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Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Cognitive dysfunction is common in major depressive disorder (MDD) and a critical determinant of health outcome. Anhedonia is a criterion item toward the diagnosis of a major depressive episode (MDE) and a well-characterized domain in MDD. We sought to determine the extent to which variability in self-reported cognitive function correlates with anhedonia.
A post hoc analysis was conducted using data from (N=369) participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR)-defined diagnosis of MDD who were enrolled in the International Mood Disorders Collaborative Project (IMDCP) between January 2008 and July 2013. The IMDCP is a collaborative research platform at the Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, Canada, and the Cleveland Clinic, Cleveland, Ohio. Measures of cognitive function, anhedonia, and depression severity were analyzed using linear regression equations.
A total of 369 adults with DSM-IV-TR–defined MDD were included in this analysis. Self-rated cognitive impairment [ie, as measured by the Adult ADHD Self-Report Scale (ASRS)] was significantly correlated with a proxy measure of anhedonia (r=0.131, p=0.012). Moreover, total depression symptom severity, as measured by the total Montgomery–Åsberg Depression Rating Scale (MADRS) score, was also significantly correlated with self-rated measures of cognitive dysfunction (r=0.147, p=0.005). The association between anhedonia and self-rated cognitive dysfunction remained significant after adjusting for illness severity (r=0.162, p=0.007).
These preliminary results provide empirical data for the testable hypothesis that anhedonia and self-reported cognitive function in MDD are correlated yet dissociable domains. The foregoing observation supports the hypothesis of overlapping yet discrete neurobiological substrates for these domains.