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The relationship between cognitive function and clinical and functional outcomes in major depressive disorder

Published online by Cambridge University Press:  04 June 2008

A. Withall ,
L. M. Harris  and
S. R. Cumming
A. Withall*
Affiliation:
Primary Dementia Collaborative Research Centre, University of New South Wales, Coogee, Australia
L. M. Harris
Affiliation:
School of Behavioural and Community Health Sciences, University of Sydney, Lidcombe, Australia
S. R. Cumming
Affiliation:
School of Behavioural and Community Health Sciences, University of Sydney, Lidcombe, Australia
*
*Address for correspondence: A. Withall, Ph.D., Primary Dementia Collaborative Research Centre, Cliffbrook Campus, 45 Beach Street, Coogee, NSW, Australia 2034. (Email: [email protected])
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Abstract

Background

Although cognitive variables have been shown to be useful in predicting outcomes in late-life depression, there has not yet been a comprehensive study in younger persons with depression.

Method

The clinical symptoms and cognitive performance of participants were evaluated at admission to one of two university teaching hospitals and again at 3 months after remission and discharge. A total of 52 participants with a DSM-IV diagnosis of major depressive disorder, aged between 20 and 60 years and with a Hamilton Depression Rating Scale score ⩾17 entered the study. The sample for this paper comprises the 48 subjects (mean age 37.9 years, s.d.=10.7) who received admission and follow-up assessments; an attrition rate of 7.7%.

Results

More perseverative errors on the shortened Wisconsin Card Sorting Test at admission predicted a worse clinical outcome at follow-up. Poor event-based prospective memory and more perseverative errors on the shortened Wisconsin Card Sorting Test at admission predicted worse social and occupational outcome at follow-up.

Conclusions

These results suggest that a brief cognitive screen at hospital admission, focusing on executive function, would have a useful prognostic value in depression. Determining early predictors of individuals at risk of poorer outcomes is important for identifying those who may need altered or additional treatment approaches.

Keywords

Depressionexecutive functionneuropsychologicaloutcomepredictor
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 3 , March 2009 , pp. 393 - 402
Copyright
Copyright © 2008 Cambridge University Press

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References

Absher, JR, Cummings, JL (1995). Neurobehavioral examination of frontal lobe functions. Aphasiology 9, 181–192.CrossRefGoogle Scholar
Alexopoulos, GS, Meyers, BS, Young, RC, Kalayam, B, Kakuma, T, Gabrielle, M, Sirey, JA, Hull, J (2000). Executive dysfunction and long-term outcomes of geriatric depression. Archives of General Psychiatry 57, 285–290.CrossRefGoogle ScholarPubMed
Alexopoulos, GS, Raue, P, Arean, P (2003). Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. American Journal of Geriatric Psychiatry 11, 46–52.CrossRefGoogle ScholarPubMed
Angst, J (1988). Clinical course of affective disorders. In Depressive Illness: Prediction of Course and Outcome (ed. Helgason, T. and), pp. 1–48. Springer: Berlin.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychological Association: Washington, DC.Google Scholar
Austin, MP, Mitchell, P, Wilhelm, K, Parker, G, Hickie, I, Brodaty, H, Chan, J, Eyers, K, Milic, M, Hadzi-Pavlovic, D (1999). Cognitive function in depression: a distinct pattern of frontal impairment in melancholia? Psychological Medicine 29, 73–85.CrossRefGoogle ScholarPubMed
Axelrod, BN, Henry, RR, Woodard, JL (1992). Analysis of an abbreviated form of the Wisconsin Card Sorting Test. Clinical Neuropsychologist 6, 27–31.CrossRefGoogle Scholar
Baddeley, AD, Hitch, GJ (2000). Development of working memory: should the Pascual-Leone and the Baddeley and Hitch models be merged? Journal of Experimental Child Psychology 77, 128–137.CrossRefGoogle ScholarPubMed
Benjamini, Y, Hochberg, Y (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society Series B 57, 289–300.Google Scholar
Benton, AL, Hamsher, K (1978). Multilingual Aphasia Examination. University of Iowa Press: Iowa City, IA.Google Scholar
Burgess, PW, Veitch, E, De Lacy Costello, A, Shallice, T (2000). The cognitive and neuroanatomical correlates of multitasking. Neuropsychologia 38, 848–863.CrossRefGoogle ScholarPubMed
Chan, RC, Chen, EY, Cheung, EF, Cheung, HK (2004). Executive dysfunctions in schizophrenia. Relationship to clinical manifestation. European Archives of Psychiatry & Clinical Neuroscience 254, 256–262.CrossRefGoogle ScholarPubMed
Crawford, JR (1992). Current and premorbid intelligence measures. In Neuropsychological Assessment. A Handbook of Neuropsychological Assessment (ed. Crawford, J. R., Mckinlay, W. and), pp. 21–49. Erlbaum: London.Google Scholar
Daigneault, S, Braun, CMJ, Whitaker, HA (1992). Early effects of normal aging on perseverative and non-perseverative prefrontal measures. Developmental Neuropsychology 8, 99–114.CrossRefGoogle Scholar
Delis, DC, Kramer, JH, Kaplan, E (1987). California Verbal Learning Test: Adult Version. The Psychological Corporation: San Antonio, TX.Google Scholar
Demyttenaere, K, De Fruyt, J (2003). Getting what you ask for: on the selectivity of depression rating scales. Psychotherapy and Psychosomatics 72, 61–70.CrossRefGoogle ScholarPubMed
Dobbs, AR, Reeves, MB (1996). Prospective memory: more than memory. In Prospective Memory: Theory And Applications (ed. Brandimonte, M. and Einstein, G. O.), pp. 199–225. Lawrence Erlbaum Associates, Inc.: Mahwah: NJ.Google Scholar
Donders, FC (1969). On the speed of mental processes. Acta Psychologica (Amsterdam) 30, 412–431.CrossRefGoogle ScholarPubMed
Dunkin, JJ, Leuchter, AF, Cook, IA, Kasl-Godley, JE, Abrams, M, Rosenberg-Thompson, S (2000). Executive dysfunction predicts nonresponse to fluoxetine in major depression. Journal of Affective Disorders 60, 13–23.CrossRefGoogle ScholarPubMed
Elliott, R (1998). The neuropsychological profile in unipolar depression. Trends in Cognitive Sciences 2, 447–454.CrossRefGoogle ScholarPubMed
Evans, JJ, Chua, SE, McKenna, PJ, Wilson, BA (1997). Assessment of the dysexecutive syndrome in schizophrenia. Psychological Medicine 27, 635–646.CrossRefGoogle ScholarPubMed
Fossati, P, Amar, G, Raoux, N, Ergis, AM, Allilaire, JF (1999). Executive functioning and verbal memory in young patients with unipolar depression and schizophrenia. Psychiatry Research 89, 171–187.CrossRefGoogle ScholarPubMed
Frank, E, Prien, RF, Jarrett, RB, Keller, MB, Kupfer, DJ, Lavori, PW, Rush, AJ, Weissman, MM (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Archives of General Psychiatry 48, 851–855.CrossRefGoogle ScholarPubMed
Franke, P, Maier, W, Hardt, J, Frieboes, R, Lichtermann, D, Hain, C (1993). Assessment of frontal lobe functioning in schizophrenia and unipolar major depression. Psychopathology 26, 76–84.CrossRefGoogle ScholarPubMed
Furukawa, TA, Takeuchi, H, Hiroe, T, Mashiko, H, Kamei, K, Kitamura, T, Takahashi, K (2001). Symptomatic recovery and social functioning in major depression. Acta Psychiatrica Scandinavica 103, 257–261.CrossRefGoogle ScholarPubMed
Garden, SE, Phillips, LH, Macpherson, SE (2001). Midlife aging, open-ended planning, and laboratory measures of executive function. Neuropsychology 15, 472–482.CrossRefGoogle ScholarPubMed
Golden, CJ (1978). Stroop Color and Word Test Manual. Stoelting: Chicago, IL.Google Scholar
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google ScholarPubMed
Grace, J, Stout, JC, Malloy, PF (1999). Assessing frontal lobe behavioral syndromes with the Frontal Lobe Personality Scale. Assessment 6, 269–284.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Harris, LM, Menzies, RG (1999). Mood and prospective memory. Memory 7, 117–127.CrossRefGoogle ScholarPubMed
Hay, P, Katsikitis, M, Begg, J, Da Costa, J, Blumenfeld, N (2003). A two-year follow-up study and prospective evaluation of the DSM-IV axis V. Psychiatric Services 54, 1028–1030.CrossRefGoogle ScholarPubMed
Heaton, RK (1981). Wisconsin Card Sorting Test Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Ilsley, JE, Moffoot, APR, O'Carroll, RE (1995). An analysis of memory dysfunction in major depression. Journal of Affective Disorders 35, 1–9.CrossRefGoogle ScholarPubMed
Joseph, R (1999). Frontal lobe psychopathology: mania, depression, confabulation, catatonia, perseveration, obsessive compulsions, and schizophrenia. Psychiatry 62, 138–172.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Maser, JD, Zeller, PJ, Endicott, J, Coryell, W, Paulus, MP, Kunovac, JL, Leon, AC, Mueller, TI, Rice, JA, Keller, MB (1998). A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Archives of General Psychiatry 55, 694–700.CrossRefGoogle ScholarPubMed
Kalayam, B, Alexopoulos, GS (1999). Prefrontal dysfunction and treatment response in geriatric depression. Archives of General Psychiatry 56, 713–718.CrossRefGoogle ScholarPubMed
Kiosses, DN, Klimstra, S, Murphy, C, Alexopoulos, GS (2001). Executive dysfunction and disability in elderly patients with major depression. American Journal of Geriatric Psychiatry 9, 269–274.CrossRefGoogle ScholarPubMed
Lezak, MD (1995). Neuropsychological Assessment. Oxford University Press: New York.Google Scholar
Lombardi, WJ, Andreason, PJ, Sirocco, KY, Rio, DE, Gross, RE, Umhau, JC, Hommer, DW (1999). Wisconsin Card Sorting Test performance following head injury: dorsolateral fronto-striatal circuit activity predicts perseveration. Journal of Clinical and Experimental Neuropsychology 21, 2–16.CrossRefGoogle ScholarPubMed
Majer, M, Ising, M, Kunzel, H, Binder, EB, Holsboer, F, Modell, S, Zihl, J (2004). Impaired divided attention predicts delayed response and risk to relapse in subjects with depressive disorders. Psychological Medicine 34, 1453–1463.CrossRefGoogle ScholarPubMed
Martin, DJ, Oren, Z, Boone, K (1991). Major depressives' and dysthymics' performance on the Wisconsin Card Sorting Test. Journal of Clinical Psychology 47, 684–690.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Massman, PJ, Delis, DC, Butters, N, Dupont, RM, Gillin, JC (1992). The subcortical dysfunction hypothesis of memory deficits in depression: neuropsychological validation in a subgroup of patients. Journal of Clinical and Experimental Neuropsychology 14, 687–706.CrossRefGoogle Scholar
Mateer, CA (1999). Executive function disorders: rehabilitation challenges and strategies. Seminars in Clinical Neuropsychiatry 4, 50–59.Google ScholarPubMed
Moritz, S, Birkner, C, Kloss, M, Jahn, H, Hand, I, Haasen, C, Krausz, M (2002). Executive functioning in obsessive-compulsive disorder, unipolar depression, and schizophrenia. Archives of Clinical Neuropsychology 17, 477–483.Google ScholarPubMed
Nelson, HE, O'Connell, A (1978). Dementia: the estimation of premorbid intelligence levels using the new adult reading test. Cortex 14, 234–244.CrossRefGoogle ScholarPubMed
Okuda, J, Fujii, T, Yamadori, A, Kawashima, R, Tsukiura, T, Fukatsu, R, Suzuki, K, Ito, M, Fukuda, H (1998). Participation of the prefrontal cortices in prospective memory: evidence from a PET study in humans. Neuroscience Letters 253, 127–130.CrossRefGoogle ScholarPubMed
Pancheri, P, Picardi, A, Pasquini, M, Gaetano, P, Biondi, M (2002). Psychopathological dimensions of depression: a factor study of the 17-item Hamilton Depression Rating Scale in unipolar depressed outpatients. Journal of Affective Disorders 68, 41–47.CrossRefGoogle ScholarPubMed
Reischies, FM, Neu, P (2000). Comorbidity of mild cognitive disorder and depression – a neuropsychological analysis. European Archives of Psychiatry and Clinical Neuroscience 250, 186–193.CrossRefGoogle ScholarPubMed
Robinson, LJ, Kester, DB, Saykin, AJ, Kaplan, EF, Gur, RC (1991). Comparison of two short forms of the Wisconsin Card Sorting Test. Archives of Clinical Neuropsychology 6, 27–33.CrossRefGoogle ScholarPubMed
Rude, SS, Hertel, PT, Jarrold, W, Covich, J, Hedlund, S (1999). Depression-related impairments in prospective memory. Cognition and Emotion 13, 267–276.CrossRefGoogle Scholar
Shallice, T (1988). From Neuropsychology to Mental Structure. Cambridge University Press: Cambridge, UK.CrossRefGoogle Scholar
Shallice, T, Burgess, P (1991). Deficits in strategy application following frontal lobe damage in man. Brain 114, 727–741.CrossRefGoogle ScholarPubMed
Simpson, S, Baldwin, RC, Jackson, A, Burns, AS (1998). Is subcortical disease associated with a poor response to antidepressants? Neurological, neuropsychologica and neuroradiological findings in late-life depression. Psychological Medicine 28, 1015–1026.CrossRefGoogle Scholar
Spreen, O, Strauss, E (1998). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford University Press: New York.Google Scholar
Veiel, HO (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology 19, 587–603.CrossRefGoogle ScholarPubMed
Wechsler, DA (1987). Wechsler Memory Scale – Revised Manual. The Psychological Corporation: New York.Google Scholar
Wittchen, HU, Holsboer, F, Jacobi, F (2001). Met and unmet needs in the management of depressive disorder in the community and primary care: the size and breadth of the problem. Journal of Clinical Psychiatry 62 (Suppl. 26), 23–28.Google ScholarPubMed