Clinical characteristics associated with the discrepancy between subjective and objective cognitive impairment in depression

TY - JOUR

T1 - Clinical characteristics associated with the discrepancy between subjective and objective cognitive impairment in depression

AU - Petersen, Jeff Zarp

AU - Porter, Richard J.

AU - Miskowiak, Kamilla Woznica

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Patients with unipolar disorder (UD) commonly experience cognitive dysfunction during symptomatic and remitted phases. However, it is not necessarily the patients with the greatest subjective complaints, who display the largest objectively-measured deficits on neuropsychological tests. Objective: This report investigated the demographic and clinical factors associated with the discrepancy between subjective and objective measures of cognition in two separate depressed patient populations in Denmark and New Zealand, respectively, using a new methodology. Methods: Data from 137 depressed patients and 103 healthy controls including neuropsychological test scores, self-reported cognitive difficulties, and ratings of mood were pooled from two studies conducted in Copenhagen, Denmark, and Christchurch, New Zealand, respectively. Cognitive discrepancy scores were calculated using a novel methodology, with positive values indicating disproportionately more subjective than objective difficulties (i.e., “sensitivity”) and negative values indicating more objective than subjective impairments (i.e., “stoicism”). Results: In the Danish partially remitted patient sample, greater ‘sensitivity’ was associated with more subsyndromal depression severity (standardized Beta (std. β)= 0.4, p < 0.01)), illness duration (std. β = 0.4, p < 0.01), and younger age (std. β = 0.6, p < 0.001). This association was replicated in the New Zealand sample of more symptomatic patients (p-values ≤ 0.05). Limitations: The cross-sectional design hampered causal inferences. We had obtained different measures of objective and subjective cognition from the two studies. Conclusions: Patients with more depressive symptoms and younger age overreported cognitive impairments across all illness states. The use of an objective cognition screener thus seems particularly relevant for these patients to assess whether subjective complaints are accompanied by measurable cognitive deficits.

AB - Background: Patients with unipolar disorder (UD) commonly experience cognitive dysfunction during symptomatic and remitted phases. However, it is not necessarily the patients with the greatest subjective complaints, who display the largest objectively-measured deficits on neuropsychological tests. Objective: This report investigated the demographic and clinical factors associated with the discrepancy between subjective and objective measures of cognition in two separate depressed patient populations in Denmark and New Zealand, respectively, using a new methodology. Methods: Data from 137 depressed patients and 103 healthy controls including neuropsychological test scores, self-reported cognitive difficulties, and ratings of mood were pooled from two studies conducted in Copenhagen, Denmark, and Christchurch, New Zealand, respectively. Cognitive discrepancy scores were calculated using a novel methodology, with positive values indicating disproportionately more subjective than objective difficulties (i.e., “sensitivity”) and negative values indicating more objective than subjective impairments (i.e., “stoicism”). Results: In the Danish partially remitted patient sample, greater ‘sensitivity’ was associated with more subsyndromal depression severity (standardized Beta (std. β)= 0.4, p < 0.01)), illness duration (std. β = 0.4, p < 0.01), and younger age (std. β = 0.6, p < 0.001). This association was replicated in the New Zealand sample of more symptomatic patients (p-values ≤ 0.05). Limitations: The cross-sectional design hampered causal inferences. We had obtained different measures of objective and subjective cognition from the two studies. Conclusions: Patients with more depressive symptoms and younger age overreported cognitive impairments across all illness states. The use of an objective cognition screener thus seems particularly relevant for these patients to assess whether subjective complaints are accompanied by measurable cognitive deficits.

KW - Cognition

KW - Cognitive dysfunction

KW - Depression

KW - Neuropsychology

KW - Objective

KW - Subjective

KW - Unipolar disorder

U2 - 10.1016/j.jad.2018.12.105

DO - 10.1016/j.jad.2018.12.105

M3 - Journal article

C2 - 30623822

AN - SCOPUS:85059526811

SN - 0165-0327

VL - 246

SP - 763

EP - 774

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -