertzman et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The cumulative duration of depressive episodes, and their repetition, has a detrimental effect on depression recurrence rates and the chances of antidepressant response, and even increases the risk of dementia, raising the possibility that depressive episodes could be neurotoxic. Psychomotor retardation could constitute a marker of this negative burden of past depressive episodes, with conflicting findings according to the use of clinical versus cognitive assessments. We assessed the role of the Retardation Depressive Scale (filled in by the clinician) and the time required to perform the neurocognitive d2 attention test and the Trail Making Test (performed by patients) in a sample of 2048 depressed outpatients, before and after 6 to 8 weeks of treatment with agomelatine. From this sample, 1140 patients performed the TMT-A and –B, and 508 performed the d2 test, at baseline and after treatment. At baseline, we found that with more past depressive episodes patients had more severe clinical level of psychomotor retardation, and that they needed more time to perform both d2 and TMT. When the analyses were performed again after treatment, and especially when the analyses were restricted to patients with clinical remission, the cognitive tests were the only ones correlated with past depressive episodes. Psychomotor retardation tested at a cognitive level was therefore systematically revealing the burden of past depressive episodes, with an increased weight for patients with less remaining symptoms. If prospectively confirmed, interventions such as cognitive remediation therapy could benefit from a more specific focus on neurocognitive retardation.
    European Neuropsychopharmacology 10/2014; 24(10). DOI:10.1016/j.euroneuro.2014.07.013 · 4.37 Impact Factor
  • Source
    • "One pathway through which depression may impair social functioning is neurocognition. Cognitive impairment is a feature of both unipolar and bipolar depression, and many depressed individuals experience deficits in cognition even during symptom remission (Austin et al., 2001; Bhardwaj et al., 2010; Kurtz and Gerraty, 2009). Cognitive deficits predict functional impairment in several disorders, most notably schizophrenia (Hsieh et al., 2011; Milev et al., 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cross-sectional studies suggest that cognitive deficits contribute to psychosocial impairment among individuals with mood disorders. However, studies examining whether cognition prospectively predicts psychosocial outcome are few, have used short follow-up periods, and have not demonstrated incremental validity (i.e., that cognition predicts future functioning even when controlling for baseline functioning). In a sample of 51 individuals with unipolar depression or bipolar disorder, we investigated whether attention/processing speed (APS) performance predicted social functioning 18 years later. Baseline APS predicted 18-year social functioning even after controlling for baseline social functioning and depressive symptoms, demonstrating incremental validity. Individuals with high baseline APS had stable social functioning over 18 years, whereas functioning deteriorated among those with low APS. This finding helps clarify the temporal order of cognitive and psychosocial deficits associated with mood disorders and suggests the clinical utility of cognitive measures in identifying those at risk of deterioration in social functioning.
    Journal of Nervous & Mental Disease 09/2013; 201(9):824-7. DOI:10.1097/NMD.0b013e31829db5ed · 1.69 Impact Factor
Show more