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Cognitive Functioning and Late-Life Depression

Published online by Cambridge University Press:  31 March 2014

Aaron M. Koenig
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Rishi K. Bhalla*
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
Meryl A. Butters
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Correspondence and reprint requests to: Rishi K. Bhalla, Room 570 Centennial Pavilion, 855 West 12th Avenue, Vancouver, BC V5Z 1M9. E-mail: rishi.bhalla@vch.ca

Abstract

This brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient’s symptoms. (JINS, 2014, 20, 1–7)

Type
Short Review
Copyright
Copyright © The International Neuropsychological Society 2014 

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References

Alexopoulos, G.S., Kiosses, D.N., Heo, M., Murphy, C.F., Shanmugham, B., & Gunning-Dixon, F. (2005). Executive dysfunction and the course of geriatric depression. Biological Psychiatry, 58(3), 204210. doi:10.1016/j.biopsych.2005.04.024CrossRefGoogle ScholarPubMed
Alexopoulos, G.S., Meyers, B.S., Young, R.C., Kalayam, B., Kakuma, T., Gabrielle, M., … Hull, J. (2000). Executive dysfunction and long-term outcomes of geriatric depression. Archives of General Psychiatry, 57(3), 285290.CrossRefGoogle ScholarPubMed
Alexopoulos, G.S., Raue, P.J., Kanellopoulos, D., Mackin, S., & Arean, P.A. (2008). Problem solving therapy for the depression-executive dysfunction syndrome of late life. International Journal of Geriatric Psychiatry, 23(8), 782788. doi:10.1002/gps.1988CrossRefGoogle ScholarPubMed
Arve, S., Tilvis, R.S., Lehtonen, A., Valvanne, J., & Sairanen, S. (1999). Coexistence of lowered mood and cognitive impairment of elderly people in five birth cohorts. Aging (Milano), 11(2), 9095.Google Scholar
Barch, D.M., D’Angelo, G., Pieper, C., Wilkins, C.H., Welsh-Bohmer, K., Taylor, W., … Sheline, Y.I. (2012). Cognitive improvement following treatment in late-life depression: Relationship to vascular risk and age of onset. American Journal of Geriatric Psychiatry, 20(8), 682690. doi:10.1097/JGP.0b013e318246b6cbCrossRefGoogle ScholarPubMed
Basso, M., Miller, A., Estevis, E., & Combs, D. (2013). Neuropsychological deficits in major depressive disorder: Correlates and conundrums. In P. Arnett (Ed.), Secondary influences on neuropsychological test performance (pp 4146). New York: Oxford University Press.Google Scholar
Baudic, S., Tzortzis, C., Barba, G.D., & Traykov, L. (2004). Executive deficits in elderly patients with major unipolar depression. Journal of Geriatric Psychiatry and Neurology, 17(4), 195201. doi:10.1177/0891988704269823CrossRefGoogle ScholarPubMed
Becker, J.T., Chang, Y.F., Lopez, O.L., Dew, M.A., Sweet, R.A., Barnes, D., … Reynolds, C.F. III. (2009). Depressed mood is not a risk factor for incident dementia in a community-based cohort. American Journal of Geriatric Psychiatry, 17(8), 653663.CrossRefGoogle ScholarPubMed
Beekman, A.T., Penninx, B.W., Deeg, D.J., de Beurs, E., Geerling, S.W., & van Tilburg, W. (2002). The impact of depression on the well-being, disability and use of services in older adults: A longitudinal perspective. American Journal of Geriatric Psychiatry, 17(4), 308316. doi:10.1097/JGP.0b013e318190b8d8Google Scholar
Bhalla, R.K., Butters, M.A., Mulsant, B.H., Begley, A.E., Zmuda, M.D., Schoderbek, B., … Becker, J.T. (2006). Persistence of neuropsychologic deficits in the remitted state of late-life depression. American Journal of Geriatric Psychiatry, 14(5), 419427. doi:10.1097/01.JGP.0000203130.45421.69CrossRefGoogle ScholarPubMed
Bhalla, R.K., Butters, M.A., Becker, J.T., Houck, P.R., Snitz, B.E., Lopez, O.L., … Reynolds, C.F. 3rd. (2009). Patterns of mild cognitive impairment after treatment of depression in the elderly. American Journal of Geriatric Psychiatry, 17(4), 308316.CrossRefGoogle ScholarPubMed
Blazer, D.G. (2003). Depression in late life: Review and commentary. The Journal of Gerontology Series A, 58(3), 249265.CrossRefGoogle ScholarPubMed
Bruce, M.L., Ten Have, T.R., Reynolds, C.F. III, Katz, I.I., Schulberg, H.C., Mulsant, B.H., … Alexopoulos, G.S. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A randomized controlled trial. Journal of the American Medical Association, 291(9), 10811091. doi:10.1001/jama.291.9.1081CrossRefGoogle ScholarPubMed
Butters, M.A., Becker, J.T., Nebes, R.D., Zmuda, M.D., Mulsant, B.H., Pollock, B.G., & Reynolds, C.F. III. (2000). Changes in cognitive functioning following treatment of late-life depression. The American Journal of Psychiatry, 157(12), 19491954.CrossRefGoogle ScholarPubMed
Butters, M.A., Whyte, E.M., Nebes, R.D., Begley, A.E., Dew, M.A., Mulsant, B.H., … Becker, J.T. (2004). The nature and determinants of neuropsychological functioning in late-life depression. Archives of General Psychiatry, 61(6), 587595. doi:10.1001/archpsyc.61.6.587CrossRefGoogle ScholarPubMed
Butters, M.A., Young, J.B., Lopez, O., Aizenstein, H.J., Mulsant, B.H., Reynolds, C.F. III, … Becker, J.T. (2008). Pathways linking late-life depression to persistent cognitive impairment and dementia. Dialogues in Clinical Neuroscience, 10(3), 345357.CrossRefGoogle ScholarPubMed
Byers, A.L., & Yaffe, K. (2011). Depression and risk of developing dementia. Nature Reviews Neurology, 7(6), 323331. doi:10.1038/nrneurol.2011.60CrossRefGoogle ScholarPubMed
Diniz, B.S., Butters, M.A., Albert, S.M., Dew, M.A., & Reynolds, C.F. III. (2013). Late-life depression and risk of vascular dementia and Alzheimer’s disease: Systematic review and meta-analysis of community-based cohort studies. British Journal of Psychiatry, 202(5), 329335. doi:10.1192/bjp.bp.112.118307CrossRefGoogle ScholarPubMed
Dong, H., & Csernansky, J.G. (2009). Effects of stress and stress hormones on amyloid-beta protein and plaque deposition. Journal of Alzheimer’s Disease, 18(2), 459469. doi:10.3233/JAD-2009-1152CrossRefGoogle ScholarPubMed
Doraiswamy, P.M., Krishnan, K.R., Oxman, T., Jenkyn, L.R., Coffey, D.J., Burt, T., & Clary, C.M. (2003). Does antidepressant therapy improve cognition in elderly depressed patients? The Journal of Gerontology Series A, 58(12), M1137M1144.CrossRefGoogle ScholarPubMed
Elderkin-Thompson, V., Kumar, A., Bilker, W.B., Dunkin, J.J., Mintz, J., Moberg, P.J., … Gur, R.E. (2003). Neuropsychological deficits among patients with late-onset minor and major depression. Archives of Clinical Neuropsychology, 18(5), 529549.CrossRefGoogle ScholarPubMed
Fava, G.A., Ruini, C., & Sonino, N. (2003). Treatment of recurrent depression: A sequential psychotherapeutic and psychopharmacological approach. CNS Drugs, 17(15), 11091117.CrossRefGoogle ScholarPubMed
Gallo, J.J., Rabins, P.V., Lyketsos, C.G., Tien, A.Y., & Anthony, J.C. (1997). Depression without sadness: Functional outcomes of nondysphoric depression in later life. Journal of the American Geriatrics Society, 45(5), 570578.CrossRefGoogle ScholarPubMed
Ganguli, M., Du, Y., Dodge, H.H., Ratcliff, G.G., & Chang, C.C. (2006). Depressive symptoms and cognitive decline in late life: A prospective epidemiological study. Archives of General Psychiatry, 63(2), 153160. doi:10.1001/archpsyc.63.2.153CrossRefGoogle ScholarPubMed
Geda, Y.E., Knopman, D.S., Mrazek, D.A., Jicha, G.A., Smith, G.E., Negash, S., … Rocca, W.A. (2006). Depression, apolipoprotein E genotype, and the incidence of mild cognitive impairment: A prospective cohort study. Archives of Neurology, 63(3), 435440. doi:10.1001/archneur.63.3.435CrossRefGoogle ScholarPubMed
Geerlings, M.I., den Heijer, T., Koudstaal, P.J., Hofman, A., & Breteler, M.M. (2008). History of depression, depressive symptoms, and medial temporal lobe atrophy and the risk of Alzheimer disease. Neurology, 70(15), 12581264. doi:10.1212/01.wnl.0000308937.30473.d1CrossRefGoogle ScholarPubMed
Godin, O., Dufouil, C., Ritchie, K., Dartigues, J.F., Tzourio, C., Peres, K., … Alperovitch, A. (2007). Depressive symptoms, major depressive episode and cognition in the elderly: The three-city study. Neuroepidemiology, 28(2), 101108. doi:10.1159/000101508CrossRefGoogle ScholarPubMed
Green, R.C., Cupples, L.A., Kurz, A., Auerbach, S., Go, R., Sadovnick, D., … Farrer, L. (2003). Depression as a risk factor for Alzheimer disease: The MIRAGE Study. Archives of Neurology, 60(5), 753759. doi:10.1001/archneur.60.5.753CrossRefGoogle ScholarPubMed
Hegeman, J.M., Kok, R.M., van der Mast, R.C., & Giltay, E.J. (2012). Phenomenology of depression in older compared with younger adults: Meta-analysis. British Journal of Psychiatry, 200(4), 275281. doi:10.1192/bjp.bp.111.095950CrossRefGoogle ScholarPubMed
Herrmann, L.L., Goodwin, G.M., & Ebmeier, K.P. (2007). The cognitive neuropsychology of depression in the elderly. Psychological Medicine, 37(12), 16931702. doi:10.1017/S0033291707001134CrossRefGoogle ScholarPubMed
Herrmann, L.L., Le Masurier, M., & Ebmeier, K.P. (2008). White matter hyperintensities in late life depression: A systematic review. Journal of Neurology, Neurosurgery, & Psychiatry, 79(6), 619624. doi:10.1136/jnnp.2007.124651CrossRefGoogle ScholarPubMed
Janssen, J., Hulshoff Pol, H.E., de Leeuw, F.E., Schnack, H.G., Lampe, I.K., Kok, R.M., … Heeren, T.J. (2007). Hippocampal volume and subcortical white matter lesions in late life depression: Comparison of early and late onset depression. Journal of Neurology, Neurosurgery, & Psychiatry 78(6), 638640. doi:10.1136/jnnp.2006.098087CrossRefGoogle ScholarPubMed
Jorm, A.F. (2001). History of depression as a risk factor for dementia: An updated review. Australian & New Zealand Journal of Psychiatry, 35(6), 776781.CrossRefGoogle ScholarPubMed
Kessing, L.V., & Andersen, P.K. (2004). Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder? Journal of Neurology, Neurosurgery, & Psychiatry, 75(12), 16621666. doi:10.1136/jnnp.2003.031773CrossRefGoogle ScholarPubMed
Krishnan, M.S., O’Brien, J.T., Firbank, M.J., Pantoni, L., Carlucci, G., Erkinjuntti, T., … Inzitari, D. (2006). Relationship between periventricular and deep white matter lesions and depressive symptoms in older people. The LADIS Study. International Journal of Geriatric Psychiatry, 21(10), 983989. doi:10.1002/gps.1596CrossRefGoogle ScholarPubMed
Lee, J.S., Potter, G.G., Wagner, H.R., Welsh-Bohmer, K.A., & Steffens, D.C. (2007). Persistent mild cognitive impairment in geriatric depression. International Psychogeriatrics, 19(1), 125135. doi:10.1017/S1041610206003607CrossRefGoogle ScholarPubMed
Lindsay, J., Laurin, D., Verreault, R., Hebert, R., Helliwell, B., Hill, G.B., & McDowell, I. (2002). Risk factors for Alzheimer’s disease: A prospective analysis from the Canadian Study of Health and Aging. American Journal of Epidemiology, 156(5), 445453.CrossRefGoogle ScholarPubMed
Lockwood, K.A., Alexopoulos, G.S., & van Gorp, W.G. (2002). Executive dysfunction in geriatric depression. American Journal of Psychiatry, 159(7), 11191126.CrossRefGoogle ScholarPubMed
Mendez, M.F., Underwood, K.L., Zander, B.A., Mastri, A.R., Sung, J.H., & Frey, W.H. Jr. (1992). Risk factors in Alzheimer’s disease: A clinicopathologic study. Neurology, 42(4), 770775.CrossRefGoogle ScholarPubMed
Murphy, C.F., & Alexopoulos, G.S. (2004). Longitudinal association of initiation/perseveration and severity of geriatric depression. American Journal of Geriatric Psychiatry, 12(1), 5056.CrossRefGoogle ScholarPubMed
Naismith, S.L., Norrie, L.M., Mowszowski, L., & Hickie, I.B. (2012). The neurobiology of depression in later-life: Clinical, neuropsychological, neuroimaging and pathophysiological features. Progress in Neurobiology, 98(1), 99143. doi:10.1016/j.pneurobio.2012.05.009CrossRefGoogle ScholarPubMed
Nebes, R.D., Butters, M.A., Mulsant, B.H., Pollock, B.G., Zmuda, M.D., Houck, P.R., & Reynolds, C.F. III. (2000). Decreased working memory and processing speed mediate cognitive impairment in geriatric depression. Psychological Medicine, 30(3), 679691.CrossRefGoogle ScholarPubMed
Nebes, R.D., Pollock, B.G., Houck, P.R., Butters, M.A., Mulsant, B.H., Zmuda, M.D., & Reynolds, C.F. III. (2003). Persistence of cognitive impairment in geriatric patients following antidepressant treatment: A randomized, double-blind clinical trial with nortriptyline and paroxetine. Journal of Psychiatric Research, 37(2), 99108.CrossRefGoogle ScholarPubMed
Ownby, R.L., Crocco, E., Acevedo, A., John, V., & Loewenstein, D. (2006). Depression and risk for Alzheimer disease: Systematic review, meta-analysis, and metaregression analysis. Archives of General Psychiatry, 63(5), 530538. doi:10.1001/archpsyc.63.5.530CrossRefGoogle ScholarPubMed
Palsson, S., Aevarsson, O., & Skoog, I. (1999). Depression, cerebral atrophy, cognitive performance and incidence of dementia. Population study of 85-year-olds. British Journal of Psychiatry, 174, 249253.CrossRefGoogle ScholarPubMed
Paradiso, S., Lamberty, G.J., Garvey, M.J., & Robinson, R.G. (1997). Cognitive impairment in the euthymic phase of chronic unipolar depression. Journal of Nervous and Mental Disease, 185(12), 748754.CrossRefGoogle ScholarPubMed
Rapp, M.A., Dahlman, K., Sano, M., Grossman, H.T., Haroutunian, V., & Gorman, J.M. (2005). Neuropsychological differences between late-onset and recurrent geriatric major depression. American Journal of Psychiatry, 162(4), 691698. doi:10.1176/appi.ajp.162.4.691CrossRefGoogle ScholarPubMed
Reynolds, C.F. III, Alexopoulos, G.S., Katz, I.R., & Lebowitz, B.D. (2001). Chronic depression in the elderly: Approaches for prevention. Drugs & Aging, 18(7), 507514.CrossRefGoogle ScholarPubMed
Reynolds, C.F. III, Butters, M.A., Lopez, O., Pollock, B.G., Dew, M.A., Mulsant, B.H., … DeKosky, S.T. (2011). Maintenance treatment of depression in old age: A randomized, double-blind, placebo-controlled evaluation of the efficacy and safety of donepezil combined with antidepressant pharmacotherapy. Archives of General Psychiatry, 68(1), 5160. doi:10.1001/archgenpsychiatry.2010.184CrossRefGoogle ScholarPubMed
Rosenberg, P.B., Mielke, M.M., Xue, Q.L., & Carlson, M.C. (2010). Depressive symptoms predict incident cognitive impairment in cognitive healthy older women. American Journal of Geriatric Psychiatry, 18(3), 204211. doi:10.1097/JGP.0b013e3181c53487CrossRefGoogle ScholarPubMed
Rothman, S.M., & Mattson, M.P. (2010). Adverse stress, hippocampal networks, and Alzheimer’s disease. NeuroMolecular Medicine, 12(1), 5670. doi:10.1007/s12017-009-8107-9CrossRefGoogle ScholarPubMed
Salloway, S., Malloy, P., Kohn, R., Gillard, E., Duffy, J., Rogg, J., … Westlake, R. (1996). MRI and neuropsychological differences in early- and late-life-onset geriatric depression. Neurology, 46(6), 15671574.CrossRefGoogle ScholarPubMed
Schneider, J.A., Arvanitakis, Z., Bang, W., & Bennett, D.A. (2007). Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology, 69(24), 21972204. doi:10.1212/01.wnl.0000271090.28148.24CrossRefGoogle ScholarPubMed
Sheline, Y.I., Barch, D.M., Garcia, K., Gersing, K., Pieper, C., Welsh-Bohmer, K., … Doraiswamy, P.M. (2006). Cognitive function in late life depression: Relationships to depression severity, cerebrovascular risk factors and processing speed. Biological Psychiatry, 60(1), 5865. doi:10.1016/j.biopsych.2005.09.019CrossRefGoogle ScholarPubMed
Sheline, Y.I., Gado, M.H., & Kraemer, H.C. (2003). Untreated depression and hippocampal volume loss. American Journal of Psychiatry, 160(8), 15161518.CrossRefGoogle ScholarPubMed
Speck, C.E., Kukull, W.A., Brenner, D.E., Bowen, J.D., McCormick, W.C., Teri, L., … Larson, E.B. (1995). History of depression as a risk factor for Alzheimer’s disease. Epidemiology, 6(4), 366369.CrossRefGoogle ScholarPubMed
Steffens, D.C., Fisher, G.G., Langa, K.M., Potter, G.G., & Plassman, B.L. (2009). Prevalence of depression among older Americans: The Aging, Demographics and Memory Study. International Psychogeriatrics, 21(5), 879888. doi:10.1017/S1041610209990044CrossRefGoogle ScholarPubMed
Steffens, D.C., Otey, E., Alexopoulos, G.S., Butters, M.A., Cuthbert, B., Ganguli, M., … Yesavage, J. (2006). Perspectives on depression, mild cognitive impairment, and cognitive decline. Archives of General Psychiatry, 63(2), 130138. doi:10.1001/archpsyc.63.2.130CrossRefGoogle ScholarPubMed
Steffens, D.C., Plassman, B.L., Helms, M.J., Welsh-Bohmer, K.A., Saunders, A.M., & Breitner, J.C. (1997). A twin study of late-onset depression and apolipoprotein E epsilon 4 as risk factors for Alzheimer’s disease. Biological Psychiatry, 41(8), 851856. doi:10.1016/S0006-3223(96)00247-8CrossRefGoogle ScholarPubMed
Sweet, R.A., Hamilton, R.L., Butters, M.A., Mulsant, B.H., Pollock, B.G., Lewis, D.A., … Reynolds, C.F. III. (2004). Neuropathologic correlates of late-onset major depression. Neuropsychopharmacology, 29(12), 22422250. doi:10.1038/sj.npp.1300554CrossRefGoogle ScholarPubMed
Taylor, W.D., Aizenstein, H.J., & Alexopoulos, G.S. (2013). The vascular depression hypothesis: Mechanisms linking vascular disease with depression. Molecular Psychiatry, 18(9), 963974. doi:10.1038/mp.2013.20CrossRefGoogle ScholarPubMed
Thomas, A.J., Kalaria, R.N., & O’Brien, J.T. (2004). Depression and vascular disease: What is the relationship? Journal of Affective Disorders, 79(1-3), 8195. doi:10.1016/S0165-0327(02)00349-XCrossRefGoogle ScholarPubMed
Vance, D., Larsen, K.I., Eagerton, G., & Wright, M.A. (2011). Comorbidities and cognitive functioning: Implications for nursing research and practice. Journal of Neuroscience in Nursing, 43(4), 215224. doi:10.1097/JNN.0b013e3182212a04CrossRefGoogle ScholarPubMed
Videbech, P., & Ravnkilde, B. (2004). Hippocampal volume and depression: A meta-analysis of MRI studies. American Journal of Psychiatry, 161(11), 19571966. doi:10.1176/appi.ajp.161.11.1957CrossRefGoogle ScholarPubMed
Wetherell, J.L., Gatz, M., Johansson, B., & Pedersen, N.L. (1999). History of depression and other psychiatric illness as risk factors for Alzheimer disease in a twin sample. Alzheimer Disease and Associated Disorders, 13(1), 4752.CrossRefGoogle Scholar
Wiese, B. (2011). Geriatric depression: The use of antidepressants in the elderly. British Columbia Medical Journal, 53(7), 341347.Google Scholar
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., & Leirer, V.O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 3749.CrossRefGoogle Scholar