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Cognitive deficits in depression: Possible implications for functional neuropathology

  • Marie-Paule Austin (a1), Philip Mitchell (a2) and Guy M. Goodwin (a3)
Abstract
Background

While depression is known to involve a disturbance of mood, movement and cognition, its associated cognitive deficits are frequently viewed as simple epiphenomena of the disorder.

Aims

To review the status of cognitive deficits in depression and their putative neurobiological underpinnings.

Method

Selective computerised review of the literature examining cognitive deficits in depression and their brain correlates.

Results

Recent studies report both mnemonic deficits and the presence of executive impairment – possibly selective for set-shifting tasks – in depression. Many studies suggest that these occur independent of age, depression severity and subtype, task ‘difficulty’, motivation and response bias: some persist upon clinical ‘recovery’.

Conclusions

M nemonic and executive deficits do not appear to be epiphenomena of depressive disorder. A focus on the interactions between motivation, affect and cognitive function may allow greater understanding of the interplay between key aspects of the dorsal and ventral aspects of the prefrontal cortex in depression.

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Copyright
Corresponding author
Dr Marie-Paule Austin, Department of Liaison Psychiatry, Prince of Wales Hospital, Randwick 2031, Australia. Tel: +61 2 93822796; fax: +61 293822177; e-mail: m.austin@unsw.edu.au
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Declaration of interest

This paper was supported by an Australian National Health and Medical Research Council Program Grant (993208).

Footnotes
References
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Abas, M. A., Sahakian, B. J. & Levy, R. (1990) Neuropsychological deficits and CT scan changes in elderly depressives. Psychological Medicine, 20, 507520.
Alexander, G. E., De Long, M. R. & Strick, P. L. (1986) Parallel organisation of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience, 9, 357381.
Alexander, G. E., Crutcher, M. D. & De Long, M. R. (1990) Basal ganglia–thalamocortical circuits: parallel substrates for motor, oculomotor, ‘prefrontal’ and ‘limbic’ functions. Progress in Brain Research, 85, 119146.
Alexopoulos, G. S., Meyers, B. S., Young, R. C., et al (1993) The course of geriatric depression with “reversible dementia”: a controlled study. American Journal of Psychiatry, 150, 16931699.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.
Austin, M-P. & Mitchell, P. (1995) The anatomy of melancholia: does fronto-subcortical pathophysiology underpin its psychomotor and cognitive manifestations? Psychological Medicine, 25, 665672.
Austin, M-P., Ross, M., Murray, C., et al (1992a) Cognitive function in major depression. Journal of Affective Disorders, 25, 2130.
Austin, M-P., Dougall, N., Ross, M., et al (1992b) Single photon emission tomography with 99mTc-exametazime in major depression and the pattern of brain activity underlying the psychotic/neurotic continuum. Journal of Affective Disorders, 26, 3144.
Austin, M-P., Mitchell, P., Wilhelm, K., et al (1999) Melancholic depression: a pattern of frontal cognitive impairment. Psychological Medicine, 29, 7385.
Bazin, N., Perruchet, P., De Bonis, R., et al (1994) The dissociation of explicit and implicit memory in depressed patients. Psychological Medicine, 24, 239245.
Beats, B. C., Sahakian, B. J. & Levy, R. (1996) Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed. Psychological Medicine, 26, 591603.
Bechara, A., Tranel, D., Damasio, H., et al (1996) Failure to respond autonomically to anticipated future outcomes following damage to prefrontal cortex. Cerebral Cortex, 6, 215225.
Beck, A. T. (1963) Thinking and depression. Archives of General Psychiatry, 9, 324333.
Bench, C. J., Frith, C. D., Grasby, E., et al (1993) Investigations of the functional anatomy of attention using the Stroop Test. Neuropsychologia, 31, 907922.
Brown, F. W., Lewine, R. J., Hudgins, P. A., et al (1992) White matter hyperintensity signals in psychiatric and non-psychiatric subjects. American Journal of Psychiatry, 149, 620625.
Brown, R. G., Scott, L. C., Bench, C. J., et al (1994) Cognitive function in depression: its relationship to the presence and severity of intellectual decline. Psychological Medicine, 24, 829847.
Byrne, D. G. (1977) Choice reaction times in depressive states. British Journal of Social and Clinical Psychology, 15, 149156.
Caine, E. D. (1986) The neuropsychology of depression: the pseudomentia syndrome. In The Assessment of Neuropsychiatric Disorders (eds I. Grant & K. M. Admas). Oxford: Oxford University Press.
Calev, A., Korin, Y., Shapira, B., et al (1986) Verbal and non-verbal recall by depressed and euthymic affective patients. Psychological Medicine, 16, 789794.
Carney, M. W. P., Roth, M. & Garside, R. F. (1965) The diagnosis of depressive syndromes and the prediction of E.C.T. response. British Journal of Psychiatry, 111, 659674.
Channon, S. (1996) Executive dysfunction in depression: the Wisconsin Card Sorting Test. Journal of Affective Disorders, 39, 107114.
Channon, S. & Green, P. S. (1999) Executive function in depression: the role of performance strategies in aiding depressed and non-depressed participants. Journal of Neurology, Neurosurgery and Psychiatry, 66, 162171.
Channon, S., Baker, J. E. & Robertson, M. M. (1993) Working memory in clinical depression: an experimental study. Psychological Medicine, 23, 8791.
Cohen, R., Weingartner, H., Smallberg, S., et al (1982) Effort and cognition in depression. Archives of General Psychiatry, 39, 593598.
Cornell, D. G., Saurez, R. & Berent, S. (1984) Psychomotor retardation in melancholic and non-melancholic depression: cognitive and motor components. Journal of Abnormal Psychology, 932, 150157.
Courtney, S. M., Ungerleider, L. G., Kell, K., et al (1997) Transient and sustained activity in a distributed neural system for human working memory. Nature, 386, 608611.
Cummings, J. L. (1993) Frontal-subcortical circuits and human behavior. Archives of Neurology, 50, 873880.
Damasio, A. R. (1994) Descartes' Error: Emotion, Reason and the Human Brain. New York: Grosset/Putnam.
Danion, J. M., Kauffmann-Muller, F., Grange, D., et al (1995) Affective valence of words, explicit and implicit memory in clinical depression. Journal of Affective Disorders, 34, 227234.
Dehaene, S. & Changeux, J.-P. (1991) The Wisconsin Card Sorting Test: theoretical analysis and modeling in a neuronal network. Cerebral Cortex, 1, 6279.
Denny, E. B. & Hunt, R. R. (1992) Affective valence and memory in depression: dissociation of recall and fragment completion. Journal of Abnormal Psychology, 101, 575580.
Deptula, D., Manevitz, A. & Yozawitz, A. (1991) Asymmetry of recall in depression. Journal of Clinical and Experimental Neuropsychology, 13, 854870.
Dias, R., Robbins, T. W. & Roberts, A. C. (1996) Dissociation in prefrontal cortex of affective and attentional shifts. Nature, 380, 6972.
Drevets, W. C., Price, J. L., Simpson, J. R., et al (1997) Subgenual prefrontal cortex abnormalities in mood disorders. Nature, 386, 824827.
Duncan, J., Burgess, P. & Emslie, H. (1995) Fluid intelligence after frontal lobe lesions. Neuropsychologia, 33, 261268.
Elliott, R., Sahakian, B. J., McKay, A. P., et al (1996) Neuropsychological impairments in unipolar depression: the influence of perceived failure on subsequent performance. Psychological Medicine, 26, 975989.
Elliott, R., Sahakian, B. J., Herrod, J. J., et al (1997) Abnormal response to negative feedback in unipolar depression: evidence for a diagnostic specific impairment. Journal of Neurology, Neurosurgery and Psychiatry, 63, 7482.
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, 189198.
Friedman, A. (1964) Minimal effects of severe depression on cognitive functioning. Journal of Abnormal and Social Psychology, 69, 237243.
Frith, C. D., Steven, M., Johnstone, E. C., et al (1983) Effects of ECTand depression on various aspects of memory. British Journal of Psychiatry, 142, 610617.
Fromm, D. & Schopflocher, D. (1984) Neuropsychological test performance in depressed patients before and after drug therapy. Biological Psychiatry, 19, 5571.
Gazzaniga, M. S., Ivry, R. B. & Mangun, G. R. (1998) Cognitive Neuroscience: The Biology of the Mind. New York: Norton.
Golden, C. J. (1987) Stroop Colorand Word Test. Chicago, IL: Stoetting.
Golinkoff, M. & Sweeney, J. (1989) Cognitive impairments in depression. Journal of Affective Disorders, 17, 105112.
Goodwin, G. M. (1997) Neuropsychological and neuroimaging evidence for the involvement of the frontal lobes in depression. Journal of Psychopharmacology, 11, 115122.
Goodwin, G. M., Austin, M.-P., Dougall, N., et al (1993) State changes in brain activity shown by uptake of 99Tc-exametazime with single photon emission tomography in major depression before and after treatment. Journal of Affective Disorders, 29, 243253.
Grattan, L. M., Bloomer, R. H., Archambault, F. X., et al (1994) Cognitive flexibility and empathy after frontal lobe lesion. Neuropsychiatry, Neuropsychology and Behavioural Neurology, 7, 251259.
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.
Heaton, R. K. (1981) Wisconsin Card Sorting Test. Odessa, FL: Psychological Assessment Resources.
Henriques, J. B., Glowacki, J. M. & Davidson, R. J. (1994) Reward fails to alter response bias in depression. Journal of Abnormal Psychology, 103, 460466.
Hertel, P. T. & Hardin, T. S. (1990) Remembering with and without awareness in a depressed mood: evidence of deficits in initiative. Journal of Experimental Psychology, 119, 4559.
Hickie, I. & Scott, E. (1998) Late-onset depressive disorders: a preventable variant of cerebrovascular disease? Psychological Medicine, 28, 10071013.
Hickie, I. & Scott, E., Mitchell, P., et al (1995) Subcortical hyperintensities on magnetic resonance imaging: clinical correlates and prognostic significance in patients with severe depression. Biological Psychiatry, 37, 151161.
Hickie, I. & Scott, E., Wilhelm, K., et al (1997) Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression – longitudinal evaluation. Biological Psychiatry, 42, 367374.
Hornak, J., Rolls, E. T. & Wade, D. (1996) Face and voice expression identification in patients with emotional and behavioural changes following ventral frontal lobe damage. Neuropsychologia, 34, 247261.
Hughes, J. R., Pleasants, C. N., Pickens, R. W. (1985) Measurement of reinforcement in depression: a pilot study. Journal of Behavioural Therapy and Experimental Psychiatry, 16, 231236.
Ilsley, J. E., Moffoot, A. P. R. & O'Carrol, R. E. (1995) An analysis of memory dysfunction in major depression. Journal of Affective Disorders, 35, 19.
Jones, B. P., Henderson, M. & Welch, C. A. (1988) Executive functions in unipolar depression before and after electroconvulsive therapy. International Journal of Neuroscience, 38, 287297.
Jorm, A. F. (1986) Cognitive deficit in the depressed elderly: a review of some basic unresolved issues. Australian and New Zealand Journal of Psychiatry, 20, 1122.
Keefe, R. S. E. (1995) The contribution of neuropsychology to psychiatry. American Journal of Psychiatry, 152, 615.
Kessing, L. V. (1998) Cognitive impairment in the euthymic phase of affective disorder. Psychological Medicine, 28, 10271038.
Kramer-Ginsberg, E., Blaine, S., Krishnan, K. R. M., et al (1999) Neuropsychological functioning and MRI signal hyperintensities in geriatric depression. American Journal of Psychiatry, 156, 438444.
Layne, C. (1980) Motivational deficit in depression: Peoples expectations: the impact on outcome. Journal of Clinical Psychology, 36, 647652.
Lesser, I. M., Boone, K. B., Meringher, C. M., et al (1996) Cognition and white matter hyperintensities in older depressed patients. American Journal of Psychiatry, 153, 12801287.
Lezak, M. D. (1995) Neuropsychological Assessment (3rd edn). New York: Oxford University Press.
Marcos, T., Salamero, M., Gutierrez, F., et al (1994) Cognitive dysfunction in recovered melancholic patients. Journal of Affective Disorders, 32, 133137.
Matt, G. E., Vazquez, C. & Campbell, W. K. (1992) Mood-congruent recall of affectively toned stimuli: a meta-analytic review. Clinical Psychology Review, 12, 227255.
Mayberg, H. S., Brannan, S. K., Mahurin, R. K., et al (1997) Cingulate function in depression: a potential predictor of treatment response. Neuroreport, 8, 10571061.
Mayberg, H. S., Liotti, M., Brannan, S., et al (1999) Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. American Journal of Psychiatry, 156, 675682.
Meehl, P. E. (1975) Hedonic capacity: some conjectures. Bulletin of the Menninger Clinic, 39, 295307.
Miller, E. & Lewis, P. (1977) Recognition memory in elderly patients with depression and dementia: a signal detection analysis. Journal of Abnormal Psychology, 86, 8486.
Moffoot, A. P. R., O'Carroll, R. E., Bennie, J., et al (1994) Diurnal variation of mood and neuropsychological function in major depression with melancholia. Journal of Affective Disorders, 32, 257269.
Moreaud, D., Naegele, B., Chabannes, J. P., et al (1996) Frontal lobe dysfunction and depressive state: relation to endogenous character of depression. Encéphale, 22, 4751.
Murphy, F. C., Sahakian, B. J., Rubinsztein, J. S., et al (1999) Emotional bias and inhibitory control processes in mania and depression. Psychological Medicine, 29, 13071321.
Palmer, B. W., Boone, K. B., Lesser, I. M., et al (1996) Neuropsychological deficits among older depressed patients with predominantly psychological or vegetative symptoms. Journal of Affective Disorders, 41, 1724.
Paradiso, S., Lamberty, G. J., Garvey, M. J., et al (1997) Cognitive impairment in the euthymic phase of chronic unipolar depression. Journal of Nervous and Mental Disease, 185, 748754.
Pardo, J. V., Pardo, P. J. & Raichle, M. E. (1990) Neural correlates of self-induced dysphoria. American Journal of Psychiatry, 150, 713719.
Parker, G., Hadzi-Pavlovic, D., Wilhelm, K., et al (1994) Defining melancholia: properties of a refined sign-based measure. British Journal of Psychiatry, 164, 316326.
Peselow, E. D., Corwin, J., Fieve, R. R., et al (1991) Disappearance of memory deficits in outpatient depressives responding to imipramine. Journal of Affective Disorders, 21, 173183.
Purcell, R., Maruff, P., Kyrios, M., et al (1997) Neuropsychological function in young patients with unipolar major depression. Psychological Medicine, 27, 12771285.
Raskin, A., Friedman, A. S. & Di Mascio, A. (1982) Cognitive and performance deficits in depression. Psychopharmacology Bulletin, 18, 196206.
Richards, P. & Ruff, R. (1989) Motivational effects in neuropsychological functioning: comparison of depressed versus nondepressed individuals. Journal of Consulting and Clinical Psychology, 57, 396402.
Robbins, T. W., James, M., Owen, A. M., et al (1994) Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia, 5, 266281.
Rolls, E. T. (1996) The orbitofrontal cortex. Philosophical Transactions of the Royal Society of London, 31, 14331444.
Rolls, E. T. Hornak, J., Wade, D., et al (1994) Emotion-related learning in patients with social and emotional changes associated with frontal lobe damage. Journal of Neurology, Neurosurgery and Psychiatry, 57, 15181524.
Roy-Byrne, P. P., Weingartner, H., Bierer, L. M., et al (1986) Effortful and automatic cognitive processes in depression. Archives of General Psychiatry, 43, 265267.
Rush, A. J., Weissenburger, J., Vinson, D. B., et al (1983) Neuropsychological dysfunction in unipolar nonpsychotic major depression. Journal of Affective Disorders, 5, 281287.
Shah, P. J., O'Carroll, R. E., Rogers, A., et al (1999) Abnormal response to negative feedback in depression. Psychological Medicine, 29, 6372.
Sheline, Y. I., Wang, P. W., Gado, M. H., et al (1996) Hippocampal atrophy in recurrent major depression. Proceedings of the National Academy of Science USA, 93, 39083913.
Silberman, E. K., Weingartner, H. & Post, R. M. (1983) Thinking disorder in depression. Archives of General Psychiatry, 40, 775780.
Sternberg, D. E. & Jarvik, M. E. (1976) Memory functions in depression. Archives of General Psychiatry, 33, 219224.
Stromgren, L. S. (1977) The influence of depression on memory. Acta Psychiatrica Scandinavica, 56, 109128.
Sweeney, J., Wetzler, S., Stokes, P., et al (1989) Cognitive functioning in depression. Journal of Clinical Psychology, 45, 836842.
Tarbuck, A. F. & Paykel, E. S. (1995) Effects of major depression on the cognitive function of younger and older subjects. Psychological Medicine, 25, 285296.
Teasdale, J. D., Howard, R. J., Cox, S. G., et al (1999) Functional MRI study of the cognitive generation of affect. American Journal of Psychiatry, 156, 209215.
Trichard, C., Martinot, J. L., Alagille, M., et al (1995) Time course of prefrontal lobe dysfunction in severely depressed in patients: a longitudinal neuropsychological study. Psychological Medicine, 25, 7985.
Weingartner, H., Cohen, R. M., Murphy, D. L., et al (1981) Cognitive processes in depression. Archives of General Psychiatry, 38, 4247.
Wolfe, J., Granholm, E., Butters, N., et al (1987) Verbal memory deficits associated with major affective disorders: a comparison of unipolar and bipolar patients. Journal of Affective Disorders, 13, 8392.
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Cognitive deficits in depression: Possible implications for functional neuropathology

  • Marie-Paule Austin (a1), Philip Mitchell (a2) and Guy M. Goodwin (a3)
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eLetters

Cognitive Motivation Delay Deficits

Karen B Frank, occupational therapist in MH
30 March 2011

Dear MARIE-PAULE AUSTIN, PHILIP MITCHELL, and GUY M. GOODWIN,

Informally studying patients with depression, together with the dailygroup treatment, I appreciate the many angles and factors being consideredin your Cognitive Deficits article.

Toward motivation - A logic that appears to me in people is that while an immediate inappropriate response is produced and observed within low hedonic states, attentional set-shifting issues as well as perseveration are also noted.

My thought is to order the sypmtoms and in a sense combine them. That an appropriate response is not necessarily absent, but rather requires time to develop, due to slowed thought processes. That, [in manycases] if the stimulus were to not require the response to be instantaneous, the response provided would be considerably closer to appropriate. Keeping the stimulus active long enough to build intrinsic interest/ reward seems like the real challenge.

And, as a therapist with treatment options on my mind, it would seem that, as with any behavior, the less it gets practiced the rustier it gets. Persistance at motivating and gaining of experience have to augmentthe retaining/ regaining of skills and of hedonic capacity. Motivation itself being in real time. And with dancing and joy, at that. I love thatpeople are reported to learn better when fun is involved.

~ karen.b.frank
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