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Regular Article |
Received January 26, 2001; revised April 11, 2001; accepted April 13, 2001. From the Joan and Sanford I. Weill Medical College of Cornell University, White Plains, New York. Address correspondence to Dr. Alexopoulos, Director, Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605.
It has been proposed that a "depression–executive dysfunction (DED) syndrome" occurs in late life. This assertion was based on clinical, neuropathological, and neuroimaging findings suggesting that frontostriatal dysfunctions contribute to the development of both depression and executive dysfunction and influence the course of depression. The authors describe the clinical presentation of DED and its relationship to disability, studying 126 elderly subjects with major depression and evaluating depressive symptoms, cognitive functioning, disability, and personality dimensions. Patients with the DED syndrome had reduced fluency, impaired visual naming, paranoia, loss of interest in activities, and psychomotor retardation, but showed a rather mild vegetative syndrome. Depressive symptomatology, and especially psychomotor retardation and loss of interest in activities, contributed to disability in DED patients, whereas paranoia was associated with disability independently of executive dysfunction. These findings may aid clinicians in identifying patients needing vigilant follow-up, because depression with executive dysfunction was found to be associated with disability, poor treatment response, relapse, and recurrence.
Key Words: Depression • Executive Dysfunction Syndrome • Clinical Diagnosis
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