Role of Executive Dysfunction and Dysexecutive Behavior in Late-Life Depression and Disability

Abstract

Objective: Both executive dysfunction (ED), measured by performance-based tasks, and dysexecutive behavior (DB), measured by behavioral rating scales, contribute to late-life depression and comorbid disability. There is a modest positive association of ED and DB, but less is known about their relative contributions to core aspects of neuropsychiatric conditions and whether they provide unique or redundant information.

Methods: Latent variable analyses were applied to ED, DB, depression, and disability data from 220 older patients with major depression and ED who had been enrolled in a psychosocial treatment study of depression. ED measures included the Trail Making Test, part B, Stroop Color Word Interference Test, and Hopkins Verbal Learning Test-Trail 1. The ED scale from the Frontal Systems Behavior Scale, self and other-rated, served as the ratings-based measure of DB.

Results: The measurement model, with all four latent variables related to one another, demonstrated good fit (RMSEA=0.06). In the structural models, DB was associated with both depression (β=0.61) and disability (β=0.42), whereas ED was associated with depression (β=0.43) but not disability (β=0.16). Social problem-solving accounted for 49% of the influence of DB on late-life depression, whereas ED was not related to social problem-solving.

Conclusion: ED and the lesser studied DB measures offer unique and complementary information. DB was robustly associated with late-life depression and disability. Patients with depression and ED may be more likely to develop disability when they exhibit DB and social problem-solving difficulties.

Keywords: Late-life depression; dysexecutive behavior; executive function; neuropsychiatry; neuropsychology.

Figure One

Measurement model of Executive Dysfunction, Dysexecutive Behavior, Late-Life Depression, and Disability. ED- executive dysfunction: Trail Making Test B; Stroop Color Word Interference Condition; Hopkings Verbal Learning Test Trial 1 DB- dysexecutive behavior: Frontal Systems Behavior Scale- research assistant and patient rating of executive dysfunction LLD- late-life depression: Hamilton Rating Scale for Depression; Beck Depression Inventory, Neuroticism Extroversion and Openness Five Factor Inventory neuroticism subscale Disability: WHODAS-II getting around, getting along with others, work, understanding and communicating, self-care, life activities, participating socially