A Meta-Analysis of Executive Dysfunction and Antidepressant Treatment Response in Late-Life Depression.
OBJECTIVE
Depressed older adults with executive dysfunction (ED) may respond poorly to antidepressant treatment. ED is a multifaceted construct and different studies have measured different aspects of ED, making it unclear which aspects predict poor response. Meta-analytic methods were used to determine whether ED predicts poor antidepressant treatment response in late-life depression and to determine which domains of executive functioning are responsible for this relationship.


METHODS
A Medline search was conducted to identify regimented treatment trials contrasting executive functioning between elderly responders and nonresponders; only regimented treatment trials for depressed outpatients aged 50 and older were included. Following the most recent PRISMA guidelines, 25 measures of executive functioning were extracted from eight studies. Six domains were identified: cognitive flexibility, planning and organization, response inhibition, selective attention, verbal fluency, and the Dementia Rating Scale Initiation/Perseveration composite score (DRS I/P). Hedge's g was calculated for each measure of executive functioning. A three-level Bayesian hierarchical linear model (HLM) was used to estimate effect sizes for each domain of executive functioning.


RESULTS
The effect of planning and organization was significantly different from zero (Bayesian HLM estimate of domain effect size: 0.91; 95% CI: 0.32-1.58), whereas cognitive flexibility, response inhibition, selective attention, verbal fluency, and the DRS I/P composite score were not.


CONCLUSIONS
The domain of planning and organization is meaningfully associated with poor antidepressant treatment response in late-life depression. These findings suggest that therapies that focus on planning and organization may provide effective augmentation strategies for antidepressant nonresponders with late-life depression.
The Graduate Center, City University of New York, New York, NY; Queens College, City University of New York, New York, NY.
Monique A
MA
Pimontel
The Graduate Center, City University of New York, New York, NY.
David
D
Rindskopf
Columbia University and the New York State Psychiatric Institute, New York, NY.
Bret R
BR
Rutherford
Columbia University and the New York State Psychiatric Institute, New York, NY.
Patrick J
PJ
Brown
Columbia University and the New York State Psychiatric Institute, New York, NY.
Steven P
SP
Roose
The Graduate Center, City University of New York, New York, NY; Queens College, City University of New York, New York, NY; Columbia University and the New York State Psychiatric Institute, New York, NY. Electronic address: joel.sneed@qc.cuny.edu.
Joel R
JR
Sneed
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001499:Bayes Theorem; D002986:Clinical Trials as Topic; D003072:Cognition Disorders / Q000523:psychology; D003863:Depression / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D056344:Executive Function; D006801:Humans; D016896:Treatment Outcome
D000928:Antidepressive Agents
Executive dysfunction; antidepressant treatment; late-life depression; meta-analysis