Cognitive Function's Importance to Recovery in Depression

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Patients commonly report inter-episodic cognitive complaints during the “remitted” phases of depression that negatively affect their ability to engage in more cognitively demanding activities.
Patients commonly report inter-episodic cognitive complaints during the “remitted” phases of depression that negatively affect their ability to engage in more cognitively demanding activities.

Few studies have sought to understand the neurobiological mechanisms responsible for disrupting cognitive networks, even in the absence of depressed mood and/or anhedonic features; nor have they sought to evaluate the effect of treatments such as psychotropic medication, cognitive behavioral therapy, or cognitive remediation on cognitive function. This underscores the need for psychometric tests specifically developed to evaluate cognitive performance among individuals with depression; the absence of a “gold standard” psychometric of cognitive function in MDD highlights a research priority in mood disorders. 14

In those with MDD, measures of general cognitive function tend to be below average compared with age-matched healthy controls. However, variability between those with depression is also often observed, suggesting the presence of other mediating factors (eg, years of education, comorbid medical conditions that impact cognition, and treatment regimens).4, 15, 16 Evidence also indicates that subjective reports of cognitive complaints do not necessarily correlate with objectively measured cognitive performance. 4 That is, an individual's experience of cognitive decline from premorbid state often does not translate as clinically significant based on standard objective measures of cognitive function. 4 The opposite phenomenon has also been reported, wherein objective measures of cognition indicate clinically significant deficits, but patients report no noticeable change in subjective evaluations of their cognitive function. 4, 17  

 

Overall, the biological functions contributing to cognitive impairment, including neuroinflammation and metabolic disturbances, as well as the possibility of cognitive impairment eventually progressing to dementia, point to an urgent need to refine our understanding of the underlying causes behind cognitive impairment in MDD. Psychiatry needs to move towards preventing these debilitating and chronic disorders via disease modification, as opposed to focusing almost exclusively on mitigating symptoms.19

References

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2. Buist-Bouwman MA, Ormel J, de GR et al. Mediators of the association between depression and role functioning. Acta Psychiatr Scand. 2008;118(6):451-458.

3. Demeyer I, De LE, Koster EH, De RR. Rumination mediates the relationship between impaired cognitive control for emotional information and depressive symptoms: A prospective study in remitted depressed adults. Behav Res Ther. 2012;50(5):292-297.

4. Roger S.McIntyre, Danielle S.Cha, Joanna K.Soczynska. Cognition in Major Depressive Disorder. Oxford: Oxford University Press; 2014.

5. McIntyre RS, Cha DS, Soczynska JK et al. COGNITIVE DEFICITS AND FUNCTIONAL OUTCOMES IN MAJOR DEPRESSIVE DISORDER: DETERMINANTS, SUBSTRATES, AND TREATMENT INTERVENTIONS. Depress Anxiety. 2013.

6. Vanderhasselt MA, De RR, Dillon DG, Dutra SJ, Brooks N, Pizzagalli DA. Decreased cognitive control in response to negative information in patients with remitted depression: an event-related potential study. J Psychiatry Neurosci. 2012;37(4):250-258.

7. Sarapas C, Shankman SA, Harrow M, Goldberg JF. Parsing Trait and State Effects of Depression Severity on Neurocognition: Evidence From a 26-Year Longitudinal Study. J Abnorm Psychol. 2012.

8. Diener C, Kuehner C, Brusniak W, Ubl B, Wessa M, Flor H. A meta-analysis of neurofunctional imaging studies of emotion and cognition in major depression. Neuroimage. 2012;61(3):677-685.

9. Murphy FC, Michael A, Sahakian BJ. Emotion modulates cognitive flexibility in patients with major depression. Psychol Med. 2012;42(7):1373-1382.

10. Roiser JP, Sahakian BJ. Hot and cold cognition in depression. CNS Spectr. 2013;1-11.

11. Lu Q, Li H, Luo G et al. Impaired prefrontal-amygdala effective connectivity is responsible for the dysfunction of emotion process in major depressive disorder: a dynamic causal modeling study on MEG. Neurosci Lett. 2012;523(2):125-130.

12. Joormann J, Levens SM, Gotlib IH. Sticky thoughts: depression and rumination are associated with difficulties manipulating emotional material in working memory. Psychol Sci. 2011;22(8):979-983.

13. Schaefer A, Collette F, Philippot P et al. Neural correlates of "hot" and "cold" emotional processing: a multilevel approach to the functional anatomy of emotion. Neuroimage. 2003;18(4):938-949.

14. McIntyre RS, Lee Y. Cognition in major depressive disorder: a 'Systemically Important Functional Index' (SIFI). Curr Opin Psychiatry. 2016;29(1):48-55.

15. Cappa SF. Subjective cognitive complaints: not to be dismissed. Eur J Neurol. 2012;19(5):665.

16. Gorwood P, Corruble E, Falissard B, Goodwin GM. Toxic effects of depression on brain function: impairment of delayed recall and the cumulative length of depressive disorder in a large sample of depressed outpatients. Am J Psychiatry. 2008;165(6):731-739.

17. Cappa SF. Subjective cognitive complaints: not to be dismissed. Eur J Neurol. 2012;19(5):665.

18. Enache D, Winblad B, Aarsland D. Depression in dementia: epidemiology, mechanisms, and treatment. Curr Opin Psychiatry. 2011;24(6):461-472.

19. Cognitive Impairment in Major Depressive Disorder: Clinical Relevance, Biological Substrates, and Treatment Opportunities. Cambridge: Cambridge University Press; 2016.

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