Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-19T23:54:14.143Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  14 July 2015

G. S. Alexopoulos ,
K. Manning ,
D. Kanellopoulos ,
A. McGovern ,
J. K. Seirup ,
S. Banerjee  and
F. Gunning
G. S. Alexopoulos*
Affiliation:
Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
K. Manning
Affiliation:
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
D. Kanellopoulos
Affiliation:
Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
A. McGovern
Affiliation:
Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
J. K. Seirup
Affiliation:
Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
S. Banerjee
Affiliation:
Department of Public Health, Weill Cornell Medical College, New York, NY, USA
F. Gunning
Affiliation:
Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
*
*Address for correspondence: G. S. Alexopoulos, M.D., Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA. (Email: gsalexop@med.cornell.edu)
Get access Rights & Permissions [Opens in a new window]

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.

Method.

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 (ToL), 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, ToL, 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 (t = −2.33, df = 331, p = 0.0202) clusters 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 selective serotonin reuptake inhibitors who may require structured psychotherapy.

Keywords

Executive functionlate-life depressionremissioncognitive controlreward processing
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 14 , October 2015 , pp. 3111 - 3120
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aizenstein, HJ, Butters, MA, Figurski, JL, Stenger, VA, Reynolds, CF 3rd, Carter, CS (2005). Prefrontal and striatal activation during sequence learning in geriatric depression. Biological Psychiatry 58, 290–296.CrossRefGoogle ScholarPubMed
Alexopoulos, GS (2001). ‘The depression-executive dysfunction syndrome of late life’: a specific target for D3 agonists? American Journal of Geriatric Psychiatry 9, 22–29.Google ScholarPubMed
Alexopoulos, GS, Hoptman, MJ, Kanellopoulos, D, Murphy, CF, Lim, KO, Gunning, FM (2012). Functional connectivity in the cognitive control network and the default mode network in late-life depression. Journal of Affective Disorders 139, 56–65.CrossRefGoogle ScholarPubMed
Alexopoulos, GS, Kiosses, DN, Heo, M, Murphy, CF, Shanmugham, B, Gunning-Dixon, F (2005). Executive dysfunction and the course of geriatric depression. Biological Psychiatry 58, 204–210.CrossRefGoogle ScholarPubMed
Alexopoulos, GS, Kiosses, DN, Murphy, C, Heo, M (2004). Executive dysfunction, heart disease burden, and remission of geriatric depression. Neuropsychopharmacology 29, 2278–2284.CrossRefGoogle ScholarPubMed
Alexopoulos, GS, Murphy, CF, Gunning-Dixon, FM, Latoussakis, V, Kanellopoulos, D, Klimstra, S, Lim, KO, Hoptman, MJ (2008). Microstructural white matter abnormalities and remission of geriatric depression. American Journal of Psychiatry 165, 238–244.CrossRefGoogle ScholarPubMed
Alexopoulos, GS, Raue, PJ, Kiosses, DN, Mackin, RS, Kanellopoulos, D, McCulloch, C, Arean, PA (2011). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Archives of General Psychiatry 68, 33–41.CrossRefGoogle ScholarPubMed
Arean, PA, Raue, P, Mackin, RS, Kanellopoulos, D, McCulloch, C, Alexopoulos, GS (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. American Journal of Psychiatry 167, 1391–1398.Google Scholar
Beauchamp, MH, Dagher, A, Aston, JA, Doyon, J (2003). Dynamic functional changes associated with cognitive skill learning of an adapted version of the Tower of London task. NeuroImage 20, 1649–1660.CrossRefGoogle ScholarPubMed
Bechara, A (2007). Iowa Gambling Task (IGT) Professional Manual. Psychological Assessment Resources: Lutz, FL.Google Scholar
Beck, AT, Weissman, A, Lester, D, Trexler, L (1974). The measurement of pessimism: the hopelessness scale. Journal of Consulting and Clinical Psychology 42, 861–865.CrossRefGoogle ScholarPubMed
Benedict, RHB, Schretlen, D, Groninger, L, Brandt, J (1998). Hopkins verbal learning test revised: normative data and analysis of inter-form and test-retest reliability. Clinical Neuropsychologist 12, 43–55.Google Scholar
Botvinick, MM, Braver, TS, Barch, DM, Carter, CS, Cohen, JD (2001). Conflict monitoring and cognitive control. Psychological Review 108, 624–652.CrossRefGoogle ScholarPubMed
Braver, TS, Barch, DM, Gray, JR, Molfese, DL, Snyder, A (2001). Anterior cingulate cortex and response conflict: effects of frequency, inhibition and errors. Cerebral Cortex 11, 825–836.CrossRefGoogle ScholarPubMed
Buckley, MJ, Mansouri, FA, Hoda, H, Mahboubi, M, Browning, PG, Kwok, SC, Phillips, A, Tanaka, K (2009). Dissociable components of rule-guided behavior depend on distinct medial and prefrontal regions. Science 325, 52–58.Google Scholar
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 (2004). The nature and determinants of neuropsychological functioning in late-life depression. Archives of General Psychiatry 61, 587–595.CrossRefGoogle ScholarPubMed
Calinski, RB, Harabasz, J (1974). A dendrite method for cluster analysis. Communications in Statistics 3, 1–27.Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 40, 373–383.Google Scholar
Costa, PT, McCrae, RR (1992). NEO PI-R Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Culbertson, WC, Zillmer, EA (2001). Tower of London Drexel University (TOL DX): Technical Manual. Chicago: Multi-Health Systems Incorporated (MHS).Google Scholar
Dagher, A, Owen, AM, Boecker, H, Brooks, DJ (1999). Mapping the network for planning: a correlational PET activation study with the Tower of London task. Brain 122, 1973–1987.CrossRefGoogle Scholar
Denburg, NL, Cole, CA, Hernandez, M, Yamada, TH, Tranel, D, Bechara, A, Wallace, RB (2007). The orbitofrontal cortex, real-world decision making, and normal aging. Annals of the New York Academy of Sciences 1121, 480–498.Google Scholar
Dombrovski, AY, Siegle, GJ, Szanto, K, Clark, L, Reynolds, CF, Aizenstein, H (2012). The temptation of suicide: striatal gray matter, discounting of delayed rewards, and suicide attempts in late-life depression. Psychological Medicine 42, 1203–1215.CrossRefGoogle ScholarPubMed
Drevets, WC (2007). Orbitofrontal cortex function and structure in depression. Annals of the New York Academy of Sciences 1121, 499–527.CrossRefGoogle ScholarPubMed
Drevets, WC, Savitz, J, Trimble, M (2008). The subgenual anterior cingulate cortex in mood disorders. CNS Spectrums 13, 663–681.Google Scholar
Elliott, R, Baker, SC, Rogers, RD, O'Leary, DA, Paykel, ES, Frith, CD, Dolan, RJ, Sahakian, BJ (1997). Prefrontal dysfunction in depressed patients performing a complex planning task: a study using positron emission tomography. Psychological Medicine 27, 931–942.CrossRefGoogle ScholarPubMed
Elliott, R, Sahakian, BJ, Michael, A, Paykel, ES, Dolan, RJ (1998). Abnormal neural response to feedback on planning and guessing tasks in patients with unipolar depression. Psychological Medicine 28, 559–571.Google Scholar
Epping-Jordan, JA, Ustun, TB (2000). The WHODAS-II: leveling the playing field for all disorders. WHO Mental Health Bulletin 6, 5–6.Google Scholar
Eshel, N, Roiser, JP (2010). Reward and punishment processing in depression. Biological Psychiatry 68, 118–124.Google Scholar
First, MB, Spitzer, RL, Williams, JBW, Gibbon, M (1995). Structured Clinical Interview for DSM-IV – Patient Version (SCID-P). American Psychiatric Press: Washington.Google Scholar
Folstein, MF, Folstein, SE, McHugh, PR (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.Google Scholar
Glascher, J, Adolphs, R, Damasio, H, Bechara, A, Rudrauf, D, Calamia, M, Paul, LK, Tranel, D (2012). Lesion mapping of cognitive control and value-based decision making in the prefrontal cortex. Proceedings of the National Academy of Sciences USA 109, 14681–14686.Google Scholar
Goethals, I, Audenaert, K, Jacobs, F, Van de Wiele, C, Pyck, H, Ham, H, Vandierendonck, A, van Heeringen, C, Dierckx, R (2004). Application of a neuropsychological activation probe with SPECT: the ‘Tower of London’ task in healthy volunteers. Nuclear Medicine Communications 25, 177–182.CrossRefGoogle Scholar
Golden, CJ (1978). The Stroop Color and Word Test (Manual) . Stoetling: Chicago.Google Scholar
Gunning, FM, Cheng, J, Murphy, CF, Kanellopoulos, D, Acuna, J, Hoptman, MJ, Klimstra, S, Morimoto, S, Weinberg, J, Alexopoulos, GS (2009). Anterior cingulate cortical volumes and treatment remission of geriatric depression. International Journal of Geriatric Psychiatry 24, 829–836.Google Scholar
Gunning-Dixon, FM, Walton, M, Cheng, J, Acuna, J, Klimstra, S, Zimmerman, ME, Brickman, AM, Hoptman, MJ, Young, RC, Alexopoulos, GS (2010). MRI signal hyperintensities and treatment remission of geriatric depression. Journal of Affective Disorders 126, 395–401.CrossRefGoogle ScholarPubMed
Halfmann, K, Hedgcock, W, Bechara, A, Denburg, NL (2014). Functional neuroimaging of the Iowa Gambling Task in older adults. Neuropsychology 28, 870–880.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.Google Scholar
Jollant, F, Bellivier, F, Leboyer, M, Astruc, B, Torres, S, Verdier, R, Castelnau, D, Malafosse, A, Courtet, P (2005). Impaired decision making in suicide attempters. American Journal of Psychiatry 162, 304–310.Google Scholar
Jollant, F, Lawrence, NS, Olie, E, O'Daly, O, Malafosse, A, Courtet, P, Phillips, ML (2010). Decreased activation of lateral orbitofrontal cortex during risky choices under uncertainty is associated with disadvantageous decision-making and suicidal behavior. NeuroImage 51, 1275–1281.CrossRefGoogle ScholarPubMed
Jueptner, M, Stephan, KM, Frith, CD, Brooks, DJ, Frackowiak, RS, Passingham, RE (1997). Anatomy of motor learning. I. Frontal cortex and attention to action. Journal of Neurophysiology 77, 1313–1324.Google Scholar
Kikuchi, T, Miller, JM, Schneck, N, Oquendo, MA, Mann, JJ, Parsey, RV, Keilp, JG (2012). Neural responses to incongruency in a blocked-trial Stroop fMRI task in major depressive disorder. Journal of Affective Disorders 143, 241–247.Google Scholar
Laird, N, Ware, J (1982). Random-effects models for longitudinal data. Biometrics 38, 963–974.Google Scholar
Lecrubier, Y (2002). How do you define remission? Acta Psychiatrica Scandinavica 106 (Suppl.), 7–11.CrossRefGoogle Scholar
Lie, CH, Specht, K, Marshall, JC, Fink, GR (2006). Using fMRI to decompose the neural processes underlying the Wisconsin card sorting test. NeuroImage 30, 1038–1049.Google Scholar
Liotti, M, Mayberg, HS (2001). The role of functional neuroimaging in the neuropsychology of depression. Journal of Clinical and Experimental Neuropsychology 23, 121–136.CrossRefGoogle ScholarPubMed
Liston, C, Chen, AC, Zebley, BD, Drysdale, AT, Gordon, R, Leuchter, B, Voss, HU, Casey, BJ, Etkin, A, Dubin, MJ (2014). Default mode network mechanisms of transcranial magnetic stimulation in depression. Biological Psychiatry 76, 517–526.Google Scholar
MacDonald, AW 3rd, Cohen, JD, Stenger, VA, Carter, CS (2000). Dissociating the role of the dorsolateral prefrontal and anterior cingulate cortex in cognitive control. Science 288, 1835–1838.CrossRefGoogle ScholarPubMed
Mackin, RS, Nelson, JC, Delucchi, K, Raue, P, Byers, A, Barnes, D, Satre, DD, Yaffe, K, Alexopoulos, GS, Arean, PA (2013). Cognitive outcomes after psychotherapeutic interventions for major depression in older adults with executive dysfunction. American Journal of Geriatric Psychiatry 22, 1496–1503.CrossRefGoogle ScholarPubMed
Marson, DC, Dymek, MP, Duke, LW, Harrell, LE (1997). Subscale validity of the Mattis Dementia Rating Scale. Archives of Clinical Neuropsychology 12, 269–275.CrossRefGoogle ScholarPubMed
Mattis, S (1989). Dementia Rating Scale. Psychological Assessment Resources: Odessa.Google Scholar
McGrath, CL, Kelley, ME, Dunlop, BW, Holtzheimer, PE 3rd, Craighead, WE, Mayberg, HS (2014). Pretreatment brain states identify likely nonresponse to standard treatments for depression. Biological Psychiatry 76, 527–535.CrossRefGoogle ScholarPubMed
Morimoto, SS, Gunning, FM, Kanellopoulos, D, Murphy, CF, Klimstra, SA, Kelly, RE Jr., Alexopoulos, GS (2012). Semantic organizational strategy predicts verbal memory and remission rate of geriatric depression. International Journal of Geriatric Psychiatry 27, 506–512.Google Scholar
Morimoto, SS, Gunning, FM, Murphy, CF, Kanellopoulos, D, Kelly, RE, Alexopoulos, GS (2011). Executive function and short-term remission of geriatric depression: the role of semantic strategy. American Journal of Geriatric Psychiatry 19, 115–122.Google Scholar
Pimontel, MA, Culang-Reinlieb, ME, Morimoto, SS, Sneed, JR (2012). Executive dysfunction and treatment response in late-life depression. International Journal of Geriatric Psychiatry 27, 893–899.Google Scholar
Roberts, KL, Hall, DA (2008). Examining a supramodal network for conflict processing: a systematic review and novel functional magnetic resonance imaging data for related visual and auditory stroop tasks. Journal of Cognitive Neuroscience 20, 1063–1078.CrossRefGoogle Scholar
Rogalsky, C, Vidal, C, Li, X, Damasio, H (2012). Risky decision-making in older adults without cognitive deficits: an fMRI study of VMPFC using the Iowa Gambling Task. Social Neuroscience 7, 178–190.Google Scholar
Roiser, JP, Sahakian, BJ (2013). Hot and cold cognition in depression. CNS Spectrums 18, 139–149.CrossRefGoogle ScholarPubMed
Ruocco, AC, Rodrigo, AH, Lam, J, Di Domenico, SI, Graves, B, Ayaz, H (2014). A problem-solving task specialized for functional neuroimaging: validation of the Scarborough adaptation of the Tower of London (S-TOL) using near-infrared spectroscopy. Frontiers in Human Neuroscience 8, 185.CrossRefGoogle Scholar
Sakai, K, Hikosaka, O, Miyauchi, S, Takino, R, Sasaki, Y, Putz, B (1998). Transition of brain activation from frontal to parietal areas in visuomotor sequence learning. Journal of Neuroscience 18, 1827–1840.CrossRefGoogle ScholarPubMed
Seminowicz, DA, Mayberg, HS, McIntosh, AR, Goldapple, K, Kennedy, S, Segal, Z, Rafi-Tari, S (2004). Limbic-frontal circuitry in major depression: a path modeling metanalysis. NeuroImage 22, 409–418.Google Scholar
Snaith, RP, Baugh, SJ, Clayden, AD, Husain, A, Sipple, MA (1982). The clinical anxiety scale: an instrument derived from the Hamilton anxiety scale. British Journal of Psychiatry 141, 518–523.Google Scholar
Sneed, JR, Culang, ME, Keilp, JG, Rutherford, BR, Devanand, DP, Roose, SP (2010). Antidepressant medication and executive dysfunction: a deleterious interaction in late-life depression. American Journal of Geriatric Psychiatry 18, 128–135.Google Scholar
Sneed, JR, Keilp, JG, Brickman, AM, Roose, SP (2008). The specificity of neuropsychological impairment in predicting antidepressant non-response in the very old depressed. International Journal of Geriatric Psychiatry 23, 319–323.Google Scholar
Stuss, DT, Levine, B, Alexander, MP, Hong, J, Palumbo, C, Hamer, L, Murphy, KJ, Izukawa, D (2000). Wisconsin card sorting test performance in patients with focal frontal and posterior brain damage: effects of lesion location and test structure on separable cognitive processes. Neuropsychologia 38, 388–402.CrossRefGoogle ScholarPubMed
van den Heuvel, OA, Groenewegen, HJ, Barkhof, F, Lazeron, RH, van Dyck, R, Veltman, DJ (2003). Frontostriatal system in planning complexity: a parametric functional magnetic resonance version of Tower of London task. NeuroImage 18, 367–374.Google Scholar
Vrieze, E, Pizzagalli, DA, Demyttenaere, K, Hompes, T, Sienaert, P, de Boer, P, Schmidt, M, Claes, S (2013). Reduced reward learning predicts outcome in major depressive disorder. Biological Psychiatry 73, 639–645.Google Scholar
Ward, JH (1963). Hierarchical grouping to optimize an objective function. Journal of the American Statistical Association 58, 236–244.CrossRefGoogle Scholar
Wood, V, Wylie, ML, Sheafor, B (1969). An analysis of a short self-report measure of life satisfaction: correlation with rater judgments. Journal of Gerontology 24, 465–469.Google Scholar