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The cognitive neuropsychology of depression in the elderly

Published online by Cambridge University Press:  05 July 2007

LUCIE L. HERRMANN ,
GUY M. GOODWIN  and
KLAUS P. EBMEIER
LUCIE L. HERRMANN
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
GUY M. GOODWIN
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
KLAUS P. EBMEIER*
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
*
*Address for correspondence: Klaus P. Ebmeier, M.D., Professor of Old Age Psychiatry, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. (Email: [email protected])
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Abstract

Background

The cognitive impairment of older depressed patients with late- as opposed to early-onset illness may show important differences, in that patients with early onset may suffer predominantly from impaired episodic memory, and those with late onset mainly from reductions of executive function and processing speed.

Method

We searched Medline and EMBASE as well as individual papers' reference lists for relevant publications, recording comparisons in neuropsychological test results between early-onset depression (EOD), late-onset depression (LOD) and healthy volunteers. Effect sizes are presented for cognitive domains, such as executive function, processing speed, episodic memory, semantic memory and mental state examination.

Results

Patients with LOD showed greater reductions in processing speed and executive function than patients with EOD and controls. Both patient groups showed reduced function in all domains, except mental state, compared with controls.

Conclusion

Pronounced executive deficits are typical of the late-onset patients described in published studies, while episodic memory impairment is not specific to early-onset illness. Possible reasons and confounders are discussed.

Type
Review Article
Information
Psychological Medicine , Volume 37 , Issue 12 , December 2007 , pp. 1693 - 1702
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

Alexopoulos, G. S. (2003). Role of executive function in late-life depression. Journal of Clinical Psychiatry 64, 18–23.Google ScholarPubMed
Alexopoulos, G. S. (2005). Depression in the elderly. Lancet 365, 1961–1970.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Kiosses, D. N., Heo, M., Murphy, C. F., Shanmugham, B. & Gunning-Dixon, F. (2005). Executive dysfunction and the course of geriatric depression. Biological Psychiatry 58, 204–210.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Meyers, B. S., Young, R. C., Kalayam, B., Kakuma, T., Gabrielle, M., Sirey, J. A. & Hull, J. (2000). Executive dysfunction and long-term outcomes of geriatric depression. Archives of General Psychiatry 57, 285–290.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Austin, M. P., Mitchell, P. & Goodwin, G. M. (2001). Cognitive deficits in depression: possible implications for functional neuropathology. British Journal of Psychiatry 178, 200–206.CrossRefGoogle ScholarPubMed
Austin, M.-P., Ross, M., Murray, C., O'Carroll, R. E., Ebmeier, K. P. & Goodwin, G. M. (1992). Cognitive function in major depression. Journal of Affective Disorders 25, 21–29.CrossRefGoogle ScholarPubMed
Baldwin, R., Jeffries, S., Jackson, A., Sytcliffe, C., Thacker, N., Scott, M. & Burns, A. (2004). Treatment response in late-onset depression: relationship to neuropsychological, neuroradiological and vascular risk factors. Psychological Medicine 34, 125–136.CrossRefGoogle ScholarPubMed
Basso, M. R. & Bornstein, R. A. (1999). Relative memory deficits in recurrent versus first-episode major depression on a word-list learning task. Neuropsychology 557, 13–14.Google Scholar
Baudic, S., Tzortzis, C., Barba, G. D. & Traykov, L. (2004). Executive deficits in elderly patients with major unipolar depression. Journal of Geriatric Psychiatry and Neurology 17, 195–201.CrossRefGoogle ScholarPubMed
Baune, B. T., Suslow, T., Engelien, A., Arolt, V. & Berger, K. (2006). The association between depressive mood and cognitive performance in an elderly general population – the MEMO Study. Dementia and Geriatric Cognitive Disorders 22, 142–149.CrossRefGoogle Scholar
Bazin, N., Perruchet, P., De Bonis, M. & Feline, A. (1994). The dissociation of explicit and implicit memory in depressed patients. Psychological Medicine 24, 239–245.CrossRefGoogle ScholarPubMed
Beats, B. C., Sahakian, B. J. & Levy, R. (1996). Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed. Psychological Medicine 26, 591–603.CrossRefGoogle ScholarPubMed
Bell-McGinty, S., Butters, M. A., Meltzer, C. C., Greer, P. J., Reynolds, C. F. III, & Becker, J. T. (2002). Brain morphometric abnormalities in geriatric depression: long-term neurobiological effects of illness duration. American Journal of Psychiatry 159, 1424–1427.CrossRefGoogle ScholarPubMed
Bemelmans, K. J., Goekoop, J. G. & Kempen, G. M. (1996). Recall performance in acutely depressed patients and plasma cortisol. Biological Psychiatry 39, 752.CrossRefGoogle ScholarPubMed
Bhalla, R. K., Butters, M. A., Zmuda, M. D., Seligman, K., Mulsant, B. H., Pollock, B. G. & Reynolds, C. F. (2006). Does education moderate neuropsychological impairment in late-life depression? International Journal of Geriatric Psychiatry 20, 413–417.CrossRefGoogle Scholar
Bieliauskas, L. A. (1993). Depressed or not depressed? That is the question. Journal of Clinical and Experimental Neuropsychology 15, 119–134.CrossRefGoogle Scholar
Boone, K. B., Lesser, I. M., Miller, B. L., Wohl, M., Berman, N., Lee, A., Palmer, B. & Back, C. (1995). Cognitive functioning in older depressed outpatients: relationship of presence and severity of depression to neuropsychological test scores. Neuropsychology 9, 390–398.CrossRefGoogle Scholar
Brodaty, H., Luscombe, G., Parker, G., Wilhelm, K., Hickie, I., Austin, M. P. & Mitchell, P. (2001). Early and late onset depression in old age: different aetiologies, same phenomenology. Journal of Affective Disorders 66, 225–236.CrossRefGoogle ScholarPubMed
Burt, D. B., Zembar, M. J. & Niederehe, G. (1995). Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity. Psychological Bulletin 117, 285–305.CrossRefGoogle ScholarPubMed
Butters, M. A., Whyte, E. M., Nebes, R. D., Begley, A. E., Dew, M. A., Mulsant, B. H., Zmuda, M. D., Bhalla, R., Meltzer, C. C., Pollock, B. G., Reynolds, C. F. III, & Becker, J. T. (2004). The nature and determinants of neuropsychological functioning in late-life depression. Archives of General Psychiatry 61, 587–595.CrossRefGoogle ScholarPubMed
Channon, S., Baker, J. E. & Robertson, M. M. (1993). Working memory in clinical depression: an experimental study. Psychological Medicine 23, 87–91.CrossRefGoogle ScholarPubMed
Cohen, R. M., Weingartner, H., Smallberg, S. A., Pickar, D. & Murphy, D. L. (1982). Effort and cognition in depression. Archives of General Psychiatry 39, 593–597.CrossRefGoogle ScholarPubMed
Devanand, D. P., Adorno, E., Cheng, J., Burt, T., Pelton, G. H., Roose, S. P. & Sackeim, H. A. (2004). Late onset dysthymic disorder and major depression differ from early onset dysthymic disorder and major depression in elderly outpatients. Journal of Affective Disorders 78, 259–267.CrossRefGoogle ScholarPubMed
Egger, M., Smith, G. D. & Phillips, A. N. (1997). Meta-analysis: principles and procedures. British Medical Journal 315, 1533–1537.CrossRefGoogle ScholarPubMed
Elderkin-Thompson, V., Kumar, A., Bilker, W. B., Dunkin, J. J., Mintz, J., Moberg, P. J., Mesholam, R. I. & Gur, R. E. (2003). Neuropsychological deficits among patients with late-onset minor and major depression. Archives of Clinical Neuropsychology 18, 529–549.CrossRefGoogle ScholarPubMed
Elderkin-Thompson, V., Mintz, J., Haroon, E., Lavretsky, H. & Kumar, A. (2007). Executive dysfunction and memory in older patients with major and minor depression. Archives of Clinical Neuropsychology 22, 261–270.CrossRefGoogle ScholarPubMed
Fossati, P., Harvey, P. O., Le Bastard, G., Ergis, A. M., Jouvent, R. & Allilaire, J. F. (2004). Verbal memory performance of patients with a first depressive episode and patients with unipolar and bipolar recurrent depression. Journal of Psychiatric Research 38, 137–144.CrossRefGoogle ScholarPubMed
Gallassi, R., Di Sarro, R., Morreale, A. & Amore, M. (2006). Memory impairment in patients with late-onset major depression: the effect of antidepressant therapy. Journal of Affective Disorders 91, 243–250.CrossRefGoogle ScholarPubMed
Goodwin, G. M. (1997). Neuropsychological and neuroimaging evidence for the involvement of the frontal lobes in depression. Journal of Psychopharmacology 11, 115–122.CrossRefGoogle ScholarPubMed
Grant, M. M., Thase, M. E. & Sweeney, J. A. (2001). Cognitive disturbance in outpatient depressed younger adults: evidence of modest impairment. Biological Psychiatry 50, 35–43.CrossRefGoogle ScholarPubMed
Henry, J. & Crawford, J. R. (2005). A meta-analytic review of verbal fluency deficits in depression. Journal of Clinical and Experimental Neuropsychology 27, 78–101.CrossRefGoogle ScholarPubMed
Hickie, I., Naismith, S., Ward, P. B., Turner, K., Scott, E., Mitchell, P., Wilhelm, K. & Parker, G. (2005). Reduced hippocampal volumes and memory loss in patients with early- and late-onset depression. British Journal of Psychiatry 186, 197–202.CrossRefGoogle ScholarPubMed
Holroyd, S. & Duryee, J. J. (1997). Differences in geriatric psychiatry outpatients with early- vs late-onset depression. International Journal of Geriatric Psychiatry 12, 1100–1106.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Ilsley, J. E., Moffoot, A. P. R. & O'Carroll, R. E. (1995). An analysis of memory dysfunction in major depression. Journal of Affective Disorders 35, 1–9.CrossRefGoogle ScholarPubMed
Janssen, J., Beekman, A. T., Comijs, H. C., Deeg, D. J. & Heeren, T. J. (2006). Late-life depression: the differences between early- and late-onset illness in a community-based sample. International Journal of Geriatric Psychiatry 21, 86–93.CrossRefGoogle Scholar
King, D. A., Cox, C., Lyness, J. M., Conwell, Y. & Caine, E. D. (2006). Quantitative and qualitative differences in the verbal learning performance of elderly depressives and healthy controls. Journal of the International Neuropsychological Society 4, 115–126.CrossRefGoogle Scholar
Kramer-Ginsberg, E., Greenwald, B. S., Krishnan, K. R. R., Christiansen, B., Hu, J., Ashtari, M., Patel, M. & Pollack, S. (1999). Neuropsychological functioning and MRI signal hyperintensities in geriatric depression. American Journal of Psychiatry 156, 438–444.CrossRefGoogle ScholarPubMed
Lampe, I. K., Hulshoff Pol, H. E., Janssen, J., Schnack, H. G., Kahn, R. S. & Heeren, T. J. (2003). Association of depression duration with reduction of global cerebral gray matter volume in female patients with recurrent major depressive disorder. American Journal of Psychiatry 160, 2052–2054.CrossRefGoogle ScholarPubMed
Lesser, I. M., Boone, K. B., Mehringer, C. M., Wohl, M. A., Miller, B. L. & Berman, N. G. (1996). Cognition and white matter hyperintensities in older depressed patients. American Journal of Psychiatry 153, 1280–1287.Google ScholarPubMed
Lin, H. F., Kuo, Y. T., Chiang, I. C., Chen, H. M. & Chen, C. S. (2006). Structural abnormality on brain magnetic resonance imaging in late-onset major depressive disorder. Kaohsiung Journal of Medical Sciences 21, 405–411.CrossRefGoogle Scholar
Lloyd, A. J., Ferrier, I. N., Barber, R., Gholkar, A., Young, A. H. & O'Brien, J. T. (2004). Hippocampal volume change in depression: late- and early-onset illness compared. British Journal of Psychiatry 184, 488–495.CrossRefGoogle ScholarPubMed
Lockwood, K. A., Alexopoulos, G. S. & van Gorp, W. G. (2002). Executive dysfunction in geriatric depression. American Journal of Psychiatry 159, 1119–1126.CrossRefGoogle ScholarPubMed
Murata, T., Kimura, H., Omori, M., Kado, H., Kosaka, H., Iidika, T., Itoh, H. & Wada, Y. (2001). MRI white matter hyperintensities, (1)H-MR spectroscopy and cognitive function in geriatric depression: a comparison of early- and late-onset cases. International Journal of Geriatric Psychiatry 16, 1129–1135.CrossRefGoogle ScholarPubMed
Murphy, C. F. & Alexopoulos, G. S. (2006). Attention network dysfunction and treatment response of geriatric depression. Journal of Clinical and Experimental Neuropsychology 28, 96–100.CrossRefGoogle ScholarPubMed
Naismith, S. L., Hickie, I. B., Turner, K., Little, C. L., Winter, V., Ward, P. B., Wilhelm, K., Mitchell, P. & Parker, G. (2003). Neuropsychological performance in patients with depression is associated with clinical, etiological and genetic risk factors. Journal of Clinical and Experimental Neuropsychology 25, 866–877.CrossRefGoogle ScholarPubMed
Nebes, R. D., Butters, M. A., Mulsant, B. H., Pollock, B. G., Zmuda, M. D., Houck, P. R. & Reynolds, C. F. III, (2000). Decreased working memory and processing speed mediate cognitive impairment in geriatric depression. Psychological Medicine 30, 679–691.CrossRefGoogle ScholarPubMed
Nebes, R. D., Pollock, B. G., Houck, P. R., Butters, M. A., Mulsant, B. H., Zmuda, M. D. & Reynolds, C. F. (2003). Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine. Journal of Psychiatric Research 37, 99–108.CrossRefGoogle ScholarPubMed
Portella, M. J., Marcos, T., Rami, L., Navarro, V., Gasto, C. & Salamero, M. (2003). Residual cognitive impairment in late-life depression after a 12-month period follow-up. International Journal of Geriatric Psychiatry 18, 571–576.CrossRefGoogle ScholarPubMed
Post, R. M. (1992). Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. American Journal of Psychiatry 149, 999–1010.Google ScholarPubMed
Potter, G. G., Kittinger, J. D., Wagner, H. R., Steffens, D. C. & Krishnan, K. R. (2006). Prefrontal neuropsychological predictors of treatment remission in late-life depression. Neuropsychopharmacology 29, 2266–2271.CrossRefGoogle Scholar
Rainer, M. K., Mucke, H. A., Zehetmayer, S., Krampla, W., Kuselbauer, T., Weissgram, S., Jungwirth, S., Tragl, K. H. & Fischer, P. (2006). Data from the VITA Study do not support the concept of vascular depression. American Journal of Geriatric Psychiatry 14, 531–537.CrossRefGoogle Scholar
Rapp, M. A., Dahlman, K., Sano, M., Grossman, H. T., Haroutunian, V. & Gorman, J. M. (2005). Neuropsychological differences between late-onset and recurrent geriatric major depression. American Journal of Psychiatry 162, 691–698.CrossRefGoogle ScholarPubMed
Ravdin, L. D., Katzen, H. L., Agrawal, P. & Relkin, N. R. (2003). Letter and semantic fluency in older adults: effects of mild depressive symptoms and age-stratified normative data. Clinical Neuropsychology 17, 195–202.CrossRefGoogle ScholarPubMed
Ravnkilde, B., Videbech, P., Clemmensen, K., Egander, A., Rasmussen, N. A. & Rosenberg, R. (2002). Cognitive deficits in major depression. Scandinavian Journal of Psychology 43, 239–251.CrossRefGoogle ScholarPubMed
Rogers, M. A., Kasai, K., Koji, M., Fukuda, R., Iwanami, A., Nakagome, K., Fukuda, M. & Kato, N. (2004). Executive and prefrontal dysfunction in unipolar depression: a review of neuropsychological and imaging evidence. Neuroscience Research 50, 1–11.CrossRefGoogle ScholarPubMed
Rose, E. J. & Ebmeier, K. P. (2006). Pattern of impaired working memory during major depression. Journal of Affective Disorders 90, 149–161.CrossRefGoogle ScholarPubMed
Salloway, S., Molloy, P., Kohn, R., Gillard, E., Duffy, J., Rogg, J., Tung, G., Richardson, E., Thomas, C. & Westlake, R. (1995). MRI and neuropsychological differences in early- and late-life-onset geriatric depression. Neurology 46, 1567–1574.CrossRefGoogle Scholar
Shah, P. J., Glabus, M. F., Goodwin, G. M. & Ebmeier, K. P. (2002). Chronic, treatment-resistant depression and right fronto-striatal atrophy. British Journal of Psychiatry 180, 434–440.CrossRefGoogle ScholarPubMed
Sheline, Y. I., Barch, D. M., Garcia, K., Gersing, K., Pieper, C., Welsh-Bohmer, K., Steffens, D. C. & Doraiswamy, P. M. (2006). Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed. Biological Psychiatry 60, 58–65.CrossRefGoogle ScholarPubMed
Sheline, Y. I., Sanghavi, M., Mintun, M. A. & Gado, M. H. (1999). Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression. Journal of Neuroscience 19, 5034–5043.CrossRefGoogle Scholar
Steffens, D. C., Byrum, C. E., McQuoid, D. R., Greenberg, D. L., Payne, M. E., Blitchington, T. F., MacFall, J. R. & Krishnan, K. R. R. (2000). Hippocampal volume in geriatric depression. Biological Psychiatry 48, 301–309.CrossRefGoogle ScholarPubMed
Steingart, A. & Herrmann, N. (1991). Major depressive disorder in the elderly: the relationship between age of onset and cognitive impairment. International Journal of Geriatric Psychiatry 6, 593–598.CrossRefGoogle Scholar
Sweeney, J. A., Kmiec, J. A. & Kupfer, D. J. (2000). Neuropsychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biological Psychiatry 48, 674–684.CrossRefGoogle ScholarPubMed
Weingartner, H., Cohen, R. M., Murphy, D. L., Martello, J. & Gerdt, C. (1981). Cognitive processes in depression. Archives of General Psychiatry 38, 42–47.CrossRefGoogle ScholarPubMed
Wolfe, J., Granholm, E., Butters, N., Saunders, E. & Janowsky, D. (1987). Verbal memory deficits associated with major affective disorders: a comparison of unipolar and bipolar patients. Journal of Affective Disorders 13, 83–92.CrossRefGoogle ScholarPubMed