Predictors of cognitive remediation therapy improvement in (partially) remitted unipolar depression

Listunova, Lena; Bartolovic, Marina; Kienzle, Johanna; Jaehn, Anna; Grützner, Thea Marianne; Weisbrod, Matthias; Roesch-Ely, Daniela

doi:10.1016/j.jad.2019.12.006

Cited by 11 publications

(20 citation statements)

References 47 publications

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“…None of the variables emerged as major predictors of change in either everyday EF or attention. The lack of factors associated with CR improvement is generally consistent with previous research on MDD (Motter et al, 2016;Listunova et al, 2020). Even though none of the illness-related factors emerged as major predictors, surprisingly, a reliable improvement in attention was associated at trend level with having experienced more than one previous depressive episode.…”

Section: Discussionsupporting

confidence: 86%

“…Even though none of the illness-related factors emerged as major predictors, surprisingly, a reliable improvement in attention was associated at trend level with having experienced more than one previous depressive episode. Recurrence of episodes arguably indicates greater illness severity and chronicity, previously associated with reduced CR effectiveness for both MDD (Listunova et al, 2020) and schizophrenia (Medalia and Richardson, 2005;Vita et al, 2013;Lindenmayer et al, 2017). This result thus diverges from a selection of previous findings.…”

Section: Discussioncontrasting

confidence: 62%

“…Excluding participants above the age of 60 years restricted the age range and reduced the sample variability of the present study, potentially limiting the prospect of obtaining significant results. Nonetheless, the overall available evidence does not indicate that age is a reliable predictor of CR outcomes (Reser et al, 2019;Listunova et al, 2020;Seccomandi et al, 2020). However, in accordance with previous research on MDD (Motter et al, 2016;Listunova et al, 2020), neither gender nor receiving concurrent treatments predicted improvements in cognition or everyday EF, with the latter indicating no additive effect on cognition of combining CR with antidepressant medication.…”

Section: Discussionsupporting

confidence: 49%

“…Additional variables, such as gender and receiving concurrent treatment (antidepressant medication or psychotherapy), did not significantly influence outcomes. In a recent study dedicated to identifying the predictors in a CR intervention consisting of both CCT and strategy learning, Listunova et al (2020) observed a shorter duration of illness to be the only factor associated with improvement on a neuropsychological measure of attention in a partially remitted MDD sample. Several sociodemographic, neurocognitive, psychopathological, and training-specific factors thus failed to predict outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Long-Term Improvement Following Cognitive Remediation in a Sample With Elevated Depressive Symptoms

et al. 2020

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Objective: Cognitive remediation (CR) techniques (interventions to enhance cognitive functioning) have proven moderately effective in improving cognition and daily functioning in major depressive disorder (MDD). However, baseline predictors of treatment response are lacking. The present study aimed to identify factors influencing long-term CR outcomes in a sample with current or previous, mild or moderate MDD and with self-reported cognitive deficits. Methods: Forty-two completers of group-based CR (strategy learning or drill-andpractice), were pooled into one sample. Based on change scores from baseline to 6-month follow-up, participants were categorized as "improvers" or "non-improvers" using reliable change index calculations. Measures included a questionnaire of everyday executive functioning and a neuropsychological test of attention. Finally, improvers and non-improvers were compared in terms of various sociodemographic, psychological, illness-related, and neuropsychological baseline variables. Results: Seventeen participants improved reliably in everyday executive functioning, and fourteen demonstrated a reliable improvement in attention. No statistically significant differences emerged between improvers and non-improvers. Conclusion: No major predictors of CR were identified. Importantly, the current findings are insufficient to guide clinical decision-making. Large-scale studies with a priori hypotheses are needed to make advances in the future.

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Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 62%

Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

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Predictors of Long-Term Improvement Following Cognitive Remediation in a Sample With Elevated Depressive Symptoms

et al. 2020

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“…Treatments specifically targeting cognitive functioning in de-pression have been hitherto insufficiently evaluated. Cognitive remediation has been found to improve attentional capacity in adults with depression, but its benefit across other domains of cognitive functioning awaits further documentation 106,107 . Aerobic exercise shows some promise in preserving and improving cognitive functions in adults with age-related cognitive decline, but its efficacy in improving cognition in adults with depression remains just a testable hypothesis 108 .…”

Section: Neurocognitionmentioning

confidence: 99%

The clinical characterization of the adult patient with depression aimed at personalization of management

et al. 2020

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Depression is widely acknowledged to be a heterogeneous entity, and the need to further characterize the individual patient who has received this diagnosis in order to personalize the management plan has been repeatedly emphasized. However, the research evidence that should guide this personalization is at present fragmentary, and the selection of treatment is usually based on the clinician's and/or the patient's preference and on safety issues, in a trial‐and‐error fashion, paying little attention to the particular features of the specific case. This may be one of the reasons why the majority of patients with a diagnosis of depression do not achieve remission with the first treatment they receive. The predominant pessimism about the actual feasibility of the personalization of treatment of depression in routine clinical practice has recently been tempered by some secondary analyses of databases from clinical trials, using approaches such as individual patient data meta‐analysis and machine learning, which indicate that some variables may indeed contribute to the identification of patients who are likely to respond differently to various antidepressant drugs or to antidepressant medication vs. specific psychotherapies. The need to develop decision support tools guiding the personalization of treatment of depression has been recently reaffirmed, and the point made that these tools should be developed through large observational studies using a comprehensive battery of self‐report and clinical measures. The present paper aims to describe systematically the salient domains that should be considered in this effort to personalize depression treatment. For each domain, the available research evidence is summarized, and the relevant assessment instruments are reviewed, with special attention to their suitability for use in routine clinical practice, also in view of their possible inclusion in the above‐mentioned comprehensive battery of measures. The main unmet needs that research should address in this area are emphasized. Where the available evidence allows providing the clinician with specific advice that can already be used today to make the management of depression more personalized, this advice is highlighted. Indeed, some sections of the paper, such as those on neurocognition and on physical comorbidities, indicate that the modern management of depression is becoming increasingly complex, with several components other than simply the choice of an antidepressant and/or a psychotherapy, some of which can already be reliably personalized.

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Abnormal Cerebellar Volume in Patients with Remitted Major Depression with Persistent Cognitive Deficits

et al. 2020

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Cerebellar involvement in major depressive disorder (MDD) has been demonstrated by a growing number of studies, but it is unknown whether cognitive functioning in depressed individuals is related to cerebellar gray matter volume (GMV) abnormalities. Impaired attention and executive dysfunction are characteristic cognitive deficits in MDD, and critically, they often persist despite remission of mood symptoms. In this study, we investigated cerebellar GMV in patients with remitted MDD (rMDD) that showed persistent cognitive impairment. We applied cerebellum-optimized voxel-based morphometry in 37 patients with rMDD and with cognitive deficits, in 12 patients with rMDD and without cognitive deficits, and in 36 healthy controls (HC). Compared with HC, rMDD patients with cognitive deficits had lower GMV in left area VIIA, crus II, and in vermal area VIIB. In patients with rMDD, regression analyses demonstrated significant associations between GMV reductions in both regions and impaired attention and executive dysfunction. Compared with HC, patients without cognitive deficits showed increased GMV in bilateral area VIIIB. This study supports cerebellar contributions to the cognitive dimension of MDD. The data also point towards cerebellar area VII as a potential target for non-invasive brain stimulation to treat cognitive deficits related to MDD.

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Predictors of cognitive remediation therapy improvement in (partially) remitted unipolar depression

Cited by 11 publications

References 47 publications

Predictors of Long-Term Improvement Following Cognitive Remediation in a Sample With Elevated Depressive Symptoms

Predictors of Long-Term Improvement Following Cognitive Remediation in a Sample With Elevated Depressive Symptoms

The clinical characterization of the adult patient with depression aimed at personalization of management

Abnormal Cerebellar Volume in Patients with Remitted Major Depression with Persistent Cognitive Deficits

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