title: Depression and cognitive impairment following recovery from thrombotic thrombocytopenic purpura.
abstract: After recovery from an acute episode of acquired thrombotic thrombocytopenic purpura (TTP), patients often describe problems with memory, concentration, and endurance. We have previously reported the occurrence of depression and cognitive impairment in these patients. In this study, we describe the frequency, severity, and clinical course of depression and cognitive impairment. Fifty-two (85%) out of 61 eligible Oklahoma Registry patients who had recovered from TTP, documented by ADAMTS13 activity <10%, have had at least one (median, four) evaluation for depression over 11 years using the Beck Depression Inventory-II; 31 (59%) patients screened positive for depression at least once; in 15 (29%), the results suggested severe depression at least once. Nine of these 15 patients had a psychiatric interview, the definitive diagnostic evaluation; the diagnosis of major depressive disorder was established in eight (89%) patients. In 2014, cognitive ability was evaluated in 33 patients by the Montreal Cognitive Assessment and the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Both tests detected significant cognitive impairment in the patients as a group. Fifteen out of the 33 patients had been evaluated by extensive cognitive tests in 2006. The 2014 RBANS results were significantly worse than the 2006 results for the overall score and two out of the five RBANS domains (immediate and delayed memory). Neither depression nor cognitive impairment was significantly associated with the occurrence of relapses or ADAMTS13 activity <10% during remission. These observations emphasize the importance of screening evaluations for depression and cognitive impairment after recovery from acquired TTP.
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.|Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: Bowie
authors.initials: B
authors.lastname: Han
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.|Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: Evaren E
authors.initials: EE
authors.lastname: Page
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.|Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Stewart
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.|Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: Cassandra C
authors.initials: CC
authors.lastname: Deford
authors.affiliation: Department of Psychiatry & Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: James G
authors.initials: JG
authors.lastname: Scott
authors.affiliation: Department of Psychiatry & Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: Lauren H
authors.initials: LH
authors.lastname: Schwartz
authors.affiliation: Department of Psychiatry & Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: Jedidiah J
authors.initials: JJ
authors.lastname: Perdue
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: Deirdra R
authors.initials: DR
authors.lastname: Terrell
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Vesely
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.|Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
authors.forename: James N
authors.initials: JN
authors.lastname: George
mesh_terms: D051722:ADAM Proteins / Q000235:genetics; D000071120:ADAMTS13 Protein; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology / Q000235:genetics / Q000523:psychology* / Q000628:therapy; D003289:Convalescence; D003863:Depression / Q000209:etiology / Q000235:genetics / Q000523:psychology* / Q000628:therapy; D003865:Major Depressive Disorder / Q000209:etiology / Q000235:genetics / Q000523:psychology* / Q000628:therapy; D005260:Female; D015870:Gene Expression; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications / Q000235:genetics / Q000523:psychology* / Q000628:therapy; D012042:Registries; D012720:Severity of Illness Index
chemical_list: D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human