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Cognitive Response to Pharmacological Treatment for Depression in Alzheimer Disease

Secondary Outcomes From the Depression in Alzheimer's Disease Study (DIADS)

Received June 5, 2003; revised December 9, 2003; accepted January 22, 2004. From the Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine (CAM,JB), the Department of Biostatistics, Bloomberg School of Public Health (J-MES), the Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD, and The Copper Ridge Institute, Sykesville, MD (CAM,JB,CDS,MS,PVR,CGL). Send correspondence to Cynthia A. Munro, Ph.D., Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Meyer 218, Baltimore, MD 21287. e-mail: cmunro{at}jhmi.edu
© 2004 American Association for Geriatric Psychiatry

Objective: The authors assessed the cognitive effects of depression treatment with sertraline in patients with Alzheimer disease (AD) and major depression. Methods: Forty-four patients with probable AD and major depression were enrolled in a double-blind, placebo-controlled clinical trial of sertraline. Cognitive testing was done at baseline and at 3-week intervals throughout the 12-week study. At the 12th week, subjects were categorized by treatment response (full, partial, or no response). Cognitive data from 41 participants who completed three or more testing sessions and 36 who completed all five study visits were included in the analyses. Results: Neither improved mood nor use of sertraline was associated with cognitive change over time in AD patients. Post-hoc exploration of the data, however, suggested a sex difference in cognitive response to sertraline such that women treated with sertraline demonstrated improved cognition compared with women on placebo, whereas men treated with sertraline worsened significantly in cognition compared with men on placebo. Conclusions: In this study, among depressed AD patients after treatment with sertraline or placebo, there was no evidence that improved mood was associated with cognitive improvement. Future studies aimed at increasing power to detect mood as well as medication effects will be valuable in determining the relationship between cognition and treatment of depression in AD patients.

Key Words: Alzheimer Disease • Cognitive Impairment • Dementia • Antidepressants • Depression • Sertraline

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