The relationship between depression and cognitive function in adults with cardiovascular risk: Evidence from a randomised attention-controlled trial

PLOS ONE, Sep 2018

Background and aim This study assessed the association between depressive symptom severity and cognition in middle-to-older aged adults with mild-to-moderate depression and cardiovascular risk factors using an online test battery (CogState) and whether changes in depressive symptoms over 3 months were associated with changes in cognition. Methods Participants (mean age = 57.8) with cardiovascular risk and mild–to-moderate depressive symptoms completed measures of psychomotor speed, learning, and executive function prior to (n = 445)_and after (n = 334) online depression or attention control interventions. The symptom severity-cognition relationship was examined both cross-sectionally and prospectively. Results Participants exhibited significantly reduced psychomotor speed and variable impairments on measures of learning and executive functioning relative to normative data. However, there was no association of depression severity with cognition at baseline or of change in depressive symptoms with change in cognitive performance. Limitations Participants were well-educated, which may have protected against cognitive decline. Attrition may limit generalisability, though is unlikely to explain the lack of association between depression symptoms and cognition. Conclusions Adults with comorbid mild-to-moderate depressive symptoms and cardiovascular risks performed less well than age-matched normative data on three online cognitive tests; however, we were unable to show any symptom-cognition association cross-sectionally or longitudinally, despite significant improvements in depressive symptoms. This challenges the generalisability of such associations found in more severely unwell clinical samples to those with a broader depressive symptom profile, or suggests that underlying cardiovascular disease may account for the association seen in some clinical studies. This has implications for scaling up selective prevention of cognitive decline.

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The relationship between depression and cognitive function in adults with cardiovascular risk: Evidence from a randomised attention-controlled trial

September The relationship between depression and cognitive function in adults with cardiovascular risk: Evidence from a randomised attention-controlled trial Haley M. LaMonica 0 1 Daniel J. Biddle 0 1 Sharon L. Naismith 0 1 Ian B. Hickie 0 1 Paul Maruff 0 Nicholas Glozier 0 1 0 Editor: Camillo Gualtieri, North Carolina Neuropsychiatry Clinics , UNITED STATES 1 Brain and Mind Centre, University of Sydney , Camperdown , Australia , 2 Charles Perkins Centre, School of Psychology, University of Sydney , Camperdown , Australia , 3 Central Clinical School, Sydney Medical School, University of Sydney , Camperdown , Australia , 4 Cogstate, Melbourne , Australia Background and aim This study assessed the association between depressive symptom severity and cognition in middle-to-older aged adults with mild-to-moderate depression and cardiovascular risk factors using an online test battery (CogState) and whether changes in depressive symptoms over 3 months were associated with changes in cognition. Participants (mean age = 57.8) with cardiovascular risk and mild±to-moderate depressive symptoms completed measures of psychomotor speed, learning, and executive function prior to (n = 445)_and after (n = 334) online depression or attention control interventions. The symptom severity-cognition relationship was examined both cross-sectionally and - OPEN ACCESS Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The trial was supported by the Cardiovascular Disease and Depression Strategic Research Program (Award Reference No. G08S 4048 to I.H.) funded by the National Heart Foundation of Australia and beyondblue: the national depression initiative. The 45 and Up Study is managed by The Sax Institute in collaboration Methods prospectively. Results Limitations Participants exhibited significantly reduced psychomotor speed and variable impairments on measures of learning and executive functioning relative to normative data. However, there was no association of depression severity with cognition at baseline or of change in depressive symptoms with change in cognitive performance. Participants were well-educated, which may have protected against cognitive decline. Attrition may limit generalisability, though is unlikely to explain the lack of association between depression symptoms and cognition. with major partner Cancer Council New South Wales; and partners the National Heart Foundation of Australia (NSW Division); NSW Health; beyondblue: the national depression initiative; Ageing, Disability and Home Care, Department of Human Services NSW; and UnitingCare Ageing. Competing interests: Professors Naismith, Hickie, and Glozier received a grant from beyondblue to support the conduct of the study. Professor Hickie served as the Commissioner of the National Mental Health Commission and was a member of the Medibank Clinical Reference Group and the Bupa Australia Medical Advisory Board during this study. Professor Paul Maruff is a full time employee of Cogstate. All other authors declare that they have no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Conclusions Adults with comorbid mild-to-moderate depressive symptoms and cardiovascular risks performed less well than age-matched normative data on three online cognitive tests; however, we were unable to show any symptom-cognition association cross-sectionally or longitudinally, despite significant improvements in depressive symptoms. This challenges the generalisability of such associations found in more severely unwell clinical samples to those with a broader depressive symptom profile, or suggests that underlying cardiovascular disease may account for the association seen in some clinical studies. This has implications for scaling up selective prevention of cognitive decline. Introduction It is recognized widely that Major Depressive Disorder (MDD) is associated with cognitive dysfunction [1±3] including impaired learning, working memory, processing speed, and executive functions [4±6]. The neuropsychological profile is, however, heterogeneous and varies with depressive symptom severity [7, 8], disease subtype [9], age of onset [ 10 ], etiology, comorbidities and cerebrovascular disease (CVD) [8]. Regardless of the contributing factors, cognitive dysfunction in depression is associated with substantial disability and poorer quality of life [11], and frequently has been suggested as a selective target for interventions aimed at preventing cognitive decline and subsequent dementia [12]. There are three key issues that might limit such a strategy: 1. Is the depression severity-cognition association present only in the small group with diagnosed MDD or is it applicable to the much larger group with mild to moderate depression symptoms? 2. Does improvement in depression result in a significant improvement in cognitive function? The observed co (...truncated)


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Haley M. LaMonica, Daniel J. Biddle, Sharon L. Naismith, Ian B. Hickie, Paul Maruff, Nicholas Glozier. The relationship between depression and cognitive function in adults with cardiovascular risk: Evidence from a randomised attention-controlled trial, PLOS ONE, 2018, Volume 13, Issue 9, DOI: 10.1371/journal.pone.0203343