Executive dysfunction and treatment response in late-life depression

Queens College, City University of New York, NY, USA.
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 09/2012; 27(9):893-9. DOI: 10.1002/gps.2808
Source: PubMed


Executive dysfunction in geriatric depression has been shown to predict poor response to antidepressant medication. The purpose of this review is to clarify which aspects of executive functioning predict poor antidepressant treatment response.
Literature review.
From our review, the aspects of executive functioning that appear to be associated with antidepressant response rates are verbal fluency and response inhibition. There is some indication that the semantic strategy component may account for the effects of verbal fluency, although evidence comes from one study and needs replication. Processing speed has been proposed as a substrate that may underlie the effects of executive dysfunction on treatment response. Although processing speed does not appear to account for the relationship between response inhibition and treatment outcome, this issue has yet to be assessed with respect to verbal fluency.
Verbal fluency and response inhibition are specific aspects of executive dysfunction that appear to impact antidepressant response rates. Disruption of the frontostriatal limbic circuit (particularly the anterior cingulate and dorsolateral prefrontal cortex) may explain the relation between these two mechanisms.

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    • "Given internal cuing may require selfinitiated cognitive processes including executive, attention and perceptual processing speed (Hoffstaedter et al., 2012), we further hypothesized that cognitive Think times would be lower relative to motor Ink times, and primarily in the older depressed group. We based our hypothesis regarding the older depressed group on studies showing deficits on tasks that incorporate aspects of psychomotor slowing, i.e., perceptual processing, programming and motor speed in a similarly aged depressed cohort (Butters et al., 2004; Nebes et al., 2000; Pimontel et al., 2012). We also explored associations between Think and Ink time variables to indices of cognitive functioning and hypothesized that only Think times would correlate with higher-level cognition in depressed and non-depressed groups. "
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    ABSTRACT: BACKGROUND: Depression is common in the elderly and in the last few years this led to a significant increase in antidepressant prescription rates. However, little is known about antidepressant efficacy profile in relation with socio-demographic and clinical features in this population. The aim of the present study was to define the most suitable socio-demographic and clinical profile for the use of antidepressant treatments in late-life depression. METHODS: MEDLINE, EMBASE and PsycINFO were searched for randomized controlled trials (RCTs) focused on efficacy of antidepressants of all classes in major depressed elderly subjects (>60 years old). Reviews and meta-analyses focusing on this topic have been considered as well. Thirty-four RCTs were included and socio-demographic and clinical features were investigated via meta-regression analysis as moderators of efficacy measures (standardized mean difference based on Hamilton Depressive Rating Scale and Montgomery-Asberg Depression Rating Scale). RESULTS: A lower rate of response to antidepressants of all classes was found in patients of male gender, of older age, and with a longer mean duration of the current episode. On the contrary, a higher rate of response was found in patients with a higher baseline severity and at their first episode of illness. Subsamples treated with selective serotonin reuptake inhibitors alone yielded similar results. LIMITATIONS: RCTs only have been included. CONCLUSIONS: A number of socio-demographic and clinical features have been found to moderate antidepressant efficacy in elderly population. Those variables could help clinicians for a more individualized treatment.
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