Psychological Medicine

Original Articles

The pattern and course of cognitive impairment in late-life depression

S. Köhlera1a2, A. J. Thomasa1, N. A. Barnetta1 and J. T. O'Briena1 c1

a1 Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK

a2 Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, SEARCH, EURON, Maastricht University, The Netherlands

Abstract

Background Cognitive deficits persist despite clinical recovery in subjects with late-life depression, but more needs to be known about their longer-term outcome and factors affecting their course. To investigate this, we followed the pattern of cognitive impairments over time and examined the effects of current mood, remission status, age of depression onset and antidepressant (AD) treatment on these deficits.

Method Sixty-seven subjects aged 60 years with DSM-IV major depressive disorder and 36 healthy comparison subjects underwent tests of global cognition, memory, executive functioning and processing speed at baseline, 6 and 18 months, with some subjects tested again after 4 years. z scores were compared between groups, with analyses of clinical factors that may have influenced cognitive performance in depressed subjects.

Results Half of the patients exhibited a generalized cognitive impairment (GCI) that persisted after 18 months. Patients performed worse across all cognitive domains at all time points, without substantial variability due to current mood, remission status or AD treatment. Late age of onset was associated significantly with decline in memory and executive functioning. Impaired processing speed may be a partial mediator of some deficits, but was insufficient to explain differences between patients and controls. Four-year follow-up data suggest impairments persist, but do not further decline.

Conclusions Cognitive deficits in late-life depression persist up to 4 years, affect multiple domains and are related to trait rather than state effects. Differences in severity and course between early and late onset depression suggest different pathogenic processes.

(Received January 29 2009)

(Revised May 26 2009)

(Accepted June 05 2009)

(Online publication August 06 2009)

Correspondence

c1 Address for correspondence: Professor J. T. O'Brien, Professor of Old Age Psychiatry, Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK. (Email: j.t.o'brien@ncl.ac.uk)

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