Neurocognitive abilities for a clinically depressed sample versus a matched control group of normal individuals

doi:10.1016/0165-1781(94)90011-6

Psychiatry Research

Volume 51, Issue 3, March 1994, Pages 231-244

https://doi.org/10.1016/0165-1781(94)90011-6 Get rights and content

Abstract

Depressed patients have been reported to show deficits in tasks that demand memory, planning/sequencing, speeded responding, and effortful responding. Many studies of depressed patients have used inadequate instrumentation or poor control groups. In this investigation, the cognitive performance of 44 patients diagnosed as clinically depressed was compared with the performance of a control group of normal individuals that closely matched the clinical group on the variables of age, gender, race or ethnic group, and educational attainment. The groups were compared on the tasks that compose the Kaufman Adolescent and Adult Intelligence Test (KAIT), which includes reliable and valid measures of most pertinent areas of purported deficit in depressed patients. Multivariate analyses of variance indicated that the depressed and control groups did not differ significantly on KAIT variables, but the depressed patients did differ significantly from the control group on the delayed versus immediate recall of verbal information.

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Citation Excerpt :
Furthermore, WM temporarily stores, maintains and activates information and is therefore essential to a variety of cognitive functions including reasoning, comprehension and learning. Expressions of WM deficits, like impairments in learning (Grossman et al., 1994; Porter et al., 2003; Zakzanis et al., 1998), attention (Moritz et al., 2001; Porter et al., 2003; Zakzanis et al., 1998), concentration (Zakzanis et al., 1998), decision-making (Murphy et al., 2001) and planning (Beats et al., 1996; Elliott et al., 1996; Moritz et al., 2001), frequently co-occur with symptoms of anxiety and depression. More specifically, anxiety and depression have been associated to deficits in the three different WM key processes; inhibition, updating and shifting of attention (Jonides et al., 2008; Miyake and Shah, 1999; Nee and Jonides, 2008).
Rumination is one of the hallmark characteristics of both anxiety disorders and depression, and has been linked to deficient executive functioning, particularly working memory (WM). Previous findings show that working memory capacity can be increased through training.
The current study explored whether an adaptive stand-alone WM training could increase WMC and consequently reduce rumination, anxiety and depression by means of a double-blind randomized controlled trial in a sample of 98 patients with symptoms of anxiety and/or depression.
No positive effect of training on WMC was found. In addition, the results show that a WM training was not associated with a reduction of rumination, depression, nor anxiety.
The high drop-out rate in both groups (20.11% from pre- to post-training) and the overrepresentation of men and use of anti-depressants in the placebo group might have influenced the results. Furthermore, expectations and perceptions about the training might have interacted with performance on WM tasks.
Overall, results show that a stand-alone WM training in patients with symptoms of anxiety and/or depression does not result in reduced rumination nor in reduced symptoms of depression and anxiety. We discuss potential explanations for these findings.
The relation of depression and anxiety to measures of attention in young adults seeking psychoeducational evaluation
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The relation between mood and attentional functioning in young adults seeking psychoeducational evaluation has not been previously reported. This study examined the relation of self-reported depression and anxiety on attentional abilities among 161 young adults referred for psychoeducational evaluation. Depression and anxiety were measured with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory, respectively. Attentional functioning was assessed using the Trail Making Test, the d2 Test of Attention, the Conners’ Continuous Performance Test, and the WAIS-III Working Memory and Processing Speed Indices. The unique variance accounted for by depression or anxiety was minimal (typically <1.5%); these null results were confirmed by diagnostic subgroup analyses and also after examining the interaction between depression and anxiety. These results suggest that performance on measures of attention within samples of young adults seeking psychoeducational evaluation is minimally related to self-reported depression and anxiety.
Pattern of impaired working memory during major depression
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Citation Excerpt :
In order to determine the contribution of cognitive dysfunction to the presentation, experience, and treatment of MDD, it is imperative to consider: (1) evidence of specific cognitive dysfunctions in MDD; (2) if the profile of cognitive deficit observed in MDD is attributable to a common factor or mechanism; and (3) factors that may contribute to the presence/absence of cognitive dysfunction in depressed adults. Depression-associated deficits have been noted in psychomotor function (i.e. the collective mental processes leading to motor output; see Veiel, 1997 for a review), effortful information processing (see Hartlage et al., 1993 for review), information processing speed (Austin et al., 1999; Beats et al., 1996; Tsourtos et al., 2002), explicit long-term memory (Bazin et al., 1994; Cassens et al., 1990; Denny and Hunt, 1992; Ilsley et al., 1995; MacQueen et al., 2002), short-term memory (Austin et al., 1992; Austin et al., 1999; Beats et al., 1996; Brand et al., 1992; Brown et al., 1994; Elliott et al., 1996; Kessing, 1998; Moritz et al., 2001; Porter et al., 2003; Ravnkilde et al., 2002), and executive function, including: attention (Grossman et al., 1993; Miller et al., 1991; Moritz et al., 2002; Porter et al., 2003; Purcell et al., 1997; Ravnkilde et al., 2002; Trichard et al., 1995); decision-making (Murphy et al., 2001) and planning (Beats et al., 1996; Elliott et al., 1996; Porter et al., 2003). It would, therefore, appear that there is a reliable deficit in cognitive function in adults with MDD.
The aim of this study was to assess working memory (WM) in patients with major depressive disorder (MDD), using a robust parametric WM task (the n-back task).
Twenty patients with MDD and twenty healthy controls completed a visual version of the paradigm, comprising four levels of task difficulty (i.e. 0-, 1-, 2-, and 3-back). Performance accuracy and reaction time (RT) were measured at each difficulty level.
In comparison with controls, patients with MDD exhibited slower RTs (F_(1,38) = 25.16, p < 0.001), and reduced accuracy (F_(1,38) = 5.93, p < 0.001). There was no diagnosis-specific effect of task difficulty on performance accuracy. However, the faster response to memory (1–3-back) than to shadowing (0-back) tasks observed in controls was not as pronounced in patients.
These observations support a relatively specific impairment of WM/central executive function in MDD, which may potentially mediate the diverse pattern of cognitive dysfunction noted in MDD. The parametric n-back task is applicable to subjects with MDD and yields results interpretable across the dimensions of task difficulty and performance in controls and patients.
Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests
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This study examined the effect of depression on neurocognitive performance in patients who passed symptom validity testing. The Beck Depression Inventory (BDI) was used to assess depression in 420 patients with heterogeneous referral diagnoses (more than half of these cases were head injury or neurological disease). All patients had demonstrated satisfactory effort by passing two symptom validity tests. No differences were found on objective cognitive and psychomotor measures in groups sorted based on their self-reported depression. In contrast, on the self-report measures [i.e., Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Symptom Checklist-90-Revised (SCL-90-R), and Memory Complaints Inventory (MCI)], differences were found indicating that patients with depression report more emotional, somatic, and cognitive problems. Contrary to expectation, these data suggest that depression has no impact on objective neurocognitive functioning.
Visuoconstructional drawing ability in the differential diagnosis of neurologic compromise versus depression
1999, Archives of Clinical Neuropsychology
Neuropsychologists are often called upon to assist in making differential diagnoses between neurologic compromise and depression. However, the literature has been inconsistent about the impact of depression on neurocognitive functioning. This makes interpretation of neuropsychological test data among depressed individuals difficult. In a retrospective cross-sectional study of 200 patients, the relationship between depression (Beck Depression Inventory or Geriatric Depression Scale) and visuoconstructional drawing ability/praxis (Rey-Osterrieth Copy [RO]) was evaluated. Age and education both correlated significantly with RO performance (p < .001 and .005, respectively). There were no significant relationships found between copy performance and depression, even when controlling for the significant effects of age and education. A prospective longitudinal study of 20 psychiatric inpatients with depression tested on admission and again at discharge matched with 20 nondepressed normal controls yielded similar results in that the two groups did not differ in their initial RO performance. Moreover, an improvement in depression as measured by a decrease in Beck Depression Inventory scores did not coincide with any improvement in RO scores. By comparison, a matched positive control group of 20 neurologically compromised patients was significantly worse than both the normal control and the depressed groups on the RO (p < .05). These data suggest that poor performance on the RO should not be interpreted simply as a consequence of depression. Age and education, though, should be considered when interpreting the RO.
Prevalence of WAIS-R prototypal groups in neuropsychiatric participants
1996, Archives of Clinical Neuropsychology
Using the standardization sample for the WAIS-R, McDermott Glutting, Jones, and Noonan (1989) reported that patterns of intellectual functioning can be categorized into nine prototypal groups. We determined the prevalence of these prototypal patterns in a large sample of neuropsychiatric participants. The vast majority (93.4%) of participants were classifiable into a prototypal group, despite strong differences between the neuropsychiatric and standardization samples with respect to age, gender, occupational status, and education. Neuropsychiatric participants were much more likely to have prototypal patterns associated with low intellectual functioning than were participants in the standardization sample. We conclude that neuropsychiatric morbidity is associated with patterns of low intellectual functioning that are prototypal but that occur at rates much higher than those found in the standardization sample.

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Neurocognitive abilities for a clinically depressed sample versus a matched control group of normal individuals

Abstract

Review of Luria-Nebraska Neuropsychological Battery

DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders

The intelligence test in personality assessment

Neurocognition in acute and chronic depression: Personality disorder, major depression, and schizophrenia

Biological Psychiatry

The neuropsychology of depression

Journal of Neuropsychiatry

Estimation of premorbid intellectual status in depression

British Journal of Clinical Psychology

Minimal effects of severe depression on cognitive functioning

Journal of Abnormal and Social Psychology

Multiple comparison of means

American Educational Research Journal

Cognitive dysfunction and imipramine in outpatient depressives

Archives of General Psychiatry

The Luria-Nebraska Children's Battery: Theory and formulation

Cognitive impairments in depression

Journal of Affective Disorders

Impairments on neuropsychologic tests of temporohippocampal and frontohippocampal functions and word fluency in remitting schizophrenia and affective disorders

Archives of General Psychiatry

Influence of affective states and psychoactive drugs on verbal learning and memory

American Journal of Psychiatry

Cognitive diversity: A framework of learning

Refinement and test of the theory of fluid and crystallized intelligence

Journal of Educational Psychology

Age differences in fluid and crystallized intelligence

Acta Psychologica

On the myth of intellectual decline in adulthood

American Psychologist

Neuropsychological assessment

The Boston Process Approach and the WAIS-R as a neuropsychological instrument

Assessing Adolescent and Adult Intelligence