Persistent cognitive impairment in depression: the role of psychopathology and altered hypothalamic-pituitary-adrenocortical (HPA) system regulation.
BACKGROUND
Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system and cognitive impairment are consistent findings in depression. This study examines the associations between HPA system regulation, cognitive functioning, and psychopathology in depressed inpatients on admission and at discharge.


METHODS
The HPA system dysregulation was evaluated with the dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test. Cognitive assessment included speed of information processing, divided and selective attention, as well as short-term and working memory. Psychopathology was evaluated with the Hamilton Rating Scale for Depression (HAMD). Data from 75 depressed inpatients are reported, 51 (68%) of them achieved remission.


RESULTS
Despite a significant reduction of depressive symptoms between admission and discharge, a high rate of patients remained cognitively impaired. Selective attention improved significantly in remitters and nonremitters, while speed of information processing increased only in remitters. The cortisol response to the DEX/CRH test decreased significantly only in remitters, which was uncorrelated with cognitive performance. In nonremitters, severity of depression was significantly correlated with information processing time while improvement in short-term memory was negatively associated with the cortisol response at discharge.


CONCLUSIONS
Our data support the assumption that psychopathological symptoms and the HPA system dysregulation can be dissociated in their impact on cognitive functioning in depressed patients.
Reppermund
Simone
S
Max Planck Institute of Psychiatry, Munich, Germany. reppermund@mpipsykl.mpg.de
Zihl
Josef
J
Lucae
Susanne
S
Horstmann
Sonja
S
Kloiber
Stefan
S
Holsboer
Florian
F
Ising
Marcus
M
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D003863:Depression / Q000150:complications* / Q000473:pathology; D003907:Dexamethasone; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011599:Psychopathology; D012720:Severity of Illness Index
D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone