Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T00:23:40.520Z Has data issue: false hasContentIssue false

Successful computer-assisted cognitive remediation therapy in patients with unipolar depression: a proof of principle study

Published online by Cambridge University Press:  05 July 2007

SAFA ELGAMAL
Affiliation:
McMaster University, Hamilton, Ontario, Canada
MARGARET C. McKINNON
Affiliation:
McMaster University, Hamilton, Ontario, Canada
KARUNA RAMAKRISHNAN
Affiliation:
McMaster University, Hamilton, Ontario, Canada
RUSSELL T. JOFFE
Affiliation:
University of Medicine and Dentistry New Jersey, Newark, NJ, USA
GLENDA MacQUEEN*
Affiliation:
McMaster University, Hamilton, Ontario, Canada
*
*Address for correspondence: G. MacQueen, M.D., Ph.D., St Joseph's Center for Mental Health Services, D1, Mood Disorders Program, 100 West 5th St, Hamilton, ON, CanadaL8N 3K7. (Email: [email protected])

Abstract

Background

Despite increasing awareness of the extent and severity of cognitive deficits in major depressive disorder (MDD), trials of cognitive remediation have not been conducted. We conducted a 10-week course of cognitive remediation in patients with long-term MDD to probe whether deficits in four targeted cognitive domains, (i) memory, (ii) attention, (iii) executive functioning and (iv) psychomotor speed, could be improved by this intervention.

Method

We administered a computerized cognitive retraining package (PSSCogReHab) with demonstrated efficacy to 12 stable patients with recurrent MDD. Twelve matched patients with MDD and a group of healthy control participants were included for comparison; neither comparator group received the intervention that involved stimulation of cognitive functions through targeted, repetitive exercises in each domain.

Results

Patients who received cognitive training improved on a range of neuropsychological tests targeting attention, verbal learning and memory, psychomotor speed and executive function. This improvement exceeded that observed over the same time period in a group of matched comparisons. There was no change in depressive symptom scores over the course of the trial, thus improvement in cognitive performance occurred independent of other illness variables.

Conclusions

These results provide preliminary evidence that improvement of cognitive functions through targeted, repetitive exercises is a viable method of cognitive remediation in patients with recurrent MDD.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bell, M., Bryson, G., Greig, T., Corcoran, C. & Wexler, B. E. (2001). Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance. Archives of General Psychiatry 58, 763768.Google Scholar
Bell, M., Bryson, G. & Wexler, B. E. (2003). Cognitive remediation of working memory deficits: durability of training effects in severely impaired and less severely impaired schizophrenia. Acta Psychiatrica Scandinavica 108, 101109.CrossRefGoogle ScholarPubMed
Benton, A., Hamsher, K. & Sivan, A. B. (1983). Multilingual Aphasia Examination. AJA Associates: Iowa City, IA.Google Scholar
Bracy, O. L. (1994). PSSCogReHab Version 95: Technical Manual. Psychological Software Services: Indianapolis, IA.Google Scholar
Chen, S. H., Thomas, J. D., Glueckauf, R. L. & Bracy, O. L. (1997). The effectiveness of computer-assisted cognitive rehabilitation for persons with traumatic brain injury. Brain Injury 11, 197209.Google ScholarPubMed
Delis, D. C., Karmaer, J. H., Kaplan, E. & Ober, B. A. (1987). California Verbal Learning Test: Research Edition, Adult Version. The Psychological Corporation: New York.Google Scholar
First, M. B., Spritzer, R. L., Gibbon, M. & Williams, J. B. W. (2001). Structured Clinical Interview for DSM-IV-TR Axis 1 Disorders – Patient Edition. New York Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Fiszdon, J. M., Bryson, G. J., Wexler, B. E. & Bell, M. D. (2004). Durability of cognitive remediation training in schizophrenia: performance on two memory tasks at 6-month and 12-month follow-up. Psychiatry Research 125, 17.Google Scholar
Fossati, P., Ergis, A. M. & Allilaire, J. F. (2002). Executive functioning in unipolar depression: a review. Encephale 28, 97107.Google ScholarPubMed
Fossati, P., Harvey, P. O., Le Bastard, G., Ergis, A. M., Jouvent, R. & Allilaire, J. F. (2004). Verbal memory performance of patients with a first depressive episode and patients with unipolar and bipolar recurrent depression. Journal of Psychiatric Research 38, 137144.Google Scholar
Garcia-Toro, M., Talavera, J. A., Gonzalez, E., Tejada, P., Blanco, C., Gonzalez, A. & Saiz-Ruiz, J. (2003). Audioverbal cognitive dysfunction in depression. Factors involved. Progress in Neuropsychopharmacologyy and Biological Psychiatry 27, 3742.Google Scholar
Gorlyn, M., Keilp, J. G., Oquendo, M. A., Burke, A. K., Sackeim, H. A. & John, M. J. (2006). The WAIS-III and major depression: absence of VIQ/PIQ differences. Journal of Clinical and Experimental Neuropsychology 28, 11451157.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 5662.CrossRefGoogle ScholarPubMed
Harvey, P. O., Le Bastard, G., Pochon, J. B., Levy, R., Allilaire, J. F., Dubois, B. & Fossati, P. (2004). Executive functions and updating of the contents of working memory in unipolar depression. Journal of Psychiatric Research 38, 567576.Google Scholar
Hogarty, G. E., Flesher, S., Ulrich, R., Carter, M., Greenwald, D., Pogue-Geile, M., Kechavan, M., Cooley, S., DiBarry, A. L., Garrett, A., Parepally, H. & Zoretich, R. (2004). Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. Archives of General Psychiatry 61, 866876.Google Scholar
Kessler, R. C., Akiskal, H. S., Ames, M., Birnbaum, H., Greenberg, P., Hirschfield, R. M. A., Jin, R., Merikangas, K. R., Simon, G. E. & Wang, P. S. (2006). Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. American Journal of Psychiatry 163, 15611568.CrossRefGoogle Scholar
Lampe, I. K., Sitskoorn, M. M. & Heeren, T. J. (2004). Effects of recurrent major depressive disorder on behavior and cognitive function in female depressed patients. Psychiatry Research 125, 7379.Google Scholar
Landro, N. I., Stiles, T. C. & Sletvold, H. (2001). Neuropsychological function in nonpsychotic unipolar major depression. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 14, 233240.Google ScholarPubMed
Levine, B., Robertson, I. H., Clare, L., Carter, G., Hong, J., Wilson, B. A., Duncan, J. & Stuss, D. T. (2000). Rehabilitation of executive functioning: an experimental-clinical validation of goal management training. Journal of the International Neuropsychological Society 6, 299312.CrossRefGoogle ScholarPubMed
Levine, B., Stuss, D. T., Wincur, G., Binns, M. A., Fahy, L., Mandic, M., Bridges, K. & Robertson, I. H. (2007). Cognitive rehabilitation in the elderly: effects on strategic behavior in relation to goal management. Journal of the International Neuropsychological Society 13, 143152.Google Scholar
MacQueen, G. M., Campbell, S., McEwen, B. S., Macdonald, K., Amano, S., Joffe, R. T., Nahmias, C. & Young, L. T. (2003). Course of illness, hippocampal function, and hippocampal volume in major depression. Proceedings of the National Academy of Sciences USA 100, 13871392.Google Scholar
MacQueen, G. M., Galway, T. M., Hay, J., Young, L. T. & Joffe, R. T. (2002). Recollection memory deficits in patients with major depressive disorder predicted by past depressions but not current mood state or treatment status. Psychological Medicine 32, 251258.CrossRefGoogle ScholarPubMed
Mesulam, M. M. (2002). The human frontal lobes: transcending the default mode through contingent encoding. In Principles of Frontal Lobe Function (ed. Stuss, D. T. and Knight, R.), pp. 830. Oxford University Press: New York.CrossRefGoogle Scholar
Nelson, H. E. & Willison, J. R. (1991). National Adult Reading Test. NFER-Nelson: Windsor, ON.Google Scholar
Paelecke-Habermann, Y., Pohl, J. & Leplow, B. (2005). Attention and executive functions in remitted major depression patients. Journal of Affective Disorders 89, 125135.Google Scholar
Paradiso, S., Lamberty, G. J., Garvey, M. J. & Robinson, R. G. (1997). Cognitive impairment in the euthymic phase of chronic unipolar depression. Journal of Nervous and Mental Disease 185, 748754.Google Scholar
Reitan, R. & Wolfson, D. (1985). The Halstead–Reitan Neuropsychological Test Battery. The Neuropsychological Press: Tucson, AZ.Google Scholar
Robertson, I. H. & Murre, J. M. (1999). Rehabilitation of brain damage: brain plasticity and principles of guided recovery. Psychological Bulletin 125, 544575.Google Scholar
Robins, L. N. & Regier, D. A. (eds) (1990). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. The Free Press: New York.Google Scholar
Roediger, H. L. & McDermot, K. B. (1992). Depression and implicit memory: a commentary. Journal of Abnormal Psychology 101, 587591.Google Scholar
Ruff, R. M. & Allen, C. C. (1996). Ruff 2&7 Selective Attention Test. Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Salthouse, T. A. (2006). Mental exercise and mental aging. Perspectives on Psychological Science 1, 6887.CrossRefGoogle ScholarPubMed
Sevigny, M. C., Everett, J. & Grondin, S. (2003). Depression, attention, and time estimation. Brain and Cognition 53, 351353.CrossRefGoogle ScholarPubMed
Stordal, K. I., Lundervold, A. J., Egeland, J., Mykletun, A., Asbjornsen, A., Landro, N. I., Roness, A., Rund, B. R., Sundet, K., Oedegaard, K. J. & Lund, A. (2004). Impairment across executive functions in recurrent major depression. Nordic Journal of Psychiatry 58, 4147.Google Scholar
Ueland, T. & Rund, B. R. (2004). A controlled randomized treatment study: the effects of a cognitive remediation program on adolescents with early onset psychosis. Acta Psychiatrica Scandinavica 109, 7074.Google Scholar
van der Gaag, G. M., Kern, R. S., van den Bosch, R. J. & Liberman, R. P. (2002). A controlled trial of cognitive remediation in schizophrenia. Schizophrenia Bulletin 28, 167176.CrossRefGoogle ScholarPubMed
Veiel, H. O. (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology 19, 587603.CrossRefGoogle ScholarPubMed
Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd edn). The Psychological Corporation: San Antonio, TX.Google Scholar
Willis, S. L., Tennstedt, S. L., Marsiske, M., Ball, K., Elias, J., Koepke, K. M., Morris, J. N., Rebok, G. W., Unverzagt, F. W., Stoddard, A. M. & Wright, E.; ACTIVE Study Group (2006). Long-term effects of cognitive training on everyday functional outcomes in older adults. Journal of the American Medical Association 296, 28052814.Google Scholar
Winocur, G., Moscovitch, M., Fogel, S., Rosenbaum, R. S. & Sekeres, M. (2005). Preserved spatial memory after hippocampal lesions: effects of extensive experience in a complex environment. Nature Neuroscience 8, 273275.CrossRefGoogle Scholar
Young, R. C., Biggs, J. T., Ziegler, V. E. & Meyer, D. A. (1978). A rating scale for mania: reliability, validity and sensitivity, British Journal of Psychiatry 133, 429435.CrossRefGoogle ScholarPubMed
Zakzanis, K. K., Leach, L. & Kaplan, E. (1998). On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 11, 111119.Google Scholar