Relation Between Executive Function Test Performance and Treatment Outcomes During Brief Psychotherapies for Later-Life Depression.
Academic Article
Overview
abstract
OBJECTIVES: Executive dysfunction is common in later-life depression (LLD). This study examined whether: 1) executive function predicts change in depressive symptoms during brief psychotherapy and 2) performance on cognitive tests changes during psychotherapy. DESIGN: Post hoc analysis of a noninferiority randomized clinical trial comparing 9 weekly sessions of problem-solving therapy (PST) and Engage, a streamlined psychotherapy for depression. SETTING: Two-site trial at academic medical centers in Seattle, WA and New York, NY. PARTICIPANTS: Participants were 150 older adults (68% women) with major depressive disorder, Mini-Mental State Examination (MMSE) ≥24, and cognitive test data available for primary analysis. Participants ranged in age from 60 to 89 years (M = 70.4, SD = 7.4). MEASUREMENTS: Cognitive measures included the Iowa Gambling Task (IGT), Wisconsin Card Sorting Test (WCST), Stroop test, Digit Span, and Hopkins Verbal Learning Test (HVLT-R). Treatment outcomes consisted of longitudinal assessment using the Hamilton Depression Rating Scale (HAM-D) and World Health Organization Disability Assessment Schedule 2.0 (WHODAS). RESULTS: Linear mixed effects models showed that baseline executive functioning did not predict improvement in HAM-D scores. Better Stroop performance was associated with improved WHODAS scores. Paired t-tests revealed pre- and post-treatment improvement in executive functioning test performance as measured by the IGT (Total Money subscale; p = 0.002) and Stroop test (p = 0.002) across 9 weeks of both treatments. CONCLUSIONS: Baseline cognitive functions, including executive function, did not influence reduction in depressive symptoms during brief psychotherapies. Brief psychotherapies may improve aspects of executive function such as decision-making related to reward. CLINICALTRIALSGOV IDENTIFIER: NCT0208G201.
