Cerebrovascular risk factors, executive dysfunction, and depression in older primary care patients.
OBJECTIVE
"Executive" cognitive functions may be of particular clinical importance in geriatric depression and may reflect underlying cerebrovascular disease. This study examined the associations of selected components of executive function with cerebrovascular risk factors, depression, and overall functional status.


METHODS
Study measures were completed on 448 primary care patients aged>or=65 years based on patient interviews and medical chart review. Multiple regression techniques determined the presence of specified independent associations.


RESULTS
Some but not all study hypotheses were confirmed. Cerebrovascular risk factors were associated with major depression and with some cognitive measures, but their associations with depression and with the most specific measures of executive function were limited and not independent of overall medical burden. Measures of initiation-perseveration and mental set shifting were associated with overall functional disability; these cognitive measures were not associated with depression diagnosis, or with depressive symptoms when also covarying medical burden or excluding patients with dementia.


CONCLUSIONS
Clinicians should be aware of the potential functional significance of these components of cognition. Longitudinal risk factor studies and complementary techniques such as neuroimaging may help identify pathogenetically distinct subgroups of later-life depression that might respond preferentially to specific interventions.
Program in Geriatrics and Neuropsychiatry, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York 14642, USA.
Michelle L Schoepflin
ML
Sanders
Jeffrey M
JM
Lyness
Shirley
S
Eberly
Deborah A
DA
King
Eric D
ED
Caine
D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011320:Primary Health Care; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires