Late-life depression is characterized by slowed information processing, which affects all realms of cognition. This supports the concept that frontostriatal dysfunction plays a key role in LLD. The putative role of some risk factors was validated (eg, advanced age, low education, depression severity), whereas others were not (eg, medical burden, age at onset of first depressive episode). Further studies of neuropsychological functioning in remitted LLD patients are needed to parse episode-related and persistent factors and to relate them to underlying neural dysfunction.

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This brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient’s symptoms.

Objectives-Late-life depression (LLD) is associated with persistent cognitive impairment in a subset of individuals. The purpose of this study was to 1) examine the frequency and characteristics of cognitive diagnoses (Mild Cognitive Impairment [MCI], dementia) among remitted elderly depressed subjects and 2) to compare the prevalence rate and correlates of cognitive diagnoses with those of comparison subjects. Design-Crosssectional.Setting-Outpatient geriatric mental health clinic.Participants-The authors examined cognitive diagnoses among 109 subjects age 65 and older, after depression treatment response and 65 never-depressed, age-and education-equated comparison subjects. Measurements-Cognitive diagnoses were independently established by the University ofPittsburgh's Alzheimer's Disease Research Center. Bivariate and multivariate analyses were conducted to examine the role of specific risk factors for cognitive diagnosis among depressed subjects.Results-Relative to comparison subjects, nearly twice as many depressed subjects were diagnosed with MCI or dementia (48% versus 28%). Of the 109 depressed subjects, 38% were diagnosed with MCI (63% amnestic, 37% nonamnestic). The majority of amnestic MCI subjects (85%) had the multiple domain subtype. Age, but not age of onset or lifetime depression duration, predicted cognitive diagnosis. Becker serves as a consultant for Grifols. Dr. Lopez has received honoraria and serves as a consultant for Forest Laboratories, Grifols, Servier, and Eisai/Pfizer. Dr. Reynolds has received pharmaceutical supplies from GlaskoSmithKline, Forest Laboratories, Pfizer, Eli Lilly, and Bristol-Myers Squibb. Dr. DeKosky receives research support from Elan, Myriad, Neurochem, and ONO. He serves on the advisory boards of AstraZeneca, Baxter, Myriad, NeuroMedix, NeuroPharma, and Cephalon. Dr. DeKosky also serves as a consultant for Eisai, Forest Laboratories, GlaskoSmithKline, Eli Lilly, Merck, Pfizer, and Servier. Drs. Bhalla, Butters, Aizenstein, and Snitz have no conflicts of interest to disclose. Conclusions-Despite adequate depression treatment response, 48% of remitted depressed subjects had a cognitive diagnosis. Of the 38% diagnosed with MCI, there was high representation among both the amnestic and the nonamnestic subtypes, suggesting heterogeneity in cognitive course and outcomes in LLD. NIH Public Access KeywordsLate-life depression; mild cognitive impairment; dementia; diagnosis Late-life depression (LLD) may be associated with persistent cognitive impairment in some individuals after effective treatment of depressive symptoms (e.g., Refs. 1-4). Some studies report that LLD may be associated with subsequent Mild Cognitive Impairment (MCI) and dementia (e.g., Refs. 5-8), including Alzheimer disease -and vascular dementia. 13,14 It is not clear whether depression represents a risk factor for or occurs in the prodromal stage of dementia (e.g., Refs. 15,16). Thus, the nature of the relationship between depression and persistent cognitive impairment after resolution remains u...