Hostname: page-component-7d684dbfc8-4nnqn Total loading time: 0 Render date: 2023-09-28T16:54:43.672Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false
  • English
  • Français

Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed

Published online by Cambridge University Press:  09 July 2009

B. C. Beats ,
B. J. Sahakian  and
R. Levy
B. C. Beats
Affiliation:
Institute of Psychiatry, London; St Martin's Hospital, Canterbury; and Department of Psychiatry, University of Cambridge
B. J. Sahakian*
Affiliation:
Institute of Psychiatry, London; St Martin's Hospital, Canterbury; and Department of Psychiatry, University of Cambridge
R. Levy
Affiliation:
Institute of Psychiatry, London; St Martin's Hospital, Canterbury; and Department of Psychiatry, University of Cambridge
*
1Address for correspondence: Dr Barbara J. Sahakian, Department of Psychiatry., University of Cambridge, School of Clinical Medicine., Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ.
Get access Rights & Permissions [Opens in a new window]

Synopsis

The paper reports the profile of impairment across a variety of cognitive functions with special emphasis on tests sensitive to frontal lobe dysfunction, in 24 elderly depressed patients during and on recovery from mood disorder, compared with 15 age- and sex-matched controls. Traditional neuropsychological tests and a recently developed battery of computerized tests (CANTAB) were used. Impairments were found in the depressed group compared to controls and to themselves on recovery across all domains examined. The depressed group showed deficits on visuospatial recognition memory, attentional shifting at the extra-dimensional shift stage and in measures of both processing and motor speed without impaired accuracy in a visual search task. Impairments were also found on a planning task with disproportionately increased numbers of moves needed for more difficult problems and evidence of both slowed motor response and increased processing time once the task was commenced.

Performance on recovery improved across all tasks. Comparisons were made with the performance of patients suffering from dementia of the Alzheimer type (DAT) and Parkinson's disease on similar tests. Response latencies in test performance were found to correlate with the number of episodes of depression suffered and with ventricular size on CT scan, as measured by computerized planimetry. On recovery, residual depression scores correlated with latency of test performance and with ventricular brain ratio. The results, thus, show that depression in the elderly is associated with a significant degree of deficit on tests sensitive to frontostriatal dysfunction. Some of the deficits appear specific to depression and some do not remit following clinical recovery. However, these impairments have to be interpreted in the context of a broad profile of cognitive deficit.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 3 , May 1996 , pp. 591 - 603
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abas, M. A., Sahakian, B. J. & Levy, R. (1990). Neuropsychological deficits and CT scan changes in elderly depressives. Psychological Medicine 20, 507–520.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3 edn-revised). APA: Washington, DC.Google Scholar
Beats, B. C., Levy, R. & Forstl, H. F. (1991). Ventricular enlargement and caudate hyperdensity in elderly depressives. Biological Psychiatry 30, 452–458.CrossRefGoogle ScholarPubMed
Bench, C. J., Friston, K. J., Brown, R. G., Scott, I. C., Frackowiak, R. S. J. & Dolan, R. J. (1992). The anatomy of melancholia – focal abnormalities of cerebral blood flow in major depression. Psychological Medicine 22, 607–615.CrossRefGoogle ScholarPubMed
Bench, C. J., Friston, K. J., Brown, R. G., Frackowiak, R. S. J. & Dolan, R. J. (1993). Regional cerebral blood flow in depression measured by position emission tomography: the relationship with clinical dimensions. Psychological Medicine 23, 579–590.CrossRefGoogle Scholar
Brown, R. G. & Marsden, C. D. (1988). ‘Subcortical dementia’: the neuropsychological evidence. Neuroscience 25, 363–387.CrossRefGoogle ScholarPubMed
Carney, M. W. P., Roth, M. & Garside, R. F. (1965). The diagnosis of depressive syndromes and the production of ECT response. British Journal of Psychiatry 140, 659–674.CrossRefGoogle Scholar
Coffey, C. E., Figiel, G. S., Djang, W. T. & Weiner, R. D. (1990). Subcortical hyperintensity on magnetic resonance imaging: a comparison of normal and depressed elderly subjects. American Journal of Psychiatry 147, 187–189.Google ScholarPubMed
Copeland, J. R. M., Kelleher, M., Kellett, J. M., Gourlay, A. J., Gurland, B. J., Fleiss, J. L. & Sharpe, L. (1976). A semi-structured clinical interview for the assessment diagnosis and mental state in the elderly: the geriatric mental state schedule. Psychological Medicine 6, 439–459.CrossRefGoogle Scholar
Cummings, J. L. (1986). Subcortical dementia: neuropsychology, neuropsychiatry and pathophysiology. British Journal of Psychiatry 149, 682–697.CrossRefGoogle ScholarPubMed
Downes, J. J., Roberts, A. C., Sahakian, B. J., Evenden, J. L. & Robbins, T. W. (1989). Impaired extra-dimensional shift performance in medicated and unmedicated Parkinson's disease: evidence for a specific attentional deficit. Neuropsychologia 27, 1329–1343.CrossRefGoogle Scholar
Drevets, W. C., Videen, T. O., Price, J. L., Preskorn, S. H., Carmichael, S. T. & Raichle, M. E. (1992). A functional anatomical study of unipolar depression. Journal of Neuroscience 12, 3628–3641.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). ‘Mini-Mental state’, a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle Scholar
Kendrick, D. C. (1985). Kendrick Cognitive Tests for the Elderly. NFER-Nelson: Windsor.Google Scholar
Krishnan, K. R. R., Goli, V., Ellinwood, E. H., France, R. D., Blazer, D. G. & Nemeroff, C. B. (1988). Leukoencephalopathy in patients diagnosed as major depressive. Biological Psychiatry 23, 519–522.CrossRefGoogle ScholarPubMed
Milner, B. (1964). Some effects of frontal lobectomy in man. In The Frontal Granular Cortex and Behaviour (ed. Warren, J. M. and Akert, K.), pp. 313–331. McGraw-Hill: New York.Google Scholar
Milner, B. (1991). Interhemispheric differences in the localization of psychological processes in man. British Medical Bulletin 27, 272–277.CrossRefGoogle Scholar
Mishkin, M. (1982). A memory system in the monkey. Philosophical Transactions of the Royal Society of London 298, 85–95.CrossRefGoogle ScholarPubMed
Montgomery, S. A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Nelson, H. E.National Adult Reading Test Manual. NFER-Nelson: Windsor.Google Scholar
Nie, N. H., Hadlai Hull, C., Jenkins, J. G., Steinbrenner, K. & Bent, D. H. (1970). Statistical Package for the Social Sciences. McGraw-Hill: New York.Google Scholar
O'Brien, J. B., Sahakian, B. J. & Checkley, S. (1993). Cognitive impairments in patients with seasonal affective disorder. British Journal of Psychiatry 163, 338–343.CrossRefGoogle ScholarPubMed
Owen, A. M., Downes, J. J., Sahakian, B. J., Polkey, C. E. & Robbins, T. W. (1990). Planning and spatial working memory following frontal lobe lesions in man. Neuropsychologia 28, 1021–1034.CrossRefGoogle ScholarPubMed
Owen, A. M., Roberts, A. C., Polkey, C. E., Sahakian, B. J. & Robbins, T. W. (1991). Extra-dimensional versus intra-dimensional set shifting performance following frontal lobe excisions, temporal lobe excisions or amygdalo-hippocampectomy in man. Neuropsychologia 29, 993–1006.CrossRefGoogle ScholarPubMed
Owen, A. M., James, M., Leigh, P. N., Summers, B. A., Marsden, C. D., Quinn, N. P., Lange, K. W. & Robbins, T. W. (1992). Fronto-striatal cognitive deficits at different stages of Parkinson's disease. Brain 115, 1727–1751.CrossRefGoogle ScholarPubMed
Owen, A. M., James, M., Leigh, P. N., Summers, B. A., Marsden, C. D., Quinn, N. P., Sahakian, B. J. & Robbins, T. W. (1993). Visuospatial memory deficits at different stages of Parkinson's disease. Neuropsychologia 31, 627–644.CrossRefGoogle ScholarPubMed
Owen, A. M., Sahakian, B. J., Semple, J., Polkey, C. E. & Robbins, T. W. (1995). Visuospatial short term recognition memory and learning after temporal lobe excisions, frontal lobe excisions or amygdalo-hippocampectomy in man. Neuropsychologia 33, 1–24.CrossRefGoogle ScholarPubMed
Petrides, M. (1985). Deficits on conditional associative-learning tasks after frontal- and temporal-lobe lesions in man. Neuropsychologia 23, 601–614.CrossRefGoogle ScholarPubMed
Petrides, M. & Milner, B. (1982). Deficits on subject-ordered tasks after frontal- and temporal-lobe lesions in man. Neuropsychologia 20, 249–262.CrossRefGoogle ScholarPubMed
Robbins, T. W. (1977). A critique of the methods available for the measurement of spontaneous motor activity. In The Handbook of Psychopharmacology 7 (ed. Iversen, L. L., Iversen, S. D. and Snyder, S. H.), pp. 37–82. Plenum Press: New York.CrossRefGoogle Scholar
Robbins, T. W., James, M., Lange, K. W., Owen, A. M., Quinn, N. P. & Marsden, C. D. (1992 a). Cognitive performance in multiple system atrophy. Brain 115, 271–291.CrossRefGoogle ScholarPubMed
Robbins, T. W., Joyce, E. M. & Sahakian, B. J. (1992 b). Neuropsychology and neuroimaging of affective disorders. In The Handbook of Affective Disorders (ed. Paykel, E. S.), pp. 289–310. Churchill Livingstone: London.Google Scholar
Robbins, T. W., James, M., Owen, A. M., Lange, K. W., Lees, A. J., Leigh, P. N., Marsden, C. D., Quinn, N. P. & Summers, B. A. (1994 a). Cognitive deficits in progressive supranuclear palsy, Parkinson's disease, and multiple system atrophy in tests sensitive to frontal lobe dysfunction. Journal of Neurology, Neurosurgery and Psychiatry 57, 79–88.CrossRefGoogle ScholarPubMed
Robbins, T. W., James, M., Owen, A. M., Sahakian, B. J., MacInnes, L. & Rabbitt, P. (1994 b). Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 5, 266–281.Google ScholarPubMed
Sahakian, B. J., Morris, R. G., Evenden, J. L., Heald, A., Levy, R., Philpot, M. & Robbins, T. W. (1988). A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain 111, 695–718.CrossRefGoogle ScholarPubMed
Sahakian, B. J., Downes, J. J., Eagger, S., Evenden, J. L., Levy, R., Philpot, M. P., Roberts, A. C. & Robbins, T. W. (1990). Sparing of attentional relative to mnemonic function in a subgroup of patients with dementia of the Alzheimer type. Neuropsychologia 28, 1197–1123.CrossRefGoogle Scholar
Sahgal, A., Lloyd, S., Wray, C. J., Galloway, P. H., Robbins, T. W., Sahakian, B. J., McKeith, I. G., Cook, J. H., Disley, J. C. A. & Edwardson, J. A. (1992). Does visuospatial memory in senile dementia of the Alzheimer type depend on the severity of the disorder? International Journal of Geriatric Psychiatry 7, 427–436.CrossRefGoogle Scholar
Shallice, T. (1982). Specific impairments of planning. Philosophical Transactions of the Royal Society of London 298, 199–209.CrossRefGoogle ScholarPubMed
Spitzer, R., Endicott, J. & Robins, E. (1978). Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Treisman, A. M. & Gelade, G. A. (1982). A feature integration theory of attention. Cognitive Psychology 2, 97–136.Google Scholar
Watts, F. N., Macleod, A. K. & Morris, L. (1988). Associations between phenomenal and objective aspects of concentration problems in depressed patients. British Journal of Psychology 79, 241–250.CrossRefGoogle ScholarPubMed
Wechsler, D. (1955). Wechsler Adult Intelligence Scale Manual. Psychological Corporation: New York.Google Scholar
Whitehead, A. (1973). Verbal learning and memory in elderly depressives. British Journal of Psychiatry 123, 203–208.CrossRefGoogle ScholarPubMed
Winer, X. (1971). Statistical Principles in Experimental Design, 2nd edn.McGraw-Hill: New York.Google Scholar