W4 T2 P2

• Patients with major depressive disorder (MDD) exhibit cognitive impairments across neuropsychological domains.
• These domains include working memory, executive function, visual memory, variable memory, visual information processing, reaction time, attention, and vigilance.
• Patients with depression perform worse on working memory and reaction time tests compared to healthy controls.
• Their performance falls between that of healthy controls and individuals with schizophrenia.
• Depression presents with heterogeneity as some individuals perform similarly to healthy controls, while others are as impaired as those with schizophrenia.

Cognitive Dysfunction in Depression

• Patients often complain which causes distress, poor attention and concentration, and memory issues.
• Younger patients may be misdiagnosed with attention deficit disorder.
• Older patients may be misdiagnosed with neurodegenerative conditions like Alzheimer's.
• Deficits generally include processing speed, attention, executive function, and working memory.
• Severe and melancholic depression subtypes may have greater cognitive impairments and specific neurocognitive impairment patterns.
• Decision-making capacity is reduced, with diminished reward sensitivity.
• Decline is linked to deficits in mesolimbic-cortical circuitry affecting motivation.

Cognitive Deficits

• Cognitive impairments from major depressive disorder have clinical significance.
• Executive function is affected in up to one-third of individuals.
• Abnormalities occur in working memory, attention, and psychomotor processing speed.
• Cognitive deficits are a primary mediator of psychosocial impairment, especially in workplace performance.

Intervention Modalities

• Pharmacological, behavioural, and neuromodulatory interventions hold promise for cognitive deficits in mood disorders.
• Embarrassment (related to prejudice and stigma) and cognition are determinants associated with psychosocial impairment
• Associations exist between major depressive episodes and activity limitations.

Porter Study

• A study aimed to disprove cognitive impairment in major depression, considering confounding variables like medication, ECT, or head injury.
• 44 medication-free patients meeting DSM-IV criteria with 44 demographically matched healthy subjects.
• MDD patients showed significant impairment across cognitive domains (attention, executive function, visual spatial learning, and memory) compared to controls.
• The severity of depression correlated with poorer learning and memory performance, but not with executive function.
• Pronounced neurocognitive impairment was found in young, adult outpatients, suggesting an objective marker of brain dysfunction beyond medication effects.

Problem Levels

• Difficulty increases for MDD patients as cognitive tasks become more challenging.
• Difficulty increase is an argument for phased return to work and addressing higher levels of problem solving/cognitive tasks.

Follow-Up Study

• Patients with less psychomotor dysfunction at baseline were more likely to remit.
• Improvement in verbal memory was significantly greater in patients who remitted.
• There may be distinct temporal trajectories of neurocognitive improvement after remission.
• Aspects of neurocognitive functioning should be further examined to track treatment response objectively.

Cognitive Symptoms

• Cognitive symptoms are common residual symptoms even after resolution of major depressive episodes.
• Symptoms include decreased concentration and decision-making.

Cognitive Symptoms Impact

• Cognitive impairments severely impact the life and psychosocial functioning of depressive patients.
• Cognitive impairments remain evident even six months after hospital discharge.

Cognitive Dysfunction Management

• Uncertainty exists regarding the best practices for managing cognitive dysfunction in depressed patients.
• Improvement in cognitive dysfunction is not guaranteed with all antidepressants.
• Prioritizing the study of antidepressants' effects (both positive and negative) on cognitive function is essential.
• Cognitive dysfunction should be reassessed 4-6 months after stopping antidepressant treatment.
• Clinical recovery from depression may not always coincide with recovery of cognitive function.
• Persistent cognitive dysfunction post-recovery predicts a higher risk of relapse.
• Constant monitoring of cognitive dysfunction throughout depressive illness is important.
• Significant cognitive dysfunction must be considered when creating a patient’s individual treatment plan.