Hostname: page-component-745bb68f8f-cphqk Total loading time: 0 Render date: 2025-01-11T22:04:33.312Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropsychological deficits and CT scan changes in elderly depressives

Published online by Cambridge University Press:  09 July 2009

Melanie A. Abas ,
Barbara J. Sahakian  and
Raymond Levy
Melanie A. Abas
Affiliation:
Maudsley and Bethlem Royal Hospital and the Institute of Psychiatry, London
Barbara J. Sahakian
Affiliation:
Maudsley and Bethlem Royal Hospital and the Institute of Psychiatry, London
Raymond Levy*
Affiliation:
Maudsley and Bethlem Royal Hospital and the Institute of Psychiatry, London
*
1Address for correspondence: Professor R. Levy, Section of Old Age Psychiatry, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF.
Get access Rights & Permissions [Opens in a new window]

Synopsis

A number of computerized tests were used to study visual attention, memory and learning in elderly depressed patients. Impairment was found in approximately 70% of depressed patients and was seen particularly in memory and in measures of latency. Depressed patients showed equivalent impairment in short-term memory but less impairment in conditional associative learning compared to a group of patients with early dementia of the Alzheimer-type (DAT), matched for age and pre-morbid IQ. With respect to qualitative differences between depression and DAT, depressed patients showed a different pattern of errors and a consistently prolonged latency of response which was independent of delay in a delayed matching-to-sample test. On recovery from depression, although improvement was seen in most test scores, performance in measures of latency and in a number of tests of memory and learning failed to reach the level seen in a group of matched control subjects and approximately 35% of patients continued to show impairment. For the depressed patients, ventricular brain ratio (VBR) correlated with measures of slowing. In addition, in the ‘recovered-depressives’, VBR correlated with poor performance at high levels of task difficulty. These findings are discussed with respect to previous literature on the pattern of cognitive impairment and CT scan findings in depression.

Type
Original Articles
Information
Psychological Medicine , Volume 20 , Issue 3 , August 1990 , pp. 507 - 520
Copyright
Copyright © Cambridge University Press 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abrams, R. & Taylor, M. A. (1987). Cognitive dysfunction in melancholia. Psychological Medicine 17, 359–362.CrossRefGoogle ScholarPubMed
Agbayewa, M. O. (1986). Earlier psychiatric morbidity in patients with Alzheimer's disease. Journal of the American Geriatric Society 34, 561–564,.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1987). DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised. American Psychiatric Association: Washington D.C.Google Scholar
Benson, D. F. (1983). Subcortical dementia: a clinical approach. In The Dementias (ed. Mayeux, R. and Rosen, W. G.), pp. 185–195. Raven Press: New York.Google Scholar
Bolton, N., Savage, R. D. & Roth, M. (1967). The MWLT and the aged psychiatric patient. British Journal of Psychiatry 113, 1139–1140.CrossRefGoogle Scholar
Caine, E. D. (1981). Pseudodementia. Archives of General Psychiatry 38, 1359–1364.CrossRefGoogle ScholarPubMed
Cavanaugh, S. V. A. & Wettstein, R. M. (1983). The relationship between severity of depression, cognitive dysfunction and age in medical inpatients. American Journal of Psychiatry 140, 495–496.Google 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
Davies, G., Hamilton, S., Hendrickson, E., Levy, R. & Post, F. (1978). Psychological test performance and sedation thresholds of elderly dements, depressives and depressives with incipient brain change. Psychological Medicine 8, 103–109.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). ‘Mini-Mental state’, a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Glass, R. M., Uhlenhuth, E. H., Hartel, F. W., Matuzas, W. & Fischman, M. W. (1981). Cognitive dysfunction and imipramine in outpatient depressives. Archives of General Psychiatry 38, 1048–1051.CrossRefGoogle Scholar
Goldstein, L. H. & Oakley, D. A. (1986). Colour versus orientation discrimination in severely brain-damaged and normal adults. Cortex 22, 261–266.CrossRefGoogle ScholarPubMed
Gur, R. E. (1979). Cognitive concomitants of hemispheric dysfunction in schizophrenia. Archives of General Psychiatry 36, 269–274.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Harness, B. Z., Bental, E. & Carmon, A. (1977). Comparison of cognition and performance in patients with organic brain damage and psychiatric patients. Acta Psychiatrica Belgica 77, 339–347.Google ScholarPubMed
Hart, R. P., Kwentus, J. A., Taylor, J. R. & Harkins, S. W. (1987). Rate of forgetting in dementia and depression. Journal of Consulting and Clinical Psychology 55, 101–105.CrossRefGoogle ScholarPubMed
Hasher, L. & Zacks, R. (1979). Automatic and effortful processes in memory. Journal of Experimental Psychology: General 108, 356–388.CrossRefGoogle Scholar
Hemsi, L., Whitehead, A. & Post, F. (1986). Cognitive functioning and cerebral arousal in elderly depressives and dements. Journal of Psychosomatic Research 12, 145–156.CrossRefGoogle Scholar
Hendrickson, E., Levy, R. & Post, F. (1979). Averaged evoked responses in relation to cognitive and affective state of elderly psychiatric patients. British Journal of Psychiatry 134, 494–501.CrossRefGoogle ScholarPubMed
Henry, G. M., Weingartner, H. & Murphy, D. L. (1973). Influence of affective states and psychoactive drugs on verbal learning and memory. American Journal of Psychiatry 130, 966–971.CrossRefGoogle ScholarPubMed
Hodkinson, H. H. (1973). Mental impairment in the elderly. Journal of the Royal College of Physicians of London 7, 305–317.Google ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L A. & Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry 140, 566–572.CrossRefGoogle ScholarPubMed
Jacoby, R. J. & Levy, R. (1980). Computed tomography in the elderly: 3. Affective disorder. British Journal of Psychiatry. 136, 270–275.CrossRefGoogle ScholarPubMed
Jacoby, R. J., Levy, R. & Dawson, J. M. (1980). Computed tomography in the elderly: 1. The normal population. British Journal of Psychiatry 136, 249–255.CrossRefGoogle Scholar
Jacoby, R. J., Levy, R. & Bird, J. M. (1981). Computed tomography and the outcome of affective disorder: a follow-up study of elderly patients. British Journal of Psychiatry. 139, 288–292.CrossRefGoogle ScholarPubMed
Jorm, A. F. (1986 a). Cognitive deficit in the depressed elderly: a review of some basic unresolved issues. Australian and New Zealand Journal of Psychiatry 20, 11–22.CrossRefGoogle ScholarPubMed
Jorm, A. F. (1986 b). Controlled and automatic information processing in senile dementia; a review. Psychological Medicine 16, 77–88.CrossRefGoogle ScholarPubMed
Kay, D. W. K. (1962). Outcome and cause of death in mental disorders of old age: a long-term follow-up of functional and organic psychoses. Acta Psychiatrica Scandinavica 38, 249–276.CrossRefGoogle Scholar
Kellner, C. H., Rubinow, D. R. & Post, R. M. (1986). Cerebral ventricular size and cognitive impairment in depression. Journal of Affective Disorders 10, 215–219.CrossRefGoogle ScholarPubMed
Kendrick, D. C. (1967). A cross-validation of the use of the SLT and the DCT in screening for diffuse brain pathology in elderly subjects. British Journal of Medical Psychology 40, 173–178.CrossRefGoogle ScholarPubMed
Kendrick, D. C. (1985). Kendrick Cognitive Tests for the Elderly. NFER-Nelson: Windsor.Google Scholar
Krai, V. A. (1983). The relationship between senile dementia (Alzheimer type) and depression. Canadian Journal of Psychiatry 28, 304–305.Google Scholar
Kullback, S. (1959). Information Theory and Statistics. John Wiley: New York.Google Scholar
La Rue, A., Spar, J. & Hill, C. D. (1986). Cognitive impairment in late-life depression: clinical correlates and treatment implications. Journal of Affective Disorders 11, 179–184.CrossRefGoogle ScholarPubMed
Larner, S. (1977). Encoding in senile dementia and elderly depressives: a preliminary study. British Journal of Social and Clinical Psychology 16, 379–390.CrossRefGoogle ScholarPubMed
Levy, R. & Sahakian, B. J. (1987). Subcortical dementia. British Journal of Psychiatry 150, 559–560.CrossRefGoogle Scholar
McAllister, T. W. (1981). Cognitive functioning in the affective disorders. Comprehensive Psychiatry 22, 572–586.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. & Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task force on Alzheimer's Disease. Neurology, Cleveland 34, 939–944.CrossRefGoogle ScholarPubMed
Mahendra, B. (1985). Depression and dementia: the multi-faceted relationship. Psychological Medicine 15, 227–236.CrossRefGoogle ScholarPubMed
Montgomery, S. A. (1985). Personal communication.Google Scholar
Montgomery, S. A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Morris, R. G., Evenden, J. L., Sahakian, B. J. & Robbins, T. W. (1987). Computer-aided assessment of dementia: comparative studies of neuropsychological deficits in Alzheimer-type dementia and Parkinson's disease. In Cognitive Neurochemistry (ed. Stahl, S. M., Iversen, S. D. and Goodman, E. G.), pp. 22–36. Oxford University Press: Oxford.Google Scholar
Nelson, H. E. (1982). National Adult Reading Test Manual. NFER-Nelson: Windsor.Google Scholar
Philpot, M. P. & Levy, R. (1987). A memory clinic for the early diagnosis of dementia of the Alzheimer-type. International Journal of Geriatric Psychiatry 2, 195–200.CrossRefGoogle Scholar
Portin, R., Raininko, R. & Rinne, U. K. (1984). Neuropsychological disturbances and cerebral atrophy determined by computerized tomography in Parkinsonian patients with long-term levodopa treatment. In Advances in Neurology, Volume 40 (ed. Hassler, R. G. and Christ, J. F.), pp. 219–227. Raven Press: New York.Google Scholar
Post, F. (1962). The Significance of Affective Symptoms in Old Age. Oxford University Press: London.Google Scholar
Rabins, P. V., Merchant, A. & Nestadt, G. (1984). Criteria for diagnosing reversible dementia caused by depression. British Journal of Psychiatry 144, 488–492.CrossRefGoogle ScholarPubMed
Raskin, A., Friedman, A. S. & DiMascio, A. (1982). Cognitive and performance deficits in depression. Psychopharmacology Bulletin 118, 196–202.Google Scholar
Reding, M., Haycox, J. & Blass, J. (1985). Depression in patients referred to a dementia clinic. A three year prospective study. Archives of Neurology 42, 849–896.CrossRefGoogle Scholar
Reus, V. I., Silberman, E., Post, R. M. & Weingartner, H. (1979). D-Amphetamine: effects of memory in a depressed population. Biological Psychiatry 14, 345–356.Google Scholar
Robbins, T. W. (1977). A critique of the methods available for the spontaneous motor activity. In Handbook of Psychopharmacology, Volume 7 (ed. Iversen, L. I., Iversen, S. D. and Snyder, S. H.), pp. 37–82. Plenum Press: New York.CrossRefGoogle Scholar
Rogers, D., Lees, A. J., Smith, E., Trimble, T. & Stern, G. M. (1987). Bradyphrenia in Parkinson's disease and psychomotor retardation in depressive illness. Brain 110, 761–776.CrossRefGoogle ScholarPubMed
Rubinow, D. R., Post, R. M., Savard, R. & Gold, P. W. (1984). Cortisol hypersection and cognitive impairment in depression. Archives of General Psychiatry 41, 279–283.CrossRefGoogle Scholar
Sahakian, B. J., Morris, R. G., Evenden, J. L., Heald, A., Levy, R., Philpot, M. & Robbins, T. W. (1988). A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain 111, 695–718.CrossRefGoogle ScholarPubMed
Savard, R. J., Rey, A. & Post, R. M. (1980). Halstead-Reitan Category Test in bipolar and unipolar affective disorders: relationship to age and phase of illness. Journal of Nervous and Mental Disease 168, 297–304.CrossRefGoogle ScholarPubMed
Spitzer, R., Endicott, J. & Robins, E. (1978). Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Sternberg, D. E. & Jarvik, M. E. (1976). Memory functions in depression: improvement with antidepressant medication. Archives of General Psychiatry 33, 219–224.CrossRefGoogle Scholar
Strömgren, L. S. (1977). The influence of depression on memory. Acta Psychiatrica Scandinavica 56, 109–128.CrossRefGoogle ScholarPubMed
Wechsler, D. (1955). Wechsler Adult Intelligence Scale. Psychological Corporation: New York.Google Scholar
Weckowicz, T. E., Nutter, R. W. & Cruise, D. G. (1972). Speed in test performance in relation to depressive illness and age. Journal of the Canadian Psychiatric Association 17, Supplement 2SS, 241–250.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
Whitehead, A. (1973). Verbal learning and memory in elderly depressives. British Journal of Psychiatry. 123, 203–208.CrossRefGoogle ScholarPubMed
Winer, B. J. (1971). Statistical Principles in Experimental Design, Second edition. McGraw-Hill: New York.Google Scholar