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The nature and determinants of neuropsychological functioning in late-life depression.

Authors :
Butters MA
Whyte EM
Nebes RD
Begley AE
Dew MA
Mulsant BH
Zmuda MD
Bhalla R
Meltzer CC
Pollock BG
Reynolds CF 3rd
Becker JT
Source :
Archives of general psychiatry [Arch Gen Psychiatry] 2004 Jun; Vol. 61 (6), pp. 587-95.
Publication Year :
2004

Abstract

Context: Cognitive impairment in late-life depression (LLD) is highly prevalent, disabling, poorly understood, and likely related to long-term outcome.<br />Objectives: To determine the characteristics and determinants of neuropsychological functioning LLD.<br />Design: Cross-sectional study of groups of LLD patients and control subjects.<br />Setting: Outpatient, university-based depression research clinic.<br />Participants: One hundred patients without dementia 60 years and older who met DSM-IV criteria for current episode of unipolar major depression (nonpsychotic) and 40 nondepressed, age- and education-equated control subjects.<br />Main Outcome Measures: A comprehensive neuropsychological battery.<br />Results: Relative to control subjects, LLD patients performed poorer in all cognitive domains. More than half exhibited significant impairment (performance below the 10th percentile of the control group). Information processing speed and visuospatial and executive abilities were the most broadly and frequently impaired. The neuropsychological impairments were mediated almost entirely by slowed information processing (beta =.45-.80). Education (beta =.32) and ventricular atrophy (beta =.28) made additional modest contributions to variance in measures of language ability. Medical and vascular disease burden, apolipoprotein E genotype, and serum anticholinergicity did not contribute to variance in any cognitive domain.<br />Conclusions: Late-life depression is characterized by slowed information processing, which affects all realms of cognition. This supports the concept that frontostriatal dysfunction plays a key role in LLD. The putative role of some risk factors was validated (eg, advanced age, low education, depression severity), whereas others were not (eg, medical burden, age at onset of first depressive episode). Further studies of neuropsychological functioning in remitted LLD patients are needed to parse episode-related and persistent factors and to relate them to underlying neural dysfunction.

Details

Language :
English
ISSN :
0003-990X
Volume :
61
Issue :
6
Database :
MEDLINE
Journal :
Archives of general psychiatry
Publication Type :
Academic Journal
Accession number :
15184238
Full Text :
https://doi.org/10.1001/archpsyc.61.6.587