MEMORY COMPLAINTS AND DEPRESSION TREATMENT IN OLDER ADULTS

Abstract

Introduction Older adults with major depression (or late-life depression) often complain about problems with thinking and memory. Some evidence suggests that subjective cognitive complaints may be a useful prognostic indicator of response to antidepressant medication. In one prior study, older adults with major depression and executive functioning complaints responded more slowly to escitalopram treatment over 12 weeks compared with older depressed adults with no executive functioning complaints. It is unclear whether the potential association between subjective cognitive complaints and treatment response generalizes to other cognitive domains and whether there is a longer-term relationship between treatment response and subjective cognitive complaints. The aim of the current study is to understand the relationship between subjective memory complaints and late-life depression treatment response at 12 weeks and one-year. The mechanism explaining the potential association between subjective cognitive complaints and treatment responses is unclear. Subjective memory complaints may represent subtle changes in objective memory test performance. Better objective story memory at baseline was associated with better depression outcomes one-year later in older adults with major depression. However, a large body of research also suggests subjective memory complaints in older adults are related to the severity of depression, anxiety, and/or personality traits (e.g., neuroticism), all factors that detrimentally influence depression treatment in older adults. Given these findings, we expected to find an association between subjective memory complaints and treatment response in late-life depression but hypothesized that the association would no longer be significant when controlling for depression severity, state anxiety, neuroticism, and objective memory performance. Methods The Neurobiology of Late-Life Depression (NBOLD) is a naturalistic longitudinal observation study of late-life depression. Upon enrollment, all patients were offered open label treatment with sertraline but this was not a requirement of participation. Instead, patients could have received other SSRIs/SNRIs and psychological treatment from non-study providers. Moreover, in some cases of mild major depression, patients may have elected not to receive treatment at all. All subjects underwent annual cognitive evaluations and depression monitoring with the Montgomery Asberg Depression Rating Scale (MADRS) as clinically indicated (and at least every three months). At baseline, subjective memory complaints were measured with the Memory Abilities Scale (MAB), state anxiety was measured with State-Trait Anxiety Inventory (STAI), and neuroticism was measured with the NEO-PI-R. Statistical Analyses: We conducted regression models testing the association between 12 week and one-year MADRS and baseline subjective memory complaints, objective memory performance (Logical Memory Delayed Recall), state anxiety, neuroticism, antidepressant usage, and relevant demographics. We tested both linear (continuous MADRS score) and logistic (yes-no presence of remission defined as MADRS Results The sample consisted of 90 patients at 12 weeks and 85 at one year. Regarding antidepressant treatment, 47.5% of LLD patients (n=57) began treatment with sertraline upon enrollment, 27.5% (n=33) were on some other SSRI and/or SNRI combination, and 25% were not receiving antidepressants. Contrary to our hypotheses, linear regression models revealed that baseline subjective memory complaints were a significant predictor of 12 week (Coefficient = -.087 +- .038, p = .025) and one-year MADRS (Coefficient = -.097 +- .039, p = .014) scores even when accounting for objective memory performance (Logical Memory Delayed Recall), state anxiety, neuroticism, antidepressant usage, and relevant demographics. Using the same covariates, subjective memory complaints also predicted remission at 12 weeks (OR[95%CI] = 1.07 (1.02, 1.11) p Conclusions Subjective memory complaints seem to be a useful indicator of depression treatment response in older adults with major depression. Notably the relationship between subjective memory complaints and treatment response was present even when accounting for other important factors shown to be related to subjective cognitive complaints and treatment outcome. Future work should investigate the biological and cognitive correlates of subjective memory complaints in older adults with major depression. This research was funded by: The research was supported by the Leo and Anne Albert Charitable Trust & NIMH Grant R01 MH108578.