Executive dysfunction and long-term outcomes of geriatric depression

Background: This study investigated the relationship of executive and memor y impairment to relapse, recurrence, and course of residual depressive symp toms and signs after remission of geriatric major depression. Methods: Fifty-eight elderly subjects remitted from major depression receiv ed continuation nortriptyline treatment (plasma levels 60-150 ng/mL) for 16 weeks and then were randomly assigned to either nortriptyline maintenance therapy or placebo for up to 2 years. Diagnosis was made using the Research Diagnostic Criteria and the DSM-IV criteria after an interview using the S chedule for Affective Disorders and Schizophrenia. Executive dysfunction an d memory were assessed with the Dementia Rating Scale, disablity and social support were rated with the Philadelphia Multiphasic Instrument, and medic al burden was assessed with the Cumulative Illness Rating Scale. Results: Abnormal initiation and perseveration scores, but not memory impai rment, were associated with relapse and recurrence of geriatric depression and with fluctuations of depressive symptoms in the whole group and in subj ects who never met criteria for relapse or recurrence during the follow-up period. Memory impairment, disability, medical burden, social support, and history of previous episodes did not significantly influence the outcome of depression in this sample. Conclusions: Executive dysfunction was found to be associated with relapse and recurrence of geriatric major depression and with residual depressive s ymptoms. These observations, if confirmed, will aid clinicians in identifyi ng patients in need of vigilant follow-up. The findings of this study provi de the rationale for investigation of the role of specific prefrontal pathw ays in predisposing or perpetuating depressive syndromes or symptoms in eld erly patients.