Cognitive Improvement Following Treatment in Late-Life Depression: Relationship to Vascular Risk and Age of Onset

Abstract

Objectives To test the hypothesis that the degree vascular burden and/or age of onset may influence the degree to which cognition can improve during the course of treatment in late life depression. Design Measurement of cognition both prior to and following 12-weeks of treatment with Sertraline. Setting University Medical Centers (Washington University and Duke University) Participants 166 individuals with late life depression. Intervention Sertraline treatment. Measurements The cognitive tasks were grouped into five domains (language, processing speed, working memory, episodic memory, and executive function). We measured vascular risk using the Framingham Stroke Risk Profile measure. We measured T2 based white matter hyperintensities using the Fazekas criteria. Results Both episodic memory and executive function demonstrated significant improvement among adults with late life depression during treatment with sertraline. Importantly, older age, higher vascular risk scores, and lower baseline Mini-Mental state exam scores predicted less change in working memory. Further, older age, later age of onset, and higher vascular risk scores predicted less change in executive function. Conclusions These results have important clinical implications, in that they suggest that a regular assessment of vascular risk in older adults with depression is necessary as a component of treatment planning and in predicting prognosis, both for the course of the depression itself and for the cognitive impairments that often accompany depression in later life.

Cerebrovascular involvement and clinical presentation of late-life depression, findings from the NESDO study

“…Clinical and research experience shows that the cerebrovascular group probably suffers from recurrent or chronic depression and is difficult to treat with limited therapeutic success (Barch et al, 2012;Ligthart et al, 2012;O'Brien, 2006;Sneed et al, 2007). Several research groups have, however, failed to identify vascular depressed persons in general or clinical populations (Naarding et al, 2007;Valkanova & Ebmeier, 2013).…”

“…Consequently, clinical management of vascular depression would be aimed not only at treating depressive symptoms, but also involve cardiovascular risk management. Indeed, recent research findings suggest that the outcome of current treatment protocols in 'vascular depressed' older people is insufficient and that vascular depression often shows a more chronic course (Barch et al, 2012;Hajjar et al, 2009;Paulson & Lichtenberg, 2012). Furthermore, it has been stated that vascular depression is prodromal to frailty and could eventually turn into vascular dementia (Brunnstr€ om, Passant, Englund, & Gustafson, L, 2013;Paulson & Lichtenberg, 2012).…”

Neuropsychological Functioning in the Acute and Remitted States of Late-Life Depression

“…The authors concluded that cognitive deficits in late-life depression persist over months to years, affect multiple domains, and are a manifestation of trait rather than state effects of depression. Barch and colleagues [20], on the other hand, examined individuals with late life depression both prior to and following treatment with sertraline, and found that episodic memory and executive function improved significantly following treatment, concluding that impairments in these domains may be associated with state effects of depression. However, they did not have a control group, so they were unable to definitely determine that the cognitive change reflected a response to treatment rather than practice effects.…”

“…In one study, 45% of individuals with LLD were cognitively impaired after one year of follow-up, and 94% of individuals with cognitive impairment at study baseline remained impaired one year later, despite reaching depression remission [13]. Others have similarly noted persistent cognitive impairment following treatment and/or remission of depressive symptoms [11,12,16,18,19], with certain risk factors, including lower baseline cognitive function, older age, later age of depression onset, and greater vascular burden associated with less improvement in specific cognitive domains [20]. Limitations of such studies, however, have included the confounding effects of practice (i.e., performance improvement resulting from repeated testing) and time (e.g., in a progressive disease such as Alzheimer's disease, the neuropathology may have progressed from the time that the patient was first tested, during the depressive episode, and the time that the patient was re-tested, after the episode resolved).…”

Anti-depression Medication Taking And Risk Of Metabolic Syndrome Among US Citizens Aged 60+ Years: An Across-sectional Analysis Of The NHANES 2007-2008

“…has been proposed to describe a subset of depressive disorders that occurs in old age as a consequence of cerebrovascular disease [5,22]. It has been estimated that approximately 3.4% or 2.64 million American adults 50-years and older might be considered having vascular depression [23] and treating late-life depression could improve cognitive function [24]. The change of white matter lesion volume is considered to have a causal association with vascular depression [25], but it seems more research is needed to explore the bi-directional relationship between depression and vascular disease [26].…”