Elsevier

Biological Psychiatry

Volume 58, Issue 3, 1 August 2005, Pages 204-210
Biological Psychiatry

Original article
Executive Dysfunction and the Course of Geriatric Depression

https://doi.org/10.1016/j.biopsych.2005.04.024Get rights and content

Background

Executive dysfunction is common in geriatric depression and persists after improvement of depressive symptoms. This study examined the relationship of executive impairment to the course of depressive symptoms among elderly patients with major depression.

Methods

A total of 112 nondemented elderly patients with major depression participated in an 8-week citalopram trial at a target daily dose of 40 mg. Executive functions were assessed with the initiation/perseveration subscale of the Dementia Rating Scale and the Stroop Color-Word test. Medical burden was rated with the Cumulative Illness Rating Scale.

Results

Both abnormal initiation/perseveration and abnormal Stroop Color-Word scores were associated with an unfavorable response of geriatric depression to citalopram. In particular, initiation/perseveration scores below the median (≤35) and Stroop scores at the lowest quartile (≤22) predicted limited change in depressive symptoms. Impairment in other Dementia Rating Scale cognitive domains did not significantly influence the outcome of depression.

Conclusions

Executive dysfunction increases the risk for poor response of geriatric depression to citalopram. Because executive functions require frontostriatal-limbic integrity, this observation provides the rationale for investigation of the role of specific frontostriatal-limbic pathways in perpetuating geriatric depression. Depressed elderly patients with executive dysfunction require vigilant clinical attention because they might be at risk to fail treatment with a selective serotonin reuptake inhibiting antidepressant.

Section snippets

Participants

The participants were older (>60 years) psychiatric patients consecutively recruited from a University-based clinic of geriatric psychiatry. All subjects provided written informed consent. Capacity to consent was evaluated by the study psychiatrist every 2 weeks. The participants were required to meet Research Diagnostic Criteria (Spitzer et al 1978) and DSM-IV criteria (American Psychiatric Association 1994) for unipolar major depression and have a score of ≥17 on the 24-item Hamilton

Results

The participants were 112 older adults (aged 73.17 ± 6.50 years [mean ± SD]; range, 62–89 years), of whom 58 were women and 54 were men. They all met DSM-IV criteria for major depression of moderate severity (HAM-D score 24.33 ± 4.70) and had high medical burden (CIRS-G score 7.60 ± 4.01). All participants were treated with citalopram over a period of 8 weeks. Their average maximal daily dose during this trial was 35.29 mg (SD = 8.39 mg). By the end of the study, 16 participants had exited.

Discussion

The main finding of this study is that abnormal scores in initiation/perseveration or response inhibition tasks predict limited change in depressive symptoms of elderly patients treated with a selective serotonin reuptake inhibitor (SSRI). Although it has no placebo arm, this is the first controlled treatment study, to our knowledge, demonstrating a relationship between abnormal executive functions and the course of symptoms of geriatric major depression. This observation confirms earlier

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