Cognitive control, reward-related decision making and outcomes of late-life depression treated with an antidepressant

Abstract

Background Executive processes consist of at least two sets of functions: one concerned with cognitive control and the other with reward-related decision making. Abnormal performance in both sets occurs in late-life depression. This study tested the hypothesis that only abnormal performance in cognitive control tasks predicts poor outcomes of late-life depression treated with escitalopram. Methods We studied older subjects with major depression (N=53) and non-depressed subjects (N=30). Executive functions were tested with the Iowa Gambling Test (IGT), Stroop Color/Word test, Tower of London, and Dementia Rating Scale-Initiation/Perseveration Domain (DRS-IP). After a 2-week placebo washout, depressed subjects received escitalopram (target daily dose: 20 mg) for 12 weeks. Results There were no significant differences between depressed and non-depressed subjects on executive function tests. Hierarchical cluster analysis of depressed subjects identified a Cognitive Control Cluster (abnormal Stroop, Tower, DRS-IP), a Reward-Related Cluster (IGT), and an Executively Unimpaired Cluster. Decline in depression was greater in the Executively Unimpaired (t=−2.09, df=331, p=0.0375) and the Reward-Related Cluster (t=−2.33, df=331,p=0.0202) than the Cognitive Control Cluster. The Executively Unimpaired Cluster (t=2.17, df=331, p=0.03) and the Reward-Related Cluster (t=2.03, df=331, p=0.0433) had a higher probability of remission than the Cognitive Control Cluster. Conclusions Dysfunction of cognitive control functions, but not reward-related decision making, may influence the decline of symptoms and the probability of remission of late-life depression treated with escitalopram. If replicated, simple to administer cognitive control tests may be used to select depressed older patients at risk for poor outcomes to SSRIs who may require structured psychotherapy.

Decision Making assessed by the Iowa Gambling Task and Major Depressive Disorder A systematic review

“…To date, one study has sought to assess whether performance on cognitive control and reward-related DM tasks predict changes in symptoms and signs of MDD during treatment with selective serotonin reuptake inhibitors (SSRI). 27 According to the results of the study, irregularities in control of cognitive tasks, but not in DM, influenced the trajectory of symptoms and also depression remission during the treatment with antidepressants.…”

Neuroticism Traits Selectively Impact Long Term Illness Course and Cognitive Decline in Late-Life Depression

“…Urgency correlates with emotional regulation and reward regions in healthy adults (42) and is correlated with impulsive behavior and addiction in younger adults (43). Whereas urgency has not been previously investigated in LLD, a prior study found no association between reward related decision making and antidepressant treatment response over three months in older adults with major depression (44). Investigation into the neurophysiology of impulsivity constructs in LLD may elucidate the selective findings with treatment response and cognitive outcome.…”

Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial

“…However, we do not believe this is the case here: we used a similar screening protocol in our previous work (Arean et al, 2008), ensuring comparable standards between this work. More importantly, PST has already been shown to produce effects greater than a supportive therapy control in numerous studies with depressed older adults (Alexopoulos et al, 2011, 2015, 2016; Alexopoulos, Raue, & Arean, 2003; Alexopoulos, Raue, Kanellopoulos, Mackin, & Arean, 2008; Arean et al, 1993, 2008, 2010, 2015; Chu, Huynh, & Arean, 2012; Crabb, Arean, & Hegel, 2012; Gustavson et al, 2016; Mackin et al, 2014; Mackin, Arean, & Elite-Marcandonatou, 2006; Sharpe et al, 2012). Although, we cannot claim that EVO is not significantly worse than PST, we did find the effect sizes for EVO are similar to those found in the literature and is thus worth further study as a depression intervention.…”

“…Some studies have shown that older adults demonstrate marked improvement in cognitive control abilities following directed interventions that specifically target cognitive control deficits (Anguera et al, 2013; Berry et al, 2010; Mishra, de Villers-Sidani, Merzenich, & Gazzaley, 2014). Recent work by Anguera et al (2013) demonstrated that a video game targeting cognitive control abilities enhanced deficient age-related cognitive control processes, the very processes that are implicated in LLD (Alexopoulos et al, 2015). If a video game designed to target cognitive control deficits could improve cognitive control functions in older adults with LLD, it might be able to improve depression in this population.…”