Depression Forecasts Cognitive Problems in Geriatric Patients

Emily Burns, MD (APA)

Late life depression (LLD) is a common condition for older adults in the US and might help predict the risk of cognitive impairment.

A team, led by Emily Burns, BS, University of California, San Francisco, examined whether anxiety and depression help forecast self-reported cognitive complaints rather than objective cognition with a poor agreement between self and study partner ratings.

The data was presented as a poster at the American Psychiatric Association Virtual Meeting.

The Problem

Late life depression currently affects approximately 8-16% of the population and is a known risk factor for dementia. An estimate 25-60% of individuals with late life depression present with significant cognitive impairment and can report greater subjective cognitive complaints compared to older adults without depression.

Subjective cognitive complaints are often a function of depressive symptoms and anxiety, as opposed to objective cognition in geriatric adults.

However, this remains understudied in how it relates to late life depression.

Some studies have contrastingly shown that study partner ratings of participant cognition are linked to objective cognition in non-depressed patient samples.

However, the impact of participant clinical status, stress, social support, gender, and race are not clarified in late life depression.

The Analysis

In the study, the investigators examined 64 community dwelling older adults with late life depression and their study partners.

The team determined a diagnosis of depression using Structured Clinical Interview for Diagnosis (SCID) of DSM-IV Axis I Disorders and depression severity (17-item Hamilton Depression Rating Scale; HDRS-17 >= 15).

The researchers also measured subjective cognition with Everyday Cognition Scale Self (Self-ECog) and Informant (SP-ECog) versions and measured anxiety (Generalized Anxiety Disorder Assessment-7; GAD), stress (Perceived Stress Scale; PSS), and social support (Duke Social Support Index; DSSI), and a comprehensive neurocognitive battery assessing executive functioning, visual perception, verbal and visual learning and memory, language, working memory, and information processing speed.

In addition, if a score was 1 standard deviation below published normative data for each cognitive test, that represented cognitive impairment and the sum of impaired tests across all domains represented overall cognition.

Results

Overall, 44% of the patient population showed impairment across 1 or more cognitive test and 41% showed subjective cognitive impairment (ECog >= 1.81), as well as 23% of study partners.

The researchers found higher GAD (ß = .39, t = 4.03, p = 0.00) and higher HDRS-17 (ß = .24, t = 2.40, p = 0.02), which was significantly associated with higher Self-ECog scores.

“Anxiety and depression predicted subjective cognitive concerns in participants with LLD. Participant race, gender, stress and social support predicted study partner ratings of participant cognition,” the authors wrote. “Objective cognition was not a significant determinant for participant or study partner ratings. The divergence between Self and SP-ECog predictors underscore LLD’s impact on accurately interpreting cognitive concerns and the need for further research.”

The study, “Differential Predictors of Self and Informant-Assessed Subjective Cognition in Late Life Depression,” was published online by the American Psychiatric Association.