Depression is a multi-dimensional disorder with emotional, cognitive and physical effects on patients1, all of which need to be recognised and assessed. Cognitive dysfunction in depression is often overlooked, however, both by patients and physicians.2,3 This can be easily rectified by the physician asking simple questions and observing patient behaviour during the consultation.
Cognitive dysfunction in depression is often overlooked... both by patients and physicians.
For example, subjective complaints of ‘cold’ cognitive dysfunction can be elicited by asking simple questions such as [Barry H. Personal communication]:
- Do you have difficulties making decisions either at home or at work?
- Do you have difficulties reading newspapers, lecture notes or data at work, or following TV programmes or conversations?
- Do you find yourself misplacing items such as keys, or have difficulties remembering names or shopping items, or lose track of tasks at home or at work?
- Do you struggle to start or, in particular, finish common tasks, either at home or at work, due to these problems?
It is important to avoid any fears of dementia by reassuring the patient that the aim of these questions is to explore the cognitive symptoms of depression. Interviews with people who know the patient very well, such as caregivers, may be of value in the assessment of a patient’s cognitive function.4
Cognitive dysfunction in depression is often overlooked
There are several reasons why cognitive dysfunction in depression may be overlooked Physicians often prioritise other symptoms of depression for defining cure, such as interest, mood and suicidal ideation,3 and they may not pick up patient descriptors of cognitive dysfunction, especially in young adults who they don’t expect to show cognitive dysfunction. In addition, patients with depression are most likely to report symptoms associated with sleep, appetite or mood, and may not be aware of, or able to report all of their symptoms.2,3
The problem is exacerbated by poor access to comprehensive neuropsychological assessments of cognition4 and the lack of effective treatments for cognitive dysfunction in depression.5
A more comprehensive approach to the diagnosis of depression might incorporate cognitive assessment at early stages of diagnosis, since cognitive symptoms appear to be feasible early markers and targets for intervention in depression.6,7
Cognitive dysfunction in depression can be assessed objectively and subjectively as part of on-going management
Once recognised, on-going assessment of cognitive dysfunction is critical as part of the management of patients with depression moving forward, and can be achieved using objective and/or subjective tools. However, there is scope to improve the range of tools available for screening for cognitive dysfunction in patients with depression in routine clinical practice.
A range of objective neuropsychological tests are available that assess the different ‘hot’ and ‘cold’ cognitive functions affected in depression.8 Cognitive tests for assessing the different domains of ‘cold’ cognitive function are shown in Figure 1. Examples for ‘hot’ cognitive assessments include the Cambridge Neuropsychological Test Automated Battery (CANTAB) Affective Go / No-Go test and the CANTAB Cambridge Gambling Task.9,10 However, objective neuropsychological tests are not widely available and results need to be understood in the context of the effect on patients’ daily functioning.4,6