Cognitive Function in Late Life Depression: Relationships to Depression Severity, Cerebrovascular Risk Factors and Processing Speed

Duke University, Durham, North Carolina, United States
Biological Psychiatry (Impact Factor: 10.26). 08/2006; 60(1):58-65. DOI: 10.1016/j.biopsych.2005.09.019
Source: PubMed


A number of studies have examined clinical factors linked to worse neuropsychological performance in late life depression (LLD). To understand the influence of LLD on cognition, it is important to determine if deficits in a number of cognitive domains are relatively independent, or mediated by depression- related deficits in a basic domain such as processing speed.
Patients who met DSM-IV criteria for major depression (n = 155) were administered a comprehensive neuropsychological battery of tasks grouped into episodic memory, language, working memory, executive function, and processing speed domains. Multiple regression analyses were conducted to determine contributions of predictor variables to cognitive domains.
Age, depression severity, education, race and vascular risk factors all made significant and independent contributions to one or more domains of cognitive function, with all five making independent contributions to processing speed. Age of onset made no independent contribution, after accounting for age and vascular risk factors. Of the five cognitive domains investigated, changes in processing speed were found to most fully mediate the influence of predictor variables on all other cognitive domains.
While slowed processing speed appears to be the most core cognitive deficit in LLD, it was closely followed by executive function as a core cognitive deficit. Future research is needed to help clarify mechanisms leading to LLD- related changes in processing speed, including the potential role of white matter abnormalities.

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Available from: Yvette I Sheline
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    • "Furthermore, we only included emotionally healthy young and old adults in our study and can thus only speculate about the clinical role of our findings. Nevertheless, it has consistently been demonstrated that elderly patients with emotional disorders, such as geriatric depression or geriatric anxiety disorder, show marked executive control dysfunctions together with fronto-limbic abnormalities [24], [72]–[74]. Moreover, these patients are typically more strongly distracted by negative stimuli, which is paralleled by decreased prefrontal attention control activity [75], [76]. "
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    ABSTRACT: There is emerging evidence for a positivity effect in healthy aging, which describes an age-specific increased focus on positive compared to negative information. Life-span researchers have attributed this effect to the selective allocation of cognitive resources in the service of prioritized emotional goals. We explored the basic principles of this assumption by assessing selective attention and memory for visual stimuli, differing in emotional content and self-relevance, in young and old participants. To specifically address the impact of cognitive control, voluntary attentional selection during the presentation of multiple-item displays was analyzed and linked to participants' general ability of cognitive control. Results revealed a positivity effect in older adults' selective attention and memory, which was particularly pronounced for self-relevant stimuli. Focusing on positive and ignoring negative information was most evident in older participants with a generally higher ability to exert top-down control during visual search. Our findings highlight the role of controlled selectivity in the occurrence of a positivity effect in aging. Since the effect has been related to well-being in later life, we suggest that the ability to selectively allocate top-down control might represent a resilience factor for emotional health in aging.
    Full-text · Article · Aug 2014 · PLoS ONE
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    • "Individuals with late-life depression (LLD), including depressive symptoms, frequently present with neuropsychological impairment (Boone et al., 1995; Dufouil et al., 1996; Butters et al., 2004) but not always (Bieliauskas et al., 1991; Lockwood et al., 2000). Those that do present with neuropsychological impairment are particularly impaired on tasks of executive function and processing speed (Raskin, 1986; Geffen et al., 1993; Sheline et al., 2006). However, memory (Biringer et al., 2005) and visual–spatial ability (Hart et al., 1987) have also been found to be impaired in other studies. "
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    ABSTRACT: Objective The present study aimed to investigate whether cognitive reserve moderated the association between depressive symptoms and cognition, as well as brain volumes in a sample of older adults.Methods Non-demented participants (n = 3484) were selected from the Washington Heights/Hamilton Heights Inwood Columbia Aging Project (Northern Manhattan). A subsample of these participants without dementia (n = 703), who had brain imaging data, was also selected for a separate analysis. Depressive symptomatology was assessed with the 10-item Center for Epidemiologic Studies Depression Scale. Reading level and years of education were used as measures of cognitive reserve. Four distinct cognitive composite scores were calculated: executive function, memory, visual–spatial, and language.ResultsMultiple regression analysis revealed interaction effects between both measures of cognitive reserve and depressive symptoms on all the cognitive outcome measures except for visual–spatial ability. Those with greater reserve showed greater cognitive decrements than those with lower levels of reserve as depressive symptoms increased. A borderline interaction effect was revealed between reading level and depressive symptoms on total brain volumes. Those with lower reading scores showed greater volume loss as depressive symptoms increased than those with higher reading scores.Conclusions Our findings indicate that the association between late-life depressive symptoms and core aspects of cognition varies depending on one's level of cognitive reserve. Those that had greater levels of education and/or reading ability showed a greater decrease in memory, executive, and language performances as depressive symptoms increased than those with lower years of education and reading ability. Copyright © 2014 John Wiley & Sons, Ltd.
    Full-text · Article · Aug 2014 · International Journal of Geriatric Psychiatry
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    • "As neuropsychological deficits in older adults with depression have been well documented, we carried out a series of neuropsychological tests in order to control each of these potential deficits. More precisely, depression in older adults mainly leads to executive dysfunctions, impairment in processing speed, memory and language (Lockwood, Alexopoulos, & van Gorp, 2002; Naismith, Norrie, Mowszowski, & Hickie, 2012; Sheline et al., 2006). Given the literature cited above, we supposed that the ECI and the positivity effect À as two mood-regulatory functions À should be worked together in depressive older patients. "
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