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Cognitive deficits in unipolar old-age depression: a population-based study

Published online by Cambridge University Press:  10 July 2013

A. Pantzar ,
E. J. Laukka ,
A. R. Atti ,
J. Fastbom ,
L. Fratiglioni  and
L. Bäckman
A. Pantzar*
Affiliation:
Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden
E. J. Laukka
Affiliation:
Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden
A. R. Atti
Affiliation:
Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden Institute of Psychiatry P. Ottonello, Bologna University, Bologna, Italy
J. Fastbom
Affiliation:
Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden
L. Fratiglioni
Affiliation:
Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden Stockholm Gerontology Research Center, Stockholm, Sweden
L. Bäckman
Affiliation:
Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden
*
*Address for correspondence: Ms. A. Pantzar, Aging Research Center, Gävlegatan 16, 113 30 Stockholm, Sweden. (Email: alexandra.pantzar@ki.se)
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Abstract

Background

There is substantial variability in the degree of cognitive impairment among older depressed persons. Inconsistencies in previous findings may be due to differences in clinical and demographic characteristics across study samples. We assessed the influence of unipolar depression and severity of depression on cognitive performance in a population-based sample of elderly persons aged ⩾60 years.

Method

Eighty-nine persons fulfilled ICD-10 criteria for unipolar depression (mild, n = 48; moderate, n = 38; severe, n = 3) after thorough screening for dementia (DSM-IV criteria), psychiatric co-morbidities and antidepressant pharmacotherapy. Participants (n = 2486) were administered an extensive cognitive test battery.

Results

Moderate/severe unipolar depression was associated with poorer performance on tasks assessing processing speed, attention, executive function, verbal fluency, episodic memory and vocabulary. Mild depression was associated with poorer performance in processing speed, and few differences between mild and moderate/severe depression were observed. No association between depression and short-term memory, general knowledge or spatial ability was observed. Increasing age did not exacerbate the depression-related cognitive deficits, and the deficits remained largely unchanged after excluding persons in a preclinical phase of dementia. Furthermore, depression-related cognitive deficits were not associated with other pharmacological treatments that may affect cognitive performance.

Conclusions

Cognitive deficits in unipolar old-age depression involve a range of domains and the cognitive deficits seem to follow the spectrum of depression severity. The finding that mild depression was also associated with poorer cognitive functioning underscores the importance of detecting mild depression in elderly persons.

Keywords

Cognitiondepressionold agepopulation-based studyunipolar
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 5 , April 2014 , pp. 937 - 947
Copyright
Copyright © Cambridge University Press 2013 

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References

Alexopoulos, G (1997). Vascular depression hypothesis. Archives of General Psychiatry 54, 915–922.Google Scholar
Alexopoulos, G (2005). Depression in the elderly. Lancet 365, 1961–1970.Google Scholar
Alexopoulos, G (2006). The vascular depression hypothesis: 10 years later. Biological Psychiatry 60, 1304–1305.Google Scholar
Alexopoulos, G, Meyers, B, Young, RC, Kalayam, B, Kakuma, T, Gabrielle, M, Sirey, J, Hull, J (2000). Executive dysfunction and long-term outcomes of geriatric depression. Archives of General Psychiatry 57, 285–290.Google Scholar
Amati, A, Del Vecchio, M, Kemali, D, Perris, C, Vacca, L (1978). The Comprehensive Psychopathological Rating Scale (CPRS): communicability to, and inter-rater reliability among untrained raters. Acta Psychiatrica Scandinavica 57 (Suppl. 271), 63–69.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Åsberg, M, Montgomery, S, Perris, C, Schalling, D, Sedvall, G (1978). A Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica 57 (Suppl. 271), 5–27.CrossRefGoogle Scholar
Bäckman, L, Forsell, Y (1994). Episodic memory functioning in a community-based sample of old adults with major depression: utilization of cognitive support. Journal of Abnormal Psychology 103, 361–370.Google Scholar
Bäckman, L, Hill, R, Forsell, Y (1996). The influence of depressive symptomatology on episodic memory functioning among clinically nondepressed older adults. Journal of Abnormal Psychology 105, 97–105.CrossRefGoogle ScholarPubMed
Baune, B, Suslow, T, Arolt, V, Berger, K (2007). The relationship between psychological dimensions of depressive symptoms and cognitive functioning in the elderly – the MEMO-Study. Journal of Psychiatric Research 41, 247–254.Google Scholar
Beats, B, Sahakian, B, Levy, R (1996). Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed. Psychological Medicine 26, 591–603.Google Scholar
Beekman, A, Geerlings, S, Deeg, D, Smit, J, Schoevers, R, de Beurs, E, Braam, A, Penninx, B, van Tilburg, W (2002). The natural history of late-life depression. Archives of General Psychiatry 59, 605–611.Google Scholar
Berger, A-K, Fratiglioni, L, Forsell, Y, Winblad, B, Bäckman, L (1999). The occurrence of depressive symptoms in the preclinical phase of Alzheimer's disease: a population-based study. Neurology 53, 1998–2022.Google Scholar
Berger, A-K, Small, B, Forsell, Y, Winblad, B, Bäckman, L (1998). Preclinical symptoms of major depression in very old age: a prospective longitudinal study. American Journal of Psychiatry 155, 1039–1043.Google Scholar
Bhalla, R, Butters, M, Mulsant, B, Begley, A, Zmuda, M, Schoderbek, B, Pollock, B, Reynolds, C, Becker, J (2006). Persistence of neuropsychological deficits in the remitted state of late-life depression. American Journal of Geriatric Psychiatry 14, 419–427.CrossRefGoogle ScholarPubMed
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.Google Scholar
Burt, DB, Zembar, MJ, Niederhe, G (1995). Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity. Psychological Bulletin 117, 285–305.Google Scholar
Butters, M, Whyte, E, Nebes, R, Begley, A, Dew, M, Mulsant, B, Zmuda, M, Bhalla, R, Meltzer, C, Pollock, B, Reynolds, C, Becker, J (2004). The nature and determinants of neuropsychological functioning in late-life depression. Archives of General Psychiatry 61, 587–595.Google Scholar
Corder, EH, Lannfelt, L, Viitanen, M, Corder, LS, Manton, KG, Winblad, B, Basun, H (1996). Apolipoprotein E genotype determines survival in the oldest old (85 years or older) who have good cognition. Archives of Neurology 53, 418–422.Google Scholar
Degl'Innocenti, A, Agren, H, Bäckman, L (1998). Executive deficits in major depression. Acta Psychiatrica Scandinavica 97, 182–188.Google Scholar
Duman, R, Heninger, G, Nestler, E (1997). A molecular and cellular theory of depression. Archives of General Psychiatry 54, 597–606.Google Scholar
Dunkin, J, Leuchter, A, Cook, I, Kasl-Godley, J, Abrams, M, Rosenberg-Thompson, S (2000). Executive dysfunction predicts nonresponse to fluoxetine in major depression. Journal of Affective Disorders 60, 13–23.CrossRefGoogle ScholarPubMed
Dureman, I (1960). SRB:1. Psykologiförlaget: Stockholm.Google Scholar
Eaton, WW, Shao, H, Nestadt, G, Lee, HB, Bienvenu, OJ, Zandi, P (2008). Population-based study of first onset and chronicity in major depressive disorder. Archives of General Psychiatry 65, 513–520.Google Scholar
Elderkin-Thompson, V, Anand, K, Bilker, WB, Dunkin, JJ, Mintz, J, Moberg, P, Mesholam, RI, Gur, RE (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.Google Scholar
Fischer, C, Scweizer, T, Atkins, J, Bozanovic, R, Norris, M, Hermann, N, Nisenabum, R, Rourke, S (2008). Neurocognitive profiles in older adults with and without major depression. International Journal of Geriatric Psychiatry 23, 851–856.Google Scholar
Folstein, M, Folstein, S, McHugh, P (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.Google Scholar
Fossati, P, Ergis, A, Allilaire, J (2002). Executive functioning in unipolar depression: a review [in French]. L'Encéphale 28, 97–107.Google Scholar
Gallo, JJ, Rabins, PV, Lyketsos, CG, Tien, AY, Anthony, JC (1997). Depression without sadness: functional outcomes of nondysphoric depression in later life. Journal of the American Geriatrics Society 45, 570–578.CrossRefGoogle ScholarPubMed
Ganguli, M, Snitz, B, Vander Bilt, J, Chang, C-C (2009). How much do depressive symptoms affect cognition at the population level? The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. International Journal of Geriatric Psychiatry 24, 1277–1284.Google Scholar
Gottfries, C-G (2001). Late life depression. European Archives of Psychiatry and Clinical Neuroscience 251 (Suppl. 2), 1157–1161.Google Scholar
Hasher, L, Zacks, R (1979). Automatic and effortful processes in memory. Journal of Experimental Psychology 108, 356–388.CrossRefGoogle Scholar
Herrmann, L, Goodwin, G, Ebmeier, K (2007). The cognitive neuropsychology of depression in the elderly. Psychological Medicine 37, 1693–1702.Google Scholar
Herrmann, L, Le Masurier, M, Ebmeier, K (2008). White matter hyperintensities in late life depression: a systematic review. Journal of Neurology, Neurosurgery, and Psychiatry 79, 619–624.CrossRefGoogle ScholarPubMed
Kindermann, S, Brown, G (1997). Depression and memory in the elderly: a meta-analysis. Journal of Clinical and Experimental Neuropsychology 5, 625–642.Google Scholar
Köhler, S, Thomas, A, Barnett, N, O'Brien, J (2010). The pattern and course of cognitive impairment in late-life depression. Psychological Medicine 40, 591–602.Google Scholar
Krogh, J, Videbech, P, Renvillard, SG, Garde, AH, Jörgensen, MB, Nordentoft, M (2012). Cognition and HPA axis reactivity in mildly to moderately depressed outpatients. A case-control study. Nordic Journal of Psychiatry 66, 414–421.CrossRefGoogle ScholarPubMed
Laukka, E, Lövdén, M, Herlitz, A, Karlsson, S, Ferencz, B, Pantzar, A, Keller, L, Graff, C, Fratiglioni, L, Bäckman, L (2013). Genetic effects on old-age cognitive functioning: a population-based study. Psychology and Aging 28, 262–274.Google Scholar
Lee, R, Hermens, D, Porter, M, Redoblado-Hodge, M (2012). A meta-analysis of cognitive deficits in first-episode major depressive disorder. Journal of Affective Disorders 140, 113–124.Google Scholar
Lezak, MD (2004). Neuropsychological Assessment, 4th edn. Oxford University Press: New York.Google Scholar
Lockwood, K, Alexopoulos, G, van Gorp, W (2002). Executive dysfunction in geriatric depression. American Journal of Psychiatry 159, 1119–1126.Google Scholar
Lupien, S, Gillin, C, Hauger, R (1999). Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: a dose-response study in humans. Behavioral Neuroscience 113, 420–430.Google Scholar
Majer, M, Ising, M, Künsel, H, Binder, E, 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.Google Scholar
Mayberg, HS (1997). Limbic-cortical dysregulation: a proposed model of depression. Journal of Neuropsychiatry and Clinical Neuroscience 9, 471–481.Google Scholar
Mayberg, HS (2007). Defining the neural circuitry of depression: toward a new nosology with therapeutic implications. Biological Psychiatry 61, 729–730.Google Scholar
McDermott, L, Ebmeier, K (2009). A meta-analysis of depression severity and cognitive function. Journal of Affective Disorders 119, 1–8.Google Scholar
McEwan, BS (2003). Mood disorders and allostatic load. Biological Psychiatry 54, 200–207.Google Scholar
Montgomery, S, Åsberg, M, Jörnested, L, Thorén, P, Träskman, L, McAuely, R, Montgomery, D, Shaw, P (1978). Reliability of the CPRS between the disciplines of psychiatry, general practice, nursing and psychology in depressed patients. Acta Psychiatrica Scandinavica 271, 29–32.Google Scholar
Nebes, RD, Butters, MA, Mulsant, BH, Pollock, BG, Zmuda, MD, Houck, PR, Reynolds, CF (2000). Decreased working memory and processing speed mediate cognitive impairment in geriatric depression. Psychological Medicine 30, 679–691.Google Scholar
Nestler, EJ, Barrot, M, DiLeone, RJ, Eisch, AJ, Gold, SJ, Monteggia, LM (2002). Neurobiology of depression. Neuron 34, 13–25.Google Scholar
Nilsson, L-G, Bäckman, L, Erngrund, K, Nyberg, L, Adolfsson, R, Bucht, G, Karlsson, S, Widing, M, Winblad, B (1997). The Betula prospective cohort study: memory, health, and aging. Aging, Neuropsychology, and Cognition 4, 1–32.Google Scholar
Ownby, RL, Crocco, E, Acevedo, A, Vineeth, J, Lowenstein, D (2006). Depression and risk for Alzheimer's disease. Systematic review, meta-analysis, and metaregression analysis. Archives of General Psychiatry 63, 530–538.Google Scholar
Perris, C (1979). Reliability and validity studies of the Comprehensive Psychopathological Rating Scale (CPRS). Progress in Neuro-Psychopharmacology 1, 413–421.CrossRefGoogle Scholar
Raber, J, Huang, Y, Ashford, JW (2004). ApoE genotype accounts for the vast majority of AD risk and AD pathology. Neurobiology of Aging 25, 641–650.Google Scholar
Rehnman, J, Herlitz, A (2006). Higher face recognition ability in girls: magnified by own-sex and own-ethnicity bias. Memory 14, 289–296.Google Scholar
Roy-Byrne, P, Weingartner, H, Bierer, L, Thompson, K, Post, R (1986). Effortful and automatic cognitive processes in depression. Archives of General Psychiatry 43, 265–267.Google Scholar
Salthouse, TA, Babcock, RL (1991). Decomposing adult age differences in working memory. Developmental Psychology 27, 763–776.Google Scholar
Sapolsky, RM, Romero, LM, Munck, AU (2000). How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocrine Reviews 21, 55–71.Google ScholarPubMed
Sheline, Y, Barch, D, Garcia, K, Gersing, K, Pieper, C, Welsh-Bohmer, K, Steffens, D, Doraiswamy, P (2006). Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed. Biological Psychiatry 60, 58–65.Google Scholar
Shepard, RN, Metzler, J (1970). Mental rotation of three-dimensional objects. Science 171, 701–703.Google Scholar
Spiers, N, Brugha, T, Bebbington, P, McManus, S, Jenkins, R, Meltzer, H (2012). Age and birth cohort differences in depression in repeated cross-sectional surveys in England: the National Psychiatric Morbidity Surveys, 1993 to 2007. Psychological Medicine 42, 2047–2055.Google Scholar
Tagaris, GA, Kim, S-G, Strupp, JP, Andersen, P, Ugurbil, K, Georgopoulos, AP (1996). Quantitative relations between parietal activation and performance in mental rotation. Neuroreport 7, 773–776.Google Scholar
Thomas, A, O'Brien, J (2008). Depression and cognition in older adults. Current Opinion in Psychiatry 21, 8–13.Google Scholar
Thomas, A, Gallagher, P, Robinson, L, Porter, R, Young, A, Ferrier, I, O'Brien, J (2009). A comparison of neurocognitive impairment in younger and older adults with major depression. Psychological Medicine 39, 725–733.CrossRefGoogle ScholarPubMed
Vandenberg, SG, Kuse, AR (1971). Mental rotations, a group test of three-dimensional spatial visualization. Perceptual and Motor Skills 47, 599–604.Google Scholar
Veiel, H (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology 4, 587–603.Google Scholar
Wechsler, DA (1981). Wechsler Adult Intelligence Scale – Revised. Psychological Corporation: New York.Google Scholar
Weingartner, H, Cohen, R, Murphy, D, Martello, J, Gerdt, C (1981). Cognitive processes in depression. Archives of General Psychiatry 38, 42–47.Google Scholar
Wendt, PE, Risberg, J (1994). Cortical activation during visual spatial processing: relation between hemispheric asymmetry of blood flow and performance. Brain and Cognition 24, 87–103.Google Scholar
WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar
WHO (2005). Mental Health: Facing the Challenges, Building Solutions. Report from the WHO European Ministerial Conference. World Health Organization: Copenhagen.Google Scholar
Young, A, Sahakian, B, Robbins, T, Cowen, P (1999). The effects of chronic administration of hydrocortisone on cognitive function in normal male volunteers. Psychopharmacology 145, 260–266.CrossRefGoogle ScholarPubMed
Zakzanis, K, Leach, L, Kaplan, E (1998). On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 11, 111–119.Google ScholarPubMed
Zazzo, R (1974). Test des Deux Barrages. Actualités pédagogiques et psychologiques, vol. 7. Delachaux et Nestlé: Neuchâtel.Google Scholar