Executive dysfunction and the course of geriatric depression.
BACKGROUND
Executive dysfunction is common in geriatric depression and persists after improvement of depressive symptoms. This study examined the relationship of executive impairment to the course of depressive symptoms among elderly patients with major depression.


METHODS
A total of 112 nondemented elderly patients with major depression participated in an 8-week citalopram trial at a target daily dose of 40 mg. Executive functions were assessed with the initiation/perseveration subscale of the Dementia Rating Scale and the Stroop Color-Word test. Medical burden was rated with the Cumulative Illness Rating Scale.


RESULTS
Both abnormal initiation/perseveration and abnormal Stroop Color-Word scores were associated with an unfavorable response of geriatric depression to citalopram. In particular, initiation/perseveration scores below the median (< or =35) and Stroop scores at the lowest quartile (< or =22) predicted limited change in depressive symptoms. Impairment in other Dementia Rating Scale cognitive domains did not significantly influence the outcome of depression.


CONCLUSIONS
Executive dysfunction increases the risk for poor response of geriatric depression to citalopram. Because executive functions require frontostriatal-limbic integrity, this observation provides the rationale for investigation of the role of specific frontostriatal-limbic pathways in perpetuating geriatric depression. Depressed elderly patients with executive dysfunction require vigilant clinical attention because they might be at risk to fail treatment with a selective serotonin reuptake inhibiting antidepressant.
Alexopoulos
George S
GS
Cornell Institute of Geriatric Psychiatry, Weill Medical College of Cornell University, 21 Bloomingdale Road, White Plains, NY 10605, USA. gsalexop@med.cornell.edu
Kiosses
Dimitris N
DN
Heo
Moonseong
M
Murphy
Christopher F
CF
Shanmugham
Bindu
B
Gunning-Dixon
Faith
F
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D015283:Citalopram / Q000627:therapeutic use; D003710:Demography; D003863:Depression / Q000150:complications*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007859:Learning Disabilities / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011340:Problem Solving / Q000187:drug effects / Q000502:physiology*; D011569:Psychiatric Status Rating Scales; D013997:Time Factors
D000928:Antidepressive Agents; D015283:Citalopram