Psychological Medicine

Review Article

Cognitive impairment in euthymic major depressive disorder: a meta-analysis

E. Boraa1 c1, B. J. Harrisona1, M. Yücela1a2 and C. Pantelisa1

a1 Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia

a2 Orygen Youth Health Research Centre, The University of Melbourne, VIC, Australia


Background There is evidence to suggest that cognitive deficits might persist beyond the acute stages of illness in major depressive disorder (MDD). However, the findings are somewhat inconsistent across the individual studies conducted to date. Our aim was to conduct a systematic review and meta-analysis of existing studies that have examined cognition in euthymic MDD patients.

Method Following a systematic search across several publication databases, meta-analyses were conducted for 27 empirical studies that compared euthymic adult MDD patients (895 participants) and healthy controls (997 participants) across a range of cognitive domains. The influence of demographic variables and confounding factors, including age of onset and recurrent episodes, was examined.

Results Compared with healthy controls, euthymic MDD patients were characterized by significantly poorer cognitive functions. However, the magnitude of observed deficits, with the exception of inhibitory control, were generally modest when late-onset cases were excuded. Late-onset cases demonstrated significantly more pronounced deficits in verbal memory, speed of information processing and some executive functions.

Conclusions Cognitive deficits, especially poor response inhibition, are likely to be persistent features, at least of some forms, of adult-onset MDD. More studies are necessary to examine cognitive dysfunction in remitted psychotic, melancholic and bipolar spectrum MDD. Cognitive deficits overall appear to be more common among patients with late-onset depression, supporting the theories suggesting that possible vascular and neurodegenerative factors play a role in a substantial number of these patients.

(Received June 03 2012)

(Revised July 31 2012)

(Accepted August 06 2012)

(Online publication October 26 2012)

Key words

  • Cognition;
  • late onset;
  • major depression;
  • memory;
  • neuropsychology


c1 Address for correspondence: Dr E. Bora, Melbourne Neuropsychiatry Centre, Alan Gilbert Building NNF level 3, 161 Barry Street, Carlton South, VIC 3053, Australia. (Email: