Cigdem Ciftci KAYGUSUZ, Özden ARISOY, M Hamid BOZTAS, Mustafa SERCAN

Comparison of First Episode and Recurrent Major Depression Patients in Terms of Cognitive Function

Amaç: Kognitif bozukluk, depresyonun yeti yitimine yol açan önemli nedenlerindendir. Ancak literatürde, depresyondaki kognitif bozukluk ve doğası hakkında çelişkili sonuçlar mevcuttur. İlk atak (İA) ve rekürren depresyon (RD) hastaları arasında kognisyon açısından fark bulan ve bulmayan çalışmalar, kognitif bozukluğun depresyon şiddetinden bağımsız olduğunu gösteren ve göstermeyen çalışmalar vardır. Bu araştırmada, İA ve RD hastalarının kognitif işlevler açısından karşılaştırılması, atak sayısının ve depresyon şiddetinin kognitif işlevlere etkisinin incelenmesi amaçlanmıştır. Yöntem: Psikiyatri polikliniğine ayaktan başvuran, ek psikiyatrik/nörolojik bozukluğu olmayan, kognitif işlevleri etkileyebilecek bedensel hastalığı bulunmayan, ilaç kullanmakta olmayan 33 İA ve 37 RD hastası sözel bellek süreçleri, sözel akıcılık, Stroop, Benton yüz tanıma, Boston adlandırma testleri ile değerlendirilmiştir. Bulgular: İA ve RD grupları arasında, 3'ten fazla ya da az atak geçiren RD hastaları arasında kognitif işlevler açısından bir fark yoktu. Ancak ağır depresyonu olan hastaların kendiliğinden adlandırdıkları kelime sayıları ve anlık bellek puanları daha düşüktü. Depresyon puanı Stroop renkli kelimeleri okuma süresiyle pozitif, Sözel Bellek Süreçleri Testi öğrenme puanıyla negatif biçimde koreleydi. Perseverasyon puanı da toplam depresif atak süresiyle pozitif biçimde koreleydi.Sonuç: Depresif atak sayısından ziyade depresyon şiddeti bilişsel işlevler üzerinde daha belirleyici görünmektedir. Depresyon şiddetlendikçe basit dikkat, kodlama, adlandırma, mental hız ve öğrenme bozulmakta; depresyon süresi uzadıkça da kognitif esneklik azalmaktadır. Bu bulgular, depresyonda prefrontal bir işlev bozukluğu olduğu hipotezini desteklemektedir

İlk atak ve rekürren major depresyon hastalarının kognitif işlevler açısından karşılaştırılması

Objective: Cognitive impairment is one of the most important causes of disability in depression. There are conflicting results about the nature of cognitive impairment with some studies finding a difference between first episode (FE) and recurrent depression (RD) and a correlation between cognitive impairment and depression severity while others do not. Our aim was to compare cognitive function in FE and RD patients and to see if cognitive impairment is correlated with depression severity and number of depressive episodes.Method: Unmedicated 33 FE and 37 RD outpatients with no additional Axis I disorder or physical disorder likely to affect cognition were included into the study and cognitive function was evaluated with verbal memory, verbal fluency, Stroop, Benton facial recognition and Boston naming tests. Results: There were no cognitive differences between FE and RD groups or between RD patients with more or less than 3 depressive episodes. But severely depressed patients had lower naming and immediate memory scores. Depression severity was positively correlated with Stroop color word reading time and negatively correlated with verbal memory learning score. Perseveration scores were positively correlated with total depressive episode duration.Discussion: Depression severity seems to be more effective on cognitive function than the number of depressive episodes. Results indicate that simple attention, encoding, learning, naming and mental speed is affected negatively from depression severity and cognitive flexibility was negatively affected by total depressive episode duration supporting prefrontal dysfunction hypothesis in depression

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1. Rihmer Z, Angst J. Mood Disorders: epidemiology: In Aydın H, Bozkurt A (Translation editors). Kaplan & Sadocks Comprehensive Textbook of Psychiatry. Eighth Ed. Ankara: Gunes Kitabevi, 2007, 1575-1582. (Turkish)
2. Akiskal HS. Mood Disorders: clinical characteristics: In Aydın H, Bozkurt A (Translation editors). Kaplan & Sadocks Comprehensive Textbook of Psychiatry. Eighth Ed. Ankara: Gunes Kitabevi, 2007, 1611-1651. (Turkish)
3. Gualtieri CT, Johnson LG, Benedict KB. Neurocognition in depression: patients on and off medication versus healthy comparison subjects. J Neuropsychiatry Clin Neurosci 2006; 18:217-225.
4. Jeste DV, Heaton SC, Paulsen JS, Ercoli L, Harris J, Heaton RK. Clinical and neuropsychological comparison of psychotic depression with nonpsychotic depression and schizophrenia. Am J Psychiatry 1996; 153:490-496.
5. Brown RG, Scott LC, Bench CJ, Dolan RJ. Cognitive function in depression: its relationship to the presence and severity of intellectual decline. Psychol Med 1994; 24:829-847.
6. Landro N, Stiles T, Sletvold H. Neuropsychological function in nonpsychotic unipolar major depression. Neuropsychiatry Neuropsychol Behav Neurol 2001; 14:233-240.
7. Porter R, Gallagher P, Thompson JM, Young AH. Neurocognitive impairment in drug-free patients with major depressive disorder. Br J Psychiatry 2003; 182:214-220.
8. Zakzanis KK, Leach L, Kaplan E. On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry Neuropsychol Behav Neurol 1998; 11:111-119.
9. Barch DM, Sheline YI, Csernansky JG, Snyder AZ. Working memory and prefrontal cortex dysfunction: specifity to schizophrenia compared with major depression. Biol Psychiatry 2003; 53:376-384.
10. Egeland J, Rund BR, Sundet K, Landrø NI, Asbjørnsen A, Lund A, Roness A, Stordal KI, Hugdahl K. Attention profile in schizophrenia compared with depression: differential effects of processing speed, selective attention and vigilance. Acta Psychiatr Scand 2003; 108:276-284.
11. Brand AN, Jolles J, Gispen-de Wied C. Recall and recognition memory deficits in depression. J Affect Disord 1992; 25:77-86.
12. Burt DB, Zembar MJ, Niederehe G. Depression and memory impairment: a meta-analysis of the association, its pattern and specificity. Psychol Bull 1995; 117:285-305.
13. Zhang LY. A control study on memory and related factors in patients with depression. Zhonghua Shen Jing Jing Shen Ke Za Zhi 1992; 25:331-382.
14. Elliot R. The neuropsychological profile in unipolar depression. Trends Cogn Neurosci 1998; 2:447-454.
15. Ellwart T, Rinck M, Becker ES. Selective memory and memory deficits in depressed inpatients. Depress Anxiety 2003; 17:197-206.
16. Bazin N, Perruchet P, De Bonis M, Féline A.The dissociation of explicit and implicit memory in depressed patients. Psychol Med 1994; 24:239-245.
17. Bartfai A, Asberg M, Martensson B, Gustavsson P. Memory effects of clomipramine treatment: relationship to CSF monoamine metabolites and drug concentration in plasma. Biol Psychiatry 1991; 30:1075-1092.
18. Bearden CE, Glahn DC, Monkul ES, Barrett J, Najt P, Villarreal V, Soares JC. Patterns of memory impairment in bipolar disorder and unipolar major depression. Psychiatry Res 2006; 142:139-150.
19. MacQueen G, Galway T, Hay J, Young LT, Joffe RT. Recollection memory deficits in patients with major depressive disorder predicted by past depressions but not current mood state or treatment status. Psychol Med 2002; 32:251-258.
20. Butters MA, Whyte EM, Nebes RD, Begley AE, Dew MA, Mulsant BH, Zmuda MD, Bhalla R, Meltzer CC, Pollock BG, Reynolds CF 3rd, Becker JT. The nature and determinants of neuropsychological functioning in late-life depression. Arch Gen Psychiatry 2004; 61:587-595.
21. Sárosi A, Balogh G, Székely A, Sasvári M, Faludi G. Markers of cognitive vulnerability in major depression. Neuropsychopharmacol Hung 2007; 9:183-188.
22. Fossati P, Guillaume le B, Ergis AM, Allilaire JF. Qualitative analysis of verbal fluency in depression. Psychiatry Res 2003; 117:17-24.
23. Fossati P, Ergis AM, Allilaire JF. Executive functioning in unipolar depression: a review. Encephale 2002; 28:97-107. (French)
24. Gohier B, Ferracci L, Surguladze SA, Lawrence E, El Hage W, Kefi MZ, Allain P, Garre JB, Le Gall D. Cognitive inhibition and working memory in unipolar depression. J Affect Disord 2009; 116:100-105.
25. Mayberg HS. Modulating dysfunctional limbic-cortical circuits in depression, towards development of brain-based algorithms for diagnosis and optimised treatment. Br Med Bull 2003; 65:193-207.
26. Rapp MA, Dahlman K, Sano M, Grossman HT, Haroutunian V, Gorman JM. Neuropsychological differences between late-onset and recurrent geriatric major depression. Am J Psychiatry 2005; 162:691-698.
27. Basso MR, Bornstein RA. Relative memory deficits in recurrent versus first-episode major depression on a word-list learning task. Neuropsychology 1999; 13:557-563.
28. Wang CE, Halvorsen M, Sundet K, Steffensen AL, Holte A, Waterloo K. Verbal memory performance of mildly to moderately depressed outpatient younger adults. J Affect Disord 2006; 92:283-286.
29. Fossati P, Harvey PO, Le Bastard G, Ergis AM, Jouvent R, Allilaire JF. Verbal memory performance of patients with a first depressive episode and patients with unipolar and bipolar recurrent depression. J Psychiatr Res 2004; 38:137-144.
30. Habermann PY, Pohl J, Leplow B. Attention and executive functions in remitted major depression patients. J Affect Disord 2005; 89:125-135.
31. Karabekiroglu A, Topcuoglu V, Gonentur AG, Karabekiroglu K. Executive function differences between first episode and recurrent major depression patients. Turk Psikiyatri Derg 2010; 21:280-288.
32. Corapcioglu A, Aydemir O, Yildiz M, Esen A, Koroglu E. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinical Version. Hekimler Yayın Birliği, Ankara, 1999. (Turkish)
33. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 6:561-571.
34. Savasir I, Sahin NH. Bilissel davranisci terapilerde degerlendirme: sik kullanılan olcekler. Ankara: Turk Psikologlar Dernegi Yayinlari, 1997. (Turkish)
35. Hisli N. Reliability and validity of Beck Depression Inventory among university students. Journal of Psychology 1989; 7:3-13. (Turkish)
36. Hamilton MA. Rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56-62.
37. Aydemir O, Koroglu E. Psikiyatride Degerlendirme Araclari: Ozellikleri, Turleri, Kullanimi. Psikiyatride Kullanilan Klinik Olcekler. Ankara: Hekimler Yayin Birligi, 2000:21-30. (Turkish)
38. Akdemir A, Orsel S, Dag I. Clinical use and the reliability and validity of the Turkish version of the Hamilton Depression Rating Scale (HDRS). Journal of Psychiatry Psychology and Psychopharmacology 1996; 4:251-259. (Turkish)
39. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50-55.
40. Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988; 14:61-68.
41. Yazici MK, Demir B, Tanriverdi N, Karaoglu E, Yolac P. Hamilton Anxiety Rating Scale: Interrater Reliabilty and Validity Study. Turk Psikiyatri Derg 1998; 9:114-117. (Turkish)
42. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Koroglu E (Translation editor). 4. Baski, Ankara: Hekimler Yayin Birligi, 1995. (Turkish)
43. Oktem O. A verbal test of memory processes: a preliminary study. Archives of Neuropsychiatry 1992; 29:196-206. (Turkish)
44. Spreen O, Strauss E. A compendium of neuropsychological tests administration, norms and commentary. New York: Oxford University Press, 1991.
45. Tumac A. Effects of age and education to performance in some frontal lobe tests in normal subjects. Master Thesis, Istanbul University Institute of Social Sciences Department of Psychology, Istanbul, 1997. (Turkish)
46. Benton AL, Sivan AB, Hamsher KS, Varney NR, Spreen O (editors). Facial Recognition Test. In: Contributions To Neuropsychological Assessment: A Clinical Manual. New York: Oxford University Press, 1983:35.
47. Keskinkilic C. The standardization of Benton Facial Recognition Test for healty Turkish population (20-65 years old or older). Master Thesis, Istanbul University Institute of Social Sciences, Istanbul, 1998. (Turkish)
48. Kaplan E, Goodglass H, Weintraub S (Editors). The Boston Naming Test. Philadelphia: Lea and Febiger, 1983.
49. Weintraub S, Mesulam MM. Mental State Assessment Of Young And Elderly Adults In Behavioral Neurology. In Mesulam MM (editor), Principles Of Behavioral Neurology. Philadelphia: Davis Co. 1985; 71-123.
50. Douglas KM, Porter RJ. Longitudinal assessment of neuropsychological function in major depression. Aust N Z J Psychiatry 2009; 43:1105-1117.
51. Preiss M, Kucerova H, Lukavsky J, Stephankova H, Sos P, Kawaciukova R. Cognitive deficits in the euthymic phase of unipolar depression. Psychiatry Res 2009; 169:235-239.
52. Golinkoff M, Sweeney JA. Cognitive impairments in depression. J Affect Disord 1989; 17:105-112.
53. Marazziti D, Consoli G, Picchetti M, Carlini M, Faravelli L. Cognitive impairment in major depression. Eur J Pharmacol 2010; 626:83-86.
54. Tanridag O. Ihmal Sendromları: In Karakas S, Irkec C, Yuksel N (Editors). Beyin ve Noropsikoloji. Ankara: Cizgi Tip Yayinevi, 2003; 205-210. (Turkish)
55. Ardal G, Hammar A. Is impairment in cognitive inhibition in the acute phase of major depression irreversible? Results from a 10-year follow-up study. Psychol Psychother 2011;84:141-50.
56. Melrose RJ, Campa OM, Harwood DG, Osato S, Mandelkern MA, Sultzer DL. The neural correlates of naming and fluency deficits in Alzheimer’s disease: an FDG-PET study. Int J Geriatr Psychiatry 2009; 24:885-893.
57. Halperin I, Korczvn AD. Depression precedes development of dementia. Harefuah 2008; 147:335-339.
58. Fletcher PC, Henson RNA. Frontal lobes and human memory: insights from functional neuroimaging. Brain 2001; 124:849-881.
59. Phelps EA, Hyder F, Blamire AM, Shulman RG. fMRI of the prefrontal cortex during overt verbal fluency. Neuroreport 1997; 8:561-565.
60. Schlosser R, Hutchinson M, Joseffer S, Rusinek H, Saarimaki A, Stevenson J, Dewey SL, Brodie JD. Functional magnetic resonance imaging of human brain activity in a verbal fluency task. J Neurol Neurosurg Psychiatry 1998; 64:492-498.
61. Obler LK, Rykhlevskaia E, Schnyer D, Clark-Cotton MR, Spiro A 3rd, Hyun J, Kim DS, Goral M, Albert ML. Bilateral brain regions associated with naming in older adults. Brain Lang 2010; 113:113-123.
62. Adleman NE, Menon V, Blasey CM, White CD, Warsofsky IS, Glover GH,Reis AR. Developmental fMRI Study of the Stroop Color-Word Task. Neuroimage 2002; 16:61-75.