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Executive Functioning, Illness Course, and Relapse/Recurrence in Continuation and Maintenance Treatment of Late-Life Depression

Is There a Relationship?

Received December 11, 2003; revised April 2, 2004; accepted April 7, 2004. From the Intervention Research Center for Late-Life Mood Disorders, Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA (MAB,RKB,BHM,SM,PRH,MAD,BGP,RDN,JTB,CFR), the Geriatric Research, Education, and Clinical Center (GRECC), VA Pittsburgh Health System (BHM), and the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA (SM). Send correspondence to Meryl A. Butters, Ph.D., WPIC E-464, 3811 O'Hara St., Pittsburgh, PA 15213. e-mail: buttersma{at}upmc.edu
© 2004 American Association for Geriatric Psychiatry

Objective: The authors tested the hypothesis that impaired executive functioning leads to high rates of relapse and recurrence in late-life depression. Methods: They analyzed data from subjects participating in two independent intervention trials. Study I included 53 elderly depressed patients who participated in an open trial comparing the efficacy of paroxetine and nortriptyline and recurrence prevention over 18 months. Study II focused on 146 elderly depressed patients who received open treatment with paroxetine in a relapse-prevention study over 4 months of continuation treatment. They examined the effect of cognitive functioning, in general, and executive functioning, in particular, on time-to-relapse/recurrence, using baseline and post-treatment measures of neuropsychological functioning. Results: The associations between cognitive measures and both probability of, and time-to-relapse/recurrence were small and statistically nonsignificant. Conclusion: Data failed to support the hypothesis that cognitive impairment, in general, or executive dysfunction, in particular, predicts relapse or recurrence of major depression in late life. Authors recommend future testing of the hypothesis with detailed, comprehensive measures over longer periods of observation during maintenance trials.

Key Words: Cognition • Executive Functioning • Depression

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