Course of cognitive impairment following attempted suicide in older adults.
OBJECTIVE
Cognitive impairment has been associated with late-life suicidal behavior. Without longitudinal data it is unclear whether these are transient features of a depressive state or stable impairments. We examined longitudinally the course of cognitive impairment in older adults with depression and a history of suicide attempt.


METHODS
We investigated the persistence of cognitive impairment over time in 198 depressed older adults (age >60); 91 suicide attempters, 39 depressed individuals with suicidal ideation (ideators), and 68 non-suicidal depressed adults assessed over a 2-year period at four time points. We used linear mixed effects modeling to examine group differences in trajectories of cognitive decline over 2 years, using the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (DRS), and Executive Interview (EXIT).


RESULTS
Over the 2-year period, suicide attempters performed significantly worse than both suicide ideators and non-suicidal depressed older adults on the MMSE (mean difference: from ideators: -0.88, p = 0.02; from non-suicidal depressed: -1.52, p < 0.01), while on the EXIT and DRS, suicide attempters performed significantly worse than non-suicidal depressed older adults (mean difference: in EXIT: -1.75, p = 0.01; in DRS: 3.04, p < 0.01; in MMSE: 1.15, p < 0.01). Cognitive impairment in suicide attempters partly resolved, as indicated by a group × time interaction on the DRS (p = 0.039), but not the EXIT (p = 0.58) or the MMSE (p = 0.08).


CONCLUSIONS
Cognitive impairment in late-life suicidal behavior appears to involve both a stable and a state-related component.
Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.|Center for Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, PA, USA.
Swathi
S
Gujral
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
Semhar
S
Ogbagaber
Center for Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, PA, USA.|Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Alexandre Y
AY
Dombrovski
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
Meryl A
MA
Butters
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jordan F
JF
Karp
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Katalin
K
Szanto
D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data
cognitive; depression; executive function; older adults; suicide