Greater baseline subjective attentional complaints predict poorer 8-week antidepressant response in late-life depression

Abstract

<h3>Introduction</h3> Late-life depression (LLD) is characterized by both subjective cognitive complaints and objective cognitive deficits, most notably in executive functions. Worse cognitive performance, including in the executive function domain, is associated with poor antidepressant treatment outcomes. While executive-based cognitive complaints are similarly associated with poor treatment outcomes, the relationship between other subjective cognitive complaints and antidepressant response is not as clear. This may be particularly relevant for subjective attentional complaints, a common finding and clinical diagnostic criterion for Major Depressive Disorder. <h3>Methods</h3> Eighty-eight adults with LLD were recruited (mean age = 66.07 ± 4.49, 61% female, baseline mean Montgomery-Asberg Depression Rating Scale (MADRS) = 26.38 ± 5.46) and underwent an 8-week antidepressant trial. Subjective cognitive complaints were assessed with the following scales: Attentional Control Scale (ACS, focusing in-depth on attention), the WHODAS 2.0, domain 1 (focusing largely on attentional abilities), and the PROMIS Cognitive Abilities and Concerns (focusing on general / broad-based cognitive abilities). Antidepressant response was determined via the change in MADRS scores from baseline to week 8. Separate linear regressions examined the relationship between subjective cognitive complaints and change in MADRS scores, controlling for age, sex, baseline MADRS, and treatment arm. <h3>Results</h3> After covariate adjustment, ACS and WHODAS scores significantly predicted antidepressant response (<i>ß =</i> -0.42<i>, p=</i> 0.02 and <i>ß =</i> 0.57<i>, p=</i> 0.03, respectively), such that greater subjective attentional complaints at baseline were related to less improvement in MADRS scores. General cognitive complaints via the PROMIS were not significantly associated with antidepressant response. Follow-up analyses decomposing the ACS into its two subscales found that the change in MADRS scores was significantly related to attentional shifting (<i>ß = -</i>0.79, <i>p</i> = 0.01), but not focusing (<i>ß =</i> -0.57, <i>p</i> = 0.06), complaints. <h3>Conclusions</h3> Results highlight the importance of assessing for subjective cognitive complaints in LLD, particularly in the domain of attention, as their presence at baseline may be related to treatment response. Further research is needed to better understand the relationship between subjective and objective cognition in LLD, their relationship with treatment response and other outcomes, as well as underlying mechanisms. <h3>Funding</h3> R01MH102246