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Discrepancy between objective and subjective cognition and its association with the trajectory of symptoms and functioning in depressive patients

Published online by Cambridge University Press:  03 November 2023

Xuequan Zhu ,
Ruoxi Ding ,
Xu Chen ,
Xiaoyi Wang ,
Ping He  and
Gang Wang
Xuequan Zhu
Affiliation:
National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
Ruoxi Ding
Affiliation:
Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China China Center for Health Development Studies, Peking University, Beijing, China
Xu Chen
Affiliation:
National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
Xiaoyi Wang
Affiliation:
Zhejiang BrainAu Medical Technology Co., Ltd, Shaoxing, China
Ping He*
Affiliation:
China Center for Health Development Studies, Peking University, Beijing, China
Gang Wang*
Affiliation:
National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
*
Corresponding authors: Ping He; Email: phe@pku.edu.cn; Gang Wang; Email: gangwangdoc@ccmu.edu.cn
Corresponding authors: Ping He; Email: phe@pku.edu.cn; Gang Wang; Email: gangwangdoc@ccmu.edu.cn
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Abstract

Background

Discrepancy between objective and subjective cognitive deficit is common among patients with major depressive disorders (MDDs) and may play a key role in the mechanism linking cognition with recovery of symptom and psychosocial function. This study, therefore, explores the cognitive discrepancy, and its association with the trajectory of symptoms and functioning over a 6-month period.

Methods

We used data from the Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study, from which 598 patients were included. Cognitive discrepancy scores were computed using a novel methodology, with positive values indicating more subjective than objective deficit (i.e. ‘underestimation’) and negative values indicating more objective than subjective difficulties (i.e. ‘overestimation’). Linear growth curve models were employed to examine the association of the cognitive discrepancy with the trajectory of depressive symptoms, psychosocial function, and quality of life.

Results

About 68% of patients displayed disproportionately more objective than subjective cognitive deficit at baseline, and the mean cognitive discrepancy score was −1.4 (2.7). Overestimation was associated with a faster decrease of HDRS-17 (β = −0.46, p = 0.002) and a faster decrease of psychosocial function in social life (β = −0.13, p = 0.013) and family life (β = −0.12, p = 0.026), and a greater improvement of EQ-5D utility score (β = 0.01, p < 0.001).

Conclusion

We found a lower sensitivity of cognitive deficit at baseline and its decrease was associated with better health outcomes. Our findings have clinical implications of the necessity to assess both subjective and objective cognition for identification and categorization and to incorporate cognitive and psychological therapies for optimized treatment outcomes.

Keywords

major depressive disorderobjective cognitionsubjective cognitiontreatment outcome
Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 4 , March 2024 , pp. 808 - 822
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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Footnotes

*

These authors contributed equally to this study.

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