TY - JOUR
T1 - Executive function predicts antidepressant treatment noncompletion in late-life depression
AU - Cristancho, Pilar
AU - Lenze, Eric J.
AU - Dixon, David
AU - Miller, J. Philip
AU - Mulsant, Benoit H.
AU - Reynolds, Charles F.
AU - Butters, Meryl A.
N1 - Funding Information:
Submitted: November 30, 2016; accepted August the University of Toronto. Additional funding was across the life span. Gerontologist. 31, 2017. provided by the University of Pittsburgh Medical 1997;37(5):609–619.PubMed CrossRef Publishedonline:April 3, 2018. Center Endowment in Geriatric Psychiatry, Taylor 4. Hildebrand C, Taylor M, Bradway C. Elder self-Potential conflicts of interest:Dr Mulsant Family Institute for Innovative Psychiatric Research, neglect: the failure of coping because of currently receives research support from Brain Center for Brain Research in Mood Disorders, cognitive and functional impairments. J Am Canada,theCanadianInstitutesofHealthResearch,NationalCenterforAdvancingTranslational Assoc Nurse Pract.2014;26(8):452–462.PubMed the Centre for Addiction and Mental Health (CAMH) Sciences, and the Campbell Family Mental Health Kavanagh NT, Schiller B, Saxena AB, et al. Foundation,thePatient-CenteredOutcomes Research Institute. Pfizer provided venlafaxine XR Prevalence and correlates of functional Research Institute (PCORI), the US National for the study. dependence among maintenance dialysis Institutes of Health (NIH), Eli Lilly (medications for Roleofthesponsor:Fundingagenciesdidnot patients.HemodialInt. 2015;19(4):593–600.PubMedCrossRef a NIH-funded clinical trial), Pfizer (medications participate in study design; conduct, collection, Diamond A. Executive functions. Annu Rev for a NIH-funded clinical trial), Capital Solution management, analysis, or interpretation of the Psychol. 2013;64(1):135–168.PubMed CrossRef Design LLC (software used in a study founded by data; or preparation, review, or approval of the Banich MT, Compton RJ. Cognitive CAMH Foundation), and HAPPYneuron (software manuscript. Neuroscience. 3rd edition. Belmont, California: used in a study founded by Brain Canada); within Supplementary material: See accompanying Wadworth; 2011. the past 5 years, he has also received research pages. Miller EK, Cohen JD. An integrative theory of support from Bristol-Myers Squibb (medications prefrontal cortex function. Annu Rev Neurosci. for a NIH-funded clinical trial) and Pfizer/Wyeth 2001;24(1):167–202.PubMed CrossRef (medications for a NIH-funded clinical trial), and he Duncan J, Owen AM. Common regions of the owns stocks of General Electric (less than $5,000). Alvarez JA, Emory E. Executive function and human frontal lobe recruited by diverse Drs Cristancho, Lenze, Dixon, Reynolds, and the frontal lobes: a meta-analytic review. cognitive demands. Trends Neurosci. Butters and Mr Miller have no conflicts of interest Neuropsychol Rev. 2006;16(1):17–42.PubMed CrossRef 2000;23(10):475–483.PubMed CrossRef to disclose. Snyder HR. Major depressive disorder is Rajji TK, Sun Y, Zomorrodi-Moghaddam R, et al. Funding/support: Research reported in this associated with broad impairments on PAS-induced potentiation of cortical-evoked publication was supported by National Institute neuropsychological measures of executive activity in the dorsolateral prefrontal cortex. of Mental Health grants P30MH090333, P50 function: a meta-analysis and review. Psychol Neuropsychopharmacology. AG005133, and R01 MH083660 to the University Bull. 2013;139(1):81–132.PubMed CrossRef 2013;38(12):2545–2552.PubMed CrossRef of Pittsburgh, R01 MH083648 and R34MH101433 Morrell RW, Park DC, Kidder DP, et al. Mulsant BH, Ganguli M. Epidemiology and to Washington University; and R01 MH083643 to Adherence to antihypertensive medications diagnosis of depression in late life. J Clin
Funding Information:
Research reported in this publication was supported by National Institute of Mental Health grants P30MH090333, P50 AG005133, and R01 MH083660 to the University of Pittsburgh, R01 MH083648 and R34MH101433 to Washington University; and R01 MH083643 to the University of Toronto. Additional funding was provided by the University of Pittsburgh Medical Center Endowment in Geriatric Psychiatry, Taylor Family Institute for Innovative Psychiatric Research, Center for Brain Research in Mood Disorders, National Center for Advancing Translational Sciences, and the Campbell Family Mental Health Research Institute. Pfizer provided venlafaxine XR for the study.
Publisher Copyright:
© Copyright 2018 Physicians Postgraduate Press, Inc.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Objective: To examine whether executive function (EF) is associated with nonremission and noncompletion of antidepressant pharmacotherapy in older adults with depression. Design: In this prospective study (July 2009 to May 2014), older adults (aged ≥ 60 years; n = 468) with a DSM-IV-defined major depressive episode diagnosed via structured interview received 12 weeks of venlafaxine extended release with the goal of achieving remission. A hypothesis was made that worse baseline EF would predict both nonremission and noncompletion (primary outcomes). Treatment-related factors, including side effects and nonadherence, were also studied. Methods: Baseline EF, including response inhibition and set-shifting, was assessed with subtests of the Delis-Kaplan Executive Function System and the semantic fluency subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Attention, immediate memory, delayed memory, visuospatial ability, and global cognition were also assessed with the RBANS. Results: Of 468 participants, 96 (21%) failed to complete the treatment trial, 191 (41%) completed and remitted, and 181 (39%) completed and did not remit. Univariate analyses indicated that some EFs (setshifting and semantic fluency) and other cognitive variables (attention, immediate memory, visuospatial ability, and global cognition) predicted treatment noncompletion, whereas no cognitive variables predicted nonremission. In a multivariate logistic regression model, semantic fluency (P = .003), comorbid medical burden (P < .001), and early nonadherence (P < .001) were significant predictors of treatment noncompletion. Conclusions: Poorer EF predicted treatment noncompletion. These findings suggest that EFs of initiation and set maintenance (examined by the semantic fluency task) may allow depressed elderly individuals to engage and stay in treatment. Identification of those at risk for noncompletion may help implementation strategies for personalized care.
AB - Objective: To examine whether executive function (EF) is associated with nonremission and noncompletion of antidepressant pharmacotherapy in older adults with depression. Design: In this prospective study (July 2009 to May 2014), older adults (aged ≥ 60 years; n = 468) with a DSM-IV-defined major depressive episode diagnosed via structured interview received 12 weeks of venlafaxine extended release with the goal of achieving remission. A hypothesis was made that worse baseline EF would predict both nonremission and noncompletion (primary outcomes). Treatment-related factors, including side effects and nonadherence, were also studied. Methods: Baseline EF, including response inhibition and set-shifting, was assessed with subtests of the Delis-Kaplan Executive Function System and the semantic fluency subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Attention, immediate memory, delayed memory, visuospatial ability, and global cognition were also assessed with the RBANS. Results: Of 468 participants, 96 (21%) failed to complete the treatment trial, 191 (41%) completed and remitted, and 181 (39%) completed and did not remit. Univariate analyses indicated that some EFs (setshifting and semantic fluency) and other cognitive variables (attention, immediate memory, visuospatial ability, and global cognition) predicted treatment noncompletion, whereas no cognitive variables predicted nonremission. In a multivariate logistic regression model, semantic fluency (P = .003), comorbid medical burden (P < .001), and early nonadherence (P < .001) were significant predictors of treatment noncompletion. Conclusions: Poorer EF predicted treatment noncompletion. These findings suggest that EFs of initiation and set maintenance (examined by the semantic fluency task) may allow depressed elderly individuals to engage and stay in treatment. Identification of those at risk for noncompletion may help implementation strategies for personalized care.
UR - http://www.scopus.com/inward/record.url?scp=85049447285&partnerID=8YFLogxK
U2 - 10.4088/JCP.16m11371
DO - 10.4088/JCP.16m11371
M3 - Article
C2 - 29659205
AN - SCOPUS:85049447285
SN - 0160-6689
VL - 79
JO - Journal of Clinical Psychiatry
JF - Journal of Clinical Psychiatry
IS - 3
M1 - 16m11371
ER -