Depression and affective disorders

Cognitive deficits are often seen in individuals with mood disorders, potentially reflecting underlying dysfunction of monoamine neurochemical systems¹ and emotional processing circuitry². Our recommended test battery for depression and affective disorders assesses key cognitive domains often impaired in mood disorders, as well as those likely to be affected by interventions.

The tests within this battery have been shown to discriminate the neuropsychological profile of bipolar disorder from unipolar depression³, as well as be sensitive to the effects of different interventions in patients⁴. Impaired performance on these tests correlated significantly with abnormal thinning of the cortex in young people with bipolar disorder⁵, demonstrating their sensitivity to disease-specific neuropathology. Cognitive performance on these tests also correlates with quality of life, even early in the course of bipolar disorder, making the battery not only biologically but also clinically relevant for mood disorders⁶.

Measures

• Feedback sensitivity
• Emotion recognition
• Executive function
• Sustained attention
• Episodic memory

CANTAB Tests

• Rapid Visual Information Processing (RVP): 7 minutes
• Delayed Matching to Sample (DMS): 7 minutes
• Spatial Working Memory (SWM): 4 minutes
• One Touch Stockings of Cambridge (OTS): 10 minutes
• Emotion Recognition Task (ERT): 6 minutes
• Match to Sample Visual Search (MTS): 7 minutes

Research

A meta-analysis by Rock et al (2014) highlighted that cognitive impairment is still observed in individuals that had previously experienced a depressive episode, despite remission of their mood symptoms. The CANTAB tests demonstrated high sensitivity to cognitive dysfunction in depression, with moderate impairments seen in attention, memory and executive function.¹

_{Abbreviated from Rock et al., (2014).}

Key References

Clark L, Chamberlain SR, Sahakian BJ. Neurocognitive mechanisms in depression: implications for treatment. Annu Rev Neurosci. 2009;32:57-74.

Ressler KJ, Mayberg HS. Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic. Nat Neurosci. 2007 Sep;10(9):1116-24.

Drevets WC, Price JL, Simpson JR Jr, Todd RD, Reich T, Vannier M, Raichle ME. Subgenual prefrontal cortex abnormalities in mood disorders. Nature. 1997 Apr 24;386(6627):824-7.

Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med. 2014 Jul;44(10):2029-40.

Grady MM, Stahl SM. Novel agents in development for the treatment of depression. CNS Spectr. 2013 Dec;18 Suppl 1:37-40; quiz 41.

Pringle A, Browning M, Cowen PJ, Harmer CJ. A cognitive neuropsychological model of antidepressant drug action. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Aug 15;35(7):1586-92.Measures

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1. _{Grady MM, Stahl SM. Novel agents in development for the treatment of depression. CNS Spectr. 2013 Dec;18 Suppl 1:37-40; quiz 41.}
2. _{Ressler KJ, Mayberg HS. Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic. Nat Neurosci. 2007 Sep;10(9):1116-24.}
3. _{Maalouf FT, Klein C, Clark L, Sahakian BJ, Labarbara EJ, Versace A, Hassel S, Almeida JR, Phillips ML. Impaired sustained attention and executive dysfunction: bipolar disorder versus depression-specific markers of affective disorders. Neuropsychologia. 2010 May;48(6):1862-8. doi: 10.1016/j.neuropsychologia.2010.02.015. Epub 2010 Feb 20.}
4. _{Muralidharan K, Kozicky JM, Bücker J, Silveira LE, Torres IJ, Yatham LN. Are cognitive deficits similar in remitted early bipolar I disorder patients treated with lithium or valproate? Data from the STOP-EM study. Eur Neuropsychopharmacol. 2015 Feb;25(2):223-30.}
5. _{Hatton SN, Lagopoulos J, Hermens DF, Scott E, Hickie IB, Bennett MR. Cortical thinning in young psychosis and bipolar patients correlate with common neurocognitive deficits. Int J Bipolar Disord. 2013 Apr 17;1:3. doi: 10.1186/2194-7511-1-3. eCollection 2013.}
6. _{Mackala SA, Torres IJ, Kozicky J, Michalak EE, Yatham LN. Cognitive performance and quality of life early in the course of bipolar disorder. J Affect Disord. 2014 Oct;168:119-24.}