The role of cognitive dysfunction in the symptoms and remission from depression

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Abstract

The disability and burden associated with major depression comes only in part from its affective symptoms; cognitive dysfunctions associated with depression also play a crucial role. Furthermore, these cognitive impairments during depression are manifold and multilevel affecting elementary and more complex cognitive processes equally. Several models from different directions tried to evaluate, conceptualize and understand the depth and magnitude of cognitive dysfunctions in depression and their bidirectional interactions with other types of depressive symptomatology including mood symptoms. In the current review, we briefly overview different types of cognitive symptoms and deficits related to major depression including hot and cold as well as trait- and state-like cognitive alterations and we also describe current knowledge related to the impact of cognitive impairments on the course and outcomes of depression including remission, residual symptoms, function, and response to treatment. We also emphasize shortcomings of currently available treatments for depression in sufficiently improving cognitive dysfunctions and point out the need for newer pharmacological approaches especially in cooperation with psychotherapeutic interventions.

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Most cited references 27

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A meta-analysis of cognitive deficits in first-episode Major Depressive Disorder.

Rico Lee, Daniel F. Hermens, Melanie A Porter … (2012)

Recurrent-episode Major Depressive Disorder (MDD) is associated with a number of neuropsychological deficits. To date, less is known about whether these are present in the first-episode. The current aim was to systematically evaluate the literature on first-episode MDD to determine whether cognition may be a feasible target for early identification and intervention. Electronic database searches were conducted to examine neuropsychological studies in adults (mean age greater than 18 years old) with a first-episode of MDD. Effect sizes were pooled by cognitive domain. Using meta-regression techniques, demographic and clinical factors potentially influencing heterogeneity of neuropsychological outcome were also investigated. The 15 independent samples reviewed yielded data for 644 patients with a mean age of 39.36 years (SD=10.21). Significant cognitive deficits were identified (small to medium effect sizes) for psychomotor speed, attention, visual learning and memory, and all aspects of executive functioning. Symptom remission, inpatient status, antidepressant use, age and educational attainment, each significantly contributed to heterogeneity in effect sizes in at least one cognitive domain. Reviewed studies were limited by small sample sizes and often did not report important demographic and clinical characteristics of patients. The current meta-analysis was the first to systematically demonstrate reduced neuropsychological functioning in first-episode MDD. Psychomotor speed and memory functioning were associated with clinical state, whereas attention and executive functioning were more likely trait-markers. Demographic factors were also associated with heterogeneity across studies. Overall, cognitive deficits appear to be feasible early markers and targets for early intervention in MDD. Copyright © 2011 Elsevier B.V. All rights reserved.

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Neurocognitive deficits and disability in major depressive disorder.

Judith Jaeger, Stefanie Berns, Sarah Uzelac … (2006)

Disability in life functioning is an important and poorly understood consequence of major depressive disorder (MDD). Mood symptoms do not account for the magnitude of disability resulting from MDD. Impairments in several domains of neurocognitive (NC) functioning have been shown to interfere with functionality in other psychiatric populations. These deficits, also present in MDD, may play a significant role in disability experienced by many with this disorder. The aim of this study was to examine the degree to which NC deficits, independent of affective and psychotic symptoms, explain functional outcome 6 months following hospitalization for a major depressive episode. Participants with an MDD diagnosis (N=48) received NC testing and symptom ratings while in the hospital. These procedures were repeated, along with functionality ratings, 6 months later. Six-month NC performance was strongly associated with functionality ratings after covariation for residual depression. Selected NC domains tested at baseline were predictive of functionality at 6 months. These data indicate that NC deficits, at least for some MDD sufferers, play an important role in functional recovery. New treatments, whether pharmacologic or rehabilitative, may be required to help affected patients accommodate neurocognitively based performance deficits at work, at home and in the community.

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Cognitive deficits in depression: possible implications for functional neuropathology.

G Goodwin, P. Austin, Peter Mitchell (2001)

While depression is known to involve a disturbance of mood, movement and cognition, its associated cognitive deficits are frequently viewed as simple epiphenomena of the disorder. To review the status of cognitive deficits in depression and their putative neurobiological underpinnings. Selective computerised review of the literature examining cognitive deficits in depression and their brain correlates. Recent studies report both mnemonic deficits and the presence of executive impairment--possibly selective for set-shifting tasks--in depression. Many studies suggest that these occur independent of age, depression severity and subtype, task 'difficulty', motivation and response bias: some persist upon clinical 'recovery'. Mnemonic and executive deficits do no appear to be epiphenomena of depressive disorder. A focus on the interactions between motivation, affect and cognitive function may allow greater understanding of the interplay between key aspects of the dorsal and ventral aspects of the prefrontal cortex in depression.

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Author and article information

Contributors

Xenia Gonda:

ORCID: http://orcid.org/0000-0001-9015-4203

kendermagos@yahoo.com

Maurizio Pompili: Maurizio.pompili@uniroma1.it

Gianluca Serafini: gianluca.serafini@unige.it

Andre F. Carvalho: andrefc7@terra.com.br

Zoltan Rihmer: rihmer.z@kronet.hu

Peter Dome: peter_dome@yahoo.co.uk

Journal

Journal ID (nlm-ta): Ann Gen Psychiatry

Journal ID (iso-abbrev): Ann Gen Psychiatry

Title: Annals of General Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1744-859X

Publication date (Electronic): 22 September 2015

Publication date PMC-release: 22 September 2015

Publication date Collection: 2015

Volume: 14

Electronic Location Identifier: 27

Affiliations

[ ]Department of Clinical and Theoretical Mental Health, Faculty of Medicine, Semmelweis University, Kutvolgyi ut 4., Budapest, 1125 Hungary

[ ]Laboratory for Suicide Research and Prevention, National Institute of Psychiatry and Addictions, Budapest, Hungary

[ ]MTA-SE Neuropsychopharmacology and Neurochemistry Research Group of Semmelweis Univeristy and the Hungarian Academy of Sciences, Budapest, Hungary

[ ]Department of Neurosciences, Mental Health and Sensory Organs Sant’Andrea Hospital Sapienza University of Roma, Rome, Italy

[ ]Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, IRCCS San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy

[ ]Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE Brazil

Author information

Xenia Gonda http://orcid.org/0000-0001-9015-4203

Article

Publisher ID: 68

DOI: 10.1186/s12991-015-0068-9

PMC ID: 4578787

PubMed ID: 26396586

SO-VID: 754257a7-9d11-45b6-bd64-a0d260d54c8d

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 September 2015

Date accepted : 14 September 2015

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: depression,cognitive dysfunction,hot and cold cognitions,functioning

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: depression, cognitive dysfunction, hot and cold cognitions, functioning

The role of cognitive dysfunction in the symptoms and remission from depression

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Most cited references 27

A meta-analysis of cognitive deficits in first-episode Major Depressive Disorder.

Neurocognitive deficits and disability in major depressive disorder.

Cognitive deficits in depression: possible implications for functional neuropathology.

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