Audioverbal cognitive dysfunction in depression
Since long
time psychiatrists know that some forms of depression are associated with a
mild degree of cognitive dysfunction and people suffering from those
psychological impairments are often aware of their decreased performances.
Sometimes psychiatrists assessed and treated cognitive problems of
mood-impaired patients by using Computer Assisted Cognitive Remediation (CACR,
the flexible test-training software system first ideated by Gianutsos in 1981,
and many derived programs) generally associated with neuropsychological
diagnosis and therapy.
Recently Mauro Garcia-Toro et al. (Audioverbal cognitive dysfunction in depression. Factors involved, Progress
in Neuro-Psychopharmacology and Biological Psychiatry, 27:1:37-42,
2003) in order to clarify on whether this dysfunction is
only substantially associated with the most severe forms of depression, on
whether or not it decreases in parallel with clinical response, and on the role
played in these changes by psychotropic medications, analyzed the performance
in several cognitive tasks that involved attention and working memory of 40
untreated subjects with a diagnosis of dysthymia or major depressive disorder
without melancholia. The protocol used included three audioverbal tasks: vocal
reaction time (VRT), inverse spelling (IS) and text repetition (TR). The
protocol was also administered to 20 healthy volunteers that were used as a
comparison group. The same battery of assessments was administered 2 months
later to all 60 subjects. At the time of the second assessment, patients (but
not healthy volunteers) were on antidepressant medication, in accordance with
common clinical practice. The authors found a longer VRT in patients versus
healthy volunteers at baseline. VRT did not decrease in patients that responded
to treatment. However, there was an improvement in VRT in patients that took
sertraline (n=16) compared to subjects taking imipramine (n=11).
This fact was not attributable to differences in antidepressant response.
Performance in the two other tasks was globally worse in the patient group than
in the comparison group, and there was also an absence of improvement in the
scores of patients who responded to treatment. However, when the sample was
stratified by illness duration, individuals with less than 10 years from the
first episode of depression showed a decrease in IS errors compared to the
healthy volunteers. It is concluded that patients with
nonmelancholic depression suffer from cognitive dysfunction, that this
dysfunction persists after clinical improvement and that at least attention is
influenced by the type of medication taken. Time from onset of the disorder
also seems to influence changes in cognitive performance.