Abstract
ObjectivesDepressive symptoms and cognitive impairment often concur in older persons. Differentiating the cause of cognitive impairment in older persons with Depressive Disorder (DD) from other diseases such as Alzheimer’s Disease (AD) is challenging. The goal of this study was to characterize cognitive impairment in older persons with DD.DesignCross-sectional retrospective observational clinical cohort study using patient records from 2014 to 2018.SettingGerontopsychiatric services of Ulm University at Bezirkskrankenhaus Günzburg serving as primary psychiatric care institution and tertiary referral center for psychiatric care for older persons.PartcipantsDD was diagnosed according to ICD-10 criteria. When indicated by the medical history or neuropsychological assessment further diagnostic procedures were initiated. Cerebrospinal fluid (CSF) tap was routinely the first additional procedure. If patients did not consent to CSF tap or contraindications were present, 18F-fluordesoxyglucose-PET (FDG-PET) or Amyloid-PET (Am-PET) were performed.Materials and methodsExtensive neuropsychological test battery to assess cognitive profile.Results457 subjects were diagnosed with DD (DD-all; age 50–94; 159 males, 298 females). Biomarkers were assessed in 176 persons; in 90 of these subjects AD-biomarkers were negative (DD-BM-; age 54–89; 40 males, 50 females), and in 86 subjects at least one biomarker was compatible with AD (DD-BM+; age 60–90; 31 males, 55 females). Cognitive performance was below healthy controls (HC; n = 56; age 50–80; 30 males, 26 females) for all groups of patients with DD. With case-control matching of HC and DD-BM- we find that executive functions are impaired in about one out of three and delayed recall in about two out of three patients with DD.ConclusionCognitive impairment is frequent in older persons with DD. Cognitive profile in older patients with DD without and with biomarkers of AD is not distinguishable. Therefore, cognitive impairment due to DD should be diagnosed after exclusion of comorbid AD.
Highlights
Cognitive deficits are frequent in patients with Depressive Disorder (DD) [1]
Biomarkers were assessed in 176 persons; in 90 of these subjects Alzheimer’s Disease (AD)-biomarkers were negative (DD-BM-; age 54–89; 40 males, 50 females), and in 86 subjects at least one biomarker
With case-control matching of healthy controls (HC) and patients with depressive disorder (DD-BM)- we find that executive functions are impaired in about one out of three and delayed recall in about two out of three patients with DD
Summary
Cognitive deficits are frequent in patients with Depressive Disorder (DD) [1]. The majority of previous studies investigated younger patients. Due to a lack of studies including older persons it remains unclear whether the extent of the association of DD with cognitive impairment is independent of age. Until now cognitive symptoms are not included in the diagnostic classifications of ICD-10 or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with the same elaborateness as other symptoms of DD. Assessment bias cannot be ruled out because cognition may not have been assessed with sensitive methods. Reporting bias may be present because information on cognitive performance of patients with DD is undervalued and not reported
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