Cognitive deficits are associated with functional impairment in severely depressed patients
Introduction
Major depressive episode (MDE) is associated with poor quality of life (QOL) (Wells et al., 1989). Some authors have reported that the QOL deficits are related to physical illness in depressed patients (Alexopoulos et al., 1996), while others have not found this (Ormel et al., 1993, McCall et al., 1999). Surprisingly, there is no evidence whether problems in cognitive performance independently produce QOL deficits in patients with primary MDE. In contrast, secondary symptoms of depression and cognitive problems are independently associated with QOL deficits in patients with primary dementia (Pearson et al., 1989, Espiritu et al., 2001). Similarly, memory problems are related to QOL deficits in persons with schizophrenia (McDermid and Heinrichs, 2002). We conducted an exploratory analysis of whether cognitive performance was related to QOL in patients with severe depression who were about to receive electroconvulsive therapy (ECT).
Section snippets
Methods
Participants were 57.3±16.4 years old with MDE as defined by the Patient Version of the Structured Clinical Interview for Diagnosis (American Psychiatric Association, 1994) and provided informed written consent for this protocol approved by our local institutional review board. Persons with a diagnosis of dementia, schizophrenia or substance abuse were excluded from participation. All participants were inpatients who had been recruited as part of a study contrasting different ECT techniques,
Results
Seventy-seven persons aged 56.5±15.8 years (49 women and 28 men) were recruited, with a mean educational attainment of 12.7±3.5 years. Sixteen percent of the sample had psychotic symptoms. Mean HRSD and MMSE scores indicated high depression severity, but minimal cognitive problems (Table 1). The mean duration of the index MDE was 25.0±20.3 weeks. The number or prior MDE was 2.6±1.7. The age of onset of the first lifetime MDE was 37.9±17.6 years. Eighty-one percent of the sample was judged to be
Discussion
The primary novel finding of this study is that poorer global cognition is associated with poorer IADL functioning in severely depressed patients. Alexopoulos et al. also found that age, global cognition and IADL functioning scores were highly inter-correlated in their sample of depressed elderly, but in that study, age was retained while cognition was rejected in their multivariate prediction of IADL function (Alexopoulos et al., 1996). The differences between the findings of Alexopoulos et
Acknowledgements
The research reported was supported in part by NIMH awards MH01090 and MH61594.
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