Title:Cognitive Dysfunction in Major Depressive Disorder: A State-of-the-Art Clinical Review
Volume: 13
Issue: 10
Author(s): Beatrice Bortolato, Andre F. Carvalho and Roger S. McIntyre
Affiliation:
Keywords:
Antidepressant, cognitive dysfunction, psychosocial functioning, Major depressive disorder, recovery, treatment.
Abstract: Major depressive disorder (MDD) is a prevalent and recurring mental disorder often associated with high rates
of non-recovery and substantial consequences on psychosocial outcome. Cognitive impairment is one of the most frequent
residual symptoms of MDD. The persistence of cognitive impairment even in remitted phases of the disorder, notably in
the domains of executive function and attention, suggests that it may serve as a mediational nexus between MDD and
poor functional outcome, accounting for occupational and relational difficulties regardless of clinical improvement on
depressive symptoms. The critical impact of cognitive deficits on psychosocial dysfunction invites clinicians to regularly
screen and assess cognition across multiple domains, taking into account also clinical correlates of cognitive dysfunction
in MDD. Despite the availability of several instruments for the screening and assessment of cognitive dysfunction, the
lack of consensus guiding the choice of appropriate instruments increases the likelihood to underestimate cognitive
dysfunction in MDD in clinical settings. On the other hand, the unsatisfactory effect of most antidepressant treatments on
cognitive deficits for many individuals with MDD calls for the development of genuinely novel therapeutic agents with
potential to target cognitive dysfunction. Notwithstanding the necessity of further investigations, this review indicates that
neuropsychological deficits (e.g., impaired executive functions) are stable markers of MDD and underscores the need for
the development of integrative and multi-modal strategies for the prevention and treatment of neuropsychological
impairments in MDD.
