Hasselbalch BJ, Knorr U, Kessing LV. Cognitive impairment in the remitted state of unipolar depressive disorder: a systematic review. J Affect Disorder 134: 20-31

Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Denmark.
Journal of Affective Disorders (Impact Factor: 3.38). 12/2010; 134(1-3):20-31. DOI: 10.1016/j.jad.2010.11.011
Source: PubMed


It is unclear whether cognitive impairment is prevalent in the remitted state of unipolar disorder.
To evaluate whether cognitive function is impaired in the remitted state in patients with unipolar depression compared with healthy control individuals, and to investigate the association to prior course of illness, i.e. the number, duration and severity of prior depressive episodes.
Systematic search on existing on-line databases and hand-search of original published papers.
A total of 11 studies fulfilled the selection criteria and were included in the review, including a total of 500 patients remitted from unipolar depression and 471 healthy control individuals. In nine of the eleven studies performance on neuropsychological tests was found to be decreased in patients compared to healthy control individuals in at least one of the tests. Methodological drawbacks were prevalent including non-stringent definition of remission and non-correction for multiple testing. Only few studies investigated the association between cognition and prior course of illness and the results were divergent.
Stringent criteria were used in the assessment of eligibility of studies. The studies were first and foremost selected according to the criteria for remission used.
Cognitive dysfunction seems to be present in individuals suffering from unipolar disorder in the remitted state. We recommend that future studies should focus on disentangling the state and trait characteristics of cognitive dysfunction in unipolar disorder and further clarify the associations with clinical phenotype, course of illness and subsyndromal psychopathology. Furthermore, there is a need to identify the cognitive difficulties in individuals suffering from unipolar disorder in relation to psychosocial function, quality of life and risk of recurrence and to assess the effect of treatment intervention on cognitive function.

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    • "Cognitive disturbances appears to be impacted by a variety of clinical factors, including severity, comorbidity, subtype of depression and duration of illness (Hasselbalch et al., 2011; McDermott and Ebmeier, 2009). Attention, visual learning, verbal memory and executive functions are significantly impaired in major depressive disorder patients without previous depressive episodes compared to healthy controls (Lee et al., 2012). "
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    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; DOI:10.1016/j.euroneuro.2015.07.020 · 4.37 Impact Factor
    • "The lack of significant correlations between change in cognitive function and change in depression severity, along with the lack of significant between-group differences in depression severity (both objective and subjective) at posttreatment, also suggests that the observed improved cognition in the NCRT group cannot be explained by improved mood. This is consistent with recent reviews showing poor association between depression severity and cognitive function (Hasselbalch et al., 2011; McClintock et al., 2010). We may also speculate that computerized NCRT improves targeted cognitive function independently from mood variation. "
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    ABSTRACT: Major depression is the most prevalent psychiatric disorder with high relapse rates. When mood can improve or fully recover, the neurocognitive difficulties associated with depression often persist, preventing complete functional recovery. They have also been shown to predict relapse. The efficacy of neurocognitive remediation therapy (NCRT) to rehabilitate cognition has been demonstrated in several clinical populations but randomized controlled trials (RCTs) have not been conducted in depression. The present study aimed to test the feasibility and to conduct a pilot protocol testing for an RCT of computerized NCRT for inpatients with major depressive episode. The feasibility assessment demonstrated excellent acceptance of randomization and very satisfactory recruitment and compliance rates. The RCT procedures' assessment was overall consistent with a successful pilot study with the condition of protocol modification in terms of resources. Preliminary outcome data suggested specific NCRT efficacy to improve targeted neurocognitive processes in depression.
    The Journal of nervous and mental disease 07/2015; DOI:10.1097/NMD.0000000000000337 · 1.69 Impact Factor
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    • "h cognitive performance for some domains may improve during remission of depressive symptoms ( Biringer et al . , 2005 , 2007 ; Story et al . , 2008 ; Hammar and Årdal , 2012 ; Lahr et al . , 2014 ) most studies demonstrate incomplete cognitive recovery ( Beats et al . , 1996 ; Nebes et al . , 2000 ; Portella et al . , 2003 ; Yuan et al . , 2008 ; Hasselbalch et al . , 2011 ) . Heterogeneity of cognitive deficits during acute versus remitted states has raised the question of whether these deficits are state - ( present during acute states ) or trait - ( present both in acute and remitted states ) related . However , a limitation of previous studies has been that participants have been followed for relative"
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    ABSTRACT: Cognitive deficits in old-age depression vary as a function of multiple factors; one rarely examined factor is long-term psychiatric history. We investigated effects of psychiatric history on cognitive performance in old-age depression and in remitted persons. In the population-based Swedish National Study on Aging and Care in Kungsholmen study, older persons (≥60 years) without dementia were tested with a cognitive battery and matched to the Swedish National Inpatient Register (starting 1969). Participants were grouped according to current depression status and psychiatric history and compared to healthy controls (n = 96). Group differences were observed for processing speed, attention, executive functions, and verbal fluency. Persons with depression and psychiatric inpatient history (n = 20) and late-onset depression (n = 49) performed at the lowest levels, whereas cognitive performance in persons with self-reported recurrent unipolar depression (n = 52) was intermediate. Remitted persons with inpatient history of unipolar depression (n = 38) exhibited no cognitive deficits. Heart disease burden, physical inactivity, and cumulative inpatient days modulated the observed group differences in cognitive performance. Among currently depressed persons, those with inpatient history, and late onset performed at the lowest levels. Importantly, remitted persons showed no cognitive deficits, possibly reflecting the extended time since the last admission (m = 15.6 years). Thus, the present data suggest that cognitive deficits in unipolar depression may be more state- than trait-related. Information on profiles of cognitive performance, psychiatric history, and health behaviors may be useful in tailoring individualized treatment.
    Frontiers in Psychology 06/2015; 6:865. DOI:10.3389/fpsyg.2015.00865 · 2.80 Impact Factor
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