Longitudinal Cognitive Outcomes of Clinical Phenotypes of Late-Life Depression

Abstract

Objective: Late-life depression is associated with cognitive deficits and increased risk for cognitive decline. The purpose of the study was to determine whether clinical characteristics could serve as phenotypes informative of subsequent cognitive decline. Age at depression onset and antidepressant remission at 3 months (acute response) and 12 months (chronic response) were examined.

Methods: In a longitudinal study of late-life depression in an academic center, 273 depressed and 164 never-depressed community-dwelling elders aged 60 years or older were followed on average for over 5 years. Participants completed annual neuropsychological testing. Neuropsychological measures were converted to z-scores derived from the baseline performance of all participants. Cognitive domain scores at each time were then created by averaging z-scores across tests, grouped into domains of episodic memory, attention-working memory, verbal fluency, and executive function.

Results: Depressed participants exhibited poorer performance at baseline and greater subsequent decline in all domains. Early-onset depressed individuals exhibited a greater decline in all domains than late-onset or nondepressed groups. For remission, remitters and nonremitters at both 3 and 12 month exhibited greater decline in episodic memory and attention-working memory than nondepressed subjects. Three-month remitters also exhibited a greater decline in verbal fluency and executive function, whereas 12-month nonremitters exhibited greater decline in executive function than other groups.

Conclusion: Consistent with past studies, depressed elders exhibit greater cognitive decline than nondepressed subjects, particularly individuals with early depression onset, supporting the theory that repeated depressive episodes may contribute to decline. Clinical remission is not associated with less cognitive decline.

Keywords: Depression; cognition; executive function; longitudinal; memory; onset; remission; response.

Figure 1

Group differences in annual change in neuropsychological domain z-scores Figures compare annual change in z-scored neuropsychological domain performance by group, controlling for age, sex, race, and education level. Statistically significant group differences are indicated with a black horizontal bar covering the vertical group bars. Statistical results are presented in the text and in Tables 2–4. Abbreviations: D = Depressed; ND = Nondepressed; E = Early onset depression; L = Late onset depression; R = Remitted; NR = Nonremitted