Elsevier

Psychiatry Research

Volume 121, Issue 2, 1 December 2003, Pages 179-184
Psychiatry Research

Cognitive deficits are associated with functional impairment in severely depressed patients

https://doi.org/10.1016/j.psychres.2003.09.003Get rights and content

Abstract

Cognitive deficits have been associated with poorer function and quality of life (QOL) in schizophrenia, but no similar findings have been confirmed in persons with major depressive episode (MDE). We investigated whether cognitive deficits were associated with detrimental effects on the QOL of persons with primary MDE. Seventy-seven non-demented adults with MDE underwent evaluations of mood, cognition and QOL. Cognition was assessed with the Mini-Mental State Exam, and delayed recall on the Rey Auditory Verbal Learning Task and the Rey Figure. QOL assessments included instrumental activities of daily living (IADL), activities of daily living (ADL), and satisfaction in role functioning and relationships. Univariate correlation and regression models were used to find those mood and cognitive variables most closely related to each QOL dimension. ADL function and satisfaction with role functioning and relationships were most closely related to depression severity and age. IADL functioning, however, was most closely associated with global cognition. This study did not take into account the physical health of the participants, and all the participants were seriously ill with depression. Thus, the results may not apply to persons with less severe MDE. Antidepressant treatments that preserve or enhance global cognition in addition to relieving core depressive symptoms may lead to the best functional outcomes.

Introduction

Major depressive episode (MDE) is associated with poor quality of life (QOL) (Wells et al., 1989). Some authors have reported that the QOL deficits are related to physical illness in depressed patients (Alexopoulos et al., 1996), while others have not found this (Ormel et al., 1993, McCall et al., 1999). Surprisingly, there is no evidence whether problems in cognitive performance independently produce QOL deficits in patients with primary MDE. In contrast, secondary symptoms of depression and cognitive problems are independently associated with QOL deficits in patients with primary dementia (Pearson et al., 1989, Espiritu et al., 2001). Similarly, memory problems are related to QOL deficits in persons with schizophrenia (McDermid and Heinrichs, 2002). We conducted an exploratory analysis of whether cognitive performance was related to QOL in patients with severe depression who were about to receive electroconvulsive therapy (ECT).

Section snippets

Methods

Participants were 57.3±16.4 years old with MDE as defined by the Patient Version of the Structured Clinical Interview for Diagnosis (American Psychiatric Association, 1994) and provided informed written consent for this protocol approved by our local institutional review board. Persons with a diagnosis of dementia, schizophrenia or substance abuse were excluded from participation. All participants were inpatients who had been recruited as part of a study contrasting different ECT techniques,

Results

Seventy-seven persons aged 56.5±15.8 years (49 women and 28 men) were recruited, with a mean educational attainment of 12.7±3.5 years. Sixteen percent of the sample had psychotic symptoms. Mean HRSD and MMSE scores indicated high depression severity, but minimal cognitive problems (Table 1). The mean duration of the index MDE was 25.0±20.3 weeks. The number or prior MDE was 2.6±1.7. The age of onset of the first lifetime MDE was 37.9±17.6 years. Eighty-one percent of the sample was judged to be

Discussion

The primary novel finding of this study is that poorer global cognition is associated with poorer IADL functioning in severely depressed patients. Alexopoulos et al. also found that age, global cognition and IADL functioning scores were highly inter-correlated in their sample of depressed elderly, but in that study, age was retained while cognition was rejected in their multivariate prediction of IADL function (Alexopoulos et al., 1996). The differences between the findings of Alexopoulos et

Acknowledgements

The research reported was supported in part by NIMH awards MH01090 and MH61594.

References (20)

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