ASSOCIAÇÃO ENTRE A SEVERIDADE DOS SINTOMAS DEPRESSIVOS E O FUNCIONAMENTO EXECUTIVO DE IDOSOS COM DEPRESSÃO: UMA REVISÃO SISTEMÁTICA

Monteiro, Suzana; Monteiro, Bárbara; Candida, Maristela; Adler, Nathalia; Campos, Carlos; Rocha, Nuno Barbosa F.; Paes, Flávia; Nardi, Antônio Egidio; Machado, Sergio

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REVIEW • MedicalExpress (São Paulo, online) 3 (6) • Nov-Dec 2016 • https://doi.org/10.5935/MedicalExpress.2016.06.01 copiar

ASSOCIAÇÃO ENTRE A SEVERIDADE DOS SINTOMAS DEPRESSIVOS E O FUNCIONAMENTO EXECUTIVO DE IDOSOS COM DEPRESSÃO: UMA REVISÃO SISTEMÁTICA

Autoria SCIMAGO INSTITUTIONS RANKINGS

OBJETIVO:

A depressão de início tardio é uma doença subdiagnosticada e subtratada que reduz o bem-estar da pessoa idosa. A disfunção executiva é outra alteração crítica em idosos deprimidos, perturbando ainda mais o seu funcionamento diário. Esta revisão sistemática tem como objetivo analisar a associação entre o funcionamento executivo e a severidade dos sintomas depressivos em idosos diagnosticados com transtorno depressivo major.

MÉTODOS:

Foi realizada uma busca nas bases de dados MEDLINE/PubMed, ISI Web of Knowledge e PsychInfo utilizando os termos "depression", "executive function", "neuropsychological assessment", "elderly" e "late life". A seleção, classificação dos estudos e coleta de dados foram realizadas por dois avaliadores independentes.

RESULTADOS:

Foram encontrados 1130 artigos, mas apenas 8 estudos preencheram os critérios de elegebilidade. Três avaliaram a associação entre a severidade dos sintomas e o funcionamento executivo. Seis dos 8 estudos encontraram uma associação entre a severidade dos sintomas e o funcionamento executivo, com correlações de diversas magnitudes (r= -0,15 a -0,53). Os artigos incluídos apresentaram várias limitações metodológicas, tais como descrição seletiva de dados, avaliação não compreensiva do funcionamento executivo e falha no controlo de possíveis vieses.

CONCLUSÃO:

A severidade dos sintomas depressivos pode ser fortemente correlacionada com um conjunto específico de habilidades executivas, embora pareça também existir uma associação mais ampla com o funcionamento executivo como um todo. Recomenda-se a realização de estudos prospetivos com o fim de compreender a relação causal entre a severidade dos sintomas depressivos e o funcionamento executivo, tendo em conta possíveis mediadores tais como défices cognitivos associados ao envelhecimento ou outros processos neuro-degenerativos, nível de escolaridade e outras características clínicas (idade de início da doença, medicação).

PALAVRAS-CHAVE:
depressão de início tardio; depressão geriátrica; transtorno depressivo maior; funcionamento executivo

Study	Sample	Population	Criteria	Diagnostic Tool	Age	Gender (F/M)	Education	MMSE	Age of Onset	Length of Episode	Medication
Alexopoulos et al.⁹9 Alexopoulos GS, Meyers BS, Young RC, Kalayam B, Kakuma T, Gabrielle M, et al. Executive dysfunction and long-term outcomes of geriatric depression. Arch Gen Psychiatry. 2000;57(3):285-90. http://dx.doi.org/10.1001/archpsyc.57.3.285 http://dx.doi.org/10.1001/archpsyc.57.3....	43	MDD (remitted)	DSM-IV; RDC	SCID / SADS-L HRDS-24 ≥ 18	73.3 (7.6)	27 / 16	13.7 (2.9)	28 (2.7)	67.6% with one or more previous episode	No info	Maintenance antidepressant treatment (51.2%) Placebo (48.8%)
Baudic et al.²⁴24 Baudic S, Tzortzis C, Barba GD, Traykov L. Executive deficits in elderly patients with major unipolar depression. J Geriatr Psychiatry Neurol. 2004;17(4):195-201. http://dx.doi.org/10.1177/0891988704269823 http://dx.doi.org/10.1177/08919887042698...	21	MDD (currently depressed)	DSM-IV	Clinical Interview MADRS >20	71.8 (8.8)	No info	9.6 (3.3)	28.1 (1.4)	No info	No info	Unmedicated
Boone et al.²³23 Boone KB, Lesser IM, Miller BL, Wohl M, Berman N, Lee A, et al. Cognitive Functioning in Older Depressed Outpatients: Relationships of Presence and Severity of Depression to Neuropsychological Test Scores. Neuropsychology. 1995;9(3):390-8. http://dx.doi.org/10.1037/0894-4105.9.3.390 http://dx.doi.org/10.1037/0894-4105.9.3....	73	MDD (currently depressed)	DSM-III-R	SCID	61.4 (8.6)	38/35	14.9 (3.2)	No info	47.7 (19.72)	26.3 (37.27)	Unmedicated (≥ 2 weeks)
Jungwirth et al.²⁵25 Jungwirth S, Zehetmayer S, Hinterberger M, Kudrnovsky-Moser S, Weissgram S, Tragl KH, et al. The influence of depression on processing speed and executive function in nondemented subjects aged 75. J Int Neuropsychol Soc. 2011;17(5):822-31. http://dx.doi.org/10.1017/S135561771100083X http://dx.doi.org/10.1017/S1355617711000... ^* * demographic and clinical data is regarding the pooled sample including MDD, ssD and mD participants	45	MDD currently depressed (n=13) + ssD (n=9) + mD (n=23)	DSM-IV	SCID	75.78 (0.42)	36/9	88.9% completed secondary or vocational school	No info	No info	No info	Antidepressants (33%) Benzodiazepines (24.4%)
Murphy et al.²⁶26 Murphy CF, Alexopoulos GS. Longitudinal association of initiation/perseveration and severity of geriatric depression. Am J Geriatr Psychiatry. 2004;12(1):50-6. http://dx.doi.org/10.1176/appi.ajgp.12.1.50 http://dx.doi.org/10.1176/appi.ajgp.12.1...	157	MDD (currently depressed)	DSM-IV; RDC	SADS HRDS-24 ≥ 19	72 (6.9)	93 / 64	13.21	27.61	No info	No info	No information
Sair et al.²⁰20 Sair HI, Welsh-Bohmer KA, Wagner HR, Steffens DC. Ascending digits task as a measure of executive function in geriatric depression. J Neuropsychiatry Clin Neurosci. 2006;18(1):117-20. http://dx.doi.org/10.1176/appi.neuropsych.18.1.117 http://dx.doi.org/10.1176/appi.neuropsyc...	129	MDD (currently depressed)	DSM-IV	NIMH Diagnostic Interview Schedule	73.4	76/53	14.2	27.51	# episodes 5.6 (10.3)	25.2 (29.1)	No information
Sexton et al.²¹21 Sexton CE, McDermott L, Kalu UG, Herrmann LL, Bradley KM, Allan CL, et al. Exploring the pattern and neural correlates of neuropsychological impairment in late-life depression. Psychol Med. 2012;42(6):1195-202. http://dx.doi.org/10.1017/S0033291711002352 http://dx.doi.org/10.1017/S0033291711002...	36	MDD (mainly remitted)	DSM-IV	SCID	71.8 (7.7)	24/12	13.9 (3.7)	29.9 (1.4)	45.4 (19)	No info	Antidepressants (92%) Unmedicated (6%) Other medications (2%)
Sheline et al.²²22 Sheline YI, Barch DM, Garcia K, Gersing K, Pieper C, Welsh-Bohmer K, et al. Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed. Biol Psychiatry. 2006;60(1):58-65. http://dx.doi.org/10.1016/j.biopsych.2005.09.019 http://dx.doi.org/10.1016/j.biopsych.200...	155	MDD (currently depressed)	DSM-IV	SCID	68.72 (7.28)	No accurate info	14.04 (3.12)	≥21 No info on mean	54.51 17.05	No info	Unmedicated

	Mean	N studies	Studies	N participants
Age	70.65	8	9, 20-26	659
Gender (% female)	60.87	6	9, 20,21,23,25,26	483
Education (number of schooling years)	13.78	7	9, 20-24,26	614
Mini Mental State Examination	27.86	5	9, 20,21,24,26	386
Age of Onset (years)	51.38	3	21-23	264
Length of Episode (weeks)	25.60	2	20,23	202

Study	Depression Severity	Executive Function Tests	Study Design and Statistical Procedures	Quality Scale (1 to 5)	Major Findings
Alexopoulos et al.⁹9 Alexopoulos GS, Meyers BS, Young RC, Kalayam B, Kakuma T, Gabrielle M, et al. Executive dysfunction and long-term outcomes of geriatric depression. Arch Gen Psychiatry. 2000;57(3):285-90. http://dx.doi.org/10.1001/archpsyc.57.3.285 http://dx.doi.org/10.1001/archpsyc.57.3....	HDRS-24 26.7 ± 6.4	DRS-IP	2-Year Prospective Study (Mixed-effects models)	2 Pts: gold standard diagnosis; participants clinical data	DRS-IP predicted the course of depressive symptoms (p<0.001). In patients without follow-up recurrence IP was also associated with HDRS-24 (p>0.009).
Baudic et al.²²22 Sheline YI, Barch DM, Garcia K, Gersing K, Pieper C, Welsh-Bohmer K, et al. Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed. Biol Psychiatry. 2006;60(1):58-65. http://dx.doi.org/10.1016/j.biopsych.2005.09.019 http://dx.doi.org/10.1016/j.biopsych.200...	MADRS 33.3 ± 6.3 GDS-30 22.1 ± 4.9	COWAT; CET; Hayling Test; Stroop; TMT-B; GSL; WCST	Cross-sectional (Bivariate correlation)	3 Pts: no potential cofounders; no selective reporting; comprehensive assessment	No significant correlations between GDS and executive functioning; Significant correlations (p<0.05) between MADRS and COWAT (r=-0.52), WCST(r=-0.47); TMT-B (r=-0.44) & Hayling Test-B (r=0.53).
Boone et al.²¹21 Sexton CE, McDermott L, Kalu UG, Herrmann LL, Bradley KM, Allan CL, et al. Exploring the pattern and neural correlates of neuropsychological impairment in late-life depression. Psychol Med. 2012;42(6):1195-202. http://dx.doi.org/10.1017/S0033291711002352 http://dx.doi.org/10.1017/S0033291711002...	HDRS-17 19.6 ± 5.14	Stroop; ACT; WSCT; COWAT	Cross-sectional (Bivariate correlation)	5 Pts: gold standard diagnosis; participants clinical data; no potential cofounders; no selective reporting; comprehensive assessment	Significant correlation (p<0.05) between executive functioning composite score and HDRS-17 (r=-0.15).
Jungwirth et al.²³23 Boone KB, Lesser IM, Miller BL, Wohl M, Berman N, Lee A, et al. Cognitive Functioning in Older Depressed Outpatients: Relationships of Presence and Severity of Depression to Neuropsychological Test Scores. Neuropsychology. 1995;9(3):390-8. http://dx.doi.org/10.1037/0894-4105.9.3.390 http://dx.doi.org/10.1037/0894-4105.9.3.... *	HDRS-17 12.71 ± 6.18 GDS-15 4.4 ± 2.83	TMT; Verbal Fluency	Cross-sectional (Univariate ANOVA)	1 Pt: gold standard diagnosis	Significant univariate influences of HDRS-17 and GDS on Verbal Fluency (p=0.012; p=0.018) and TMT B scores (p<0.0001; p=0.005)
Murphy et al.²⁴24 Baudic S, Tzortzis C, Barba GD, Traykov L. Executive deficits in elderly patients with major unipolar depression. J Geriatr Psychiatry Neurol. 2004;17(4):195-201. http://dx.doi.org/10.1177/0891988704269823 http://dx.doi.org/10.1177/08919887042698...	HDRS-24 25.79	DRS-IP	1-Year Prospective Study (Mixed-effects models)	1 Pt: no selective reporting	There was a significant association between concurrent HDRS-24 and DRS-IP (p<0.0001; CC=0.84).
Sair et al.¹⁸18 Santos LAA, Campos C, Bento T, Lattari E, Nardi AE, Rocha NBF, Machado S. Effects of dual-task interventions on gait performance of patients with Parkinson's Disease: A systematic review. MedicalExpress (São Paulo, online). 2016;3(4):M160401. http://dx.doi.org/10.5935/MedicalExpress.2016.04.01 http://dx.doi.org/10.5935/MedicalExpress...	MADRS 22.33 ± 7.77	ADT	Cross-sectional (Multivariate regression analysis)	2 Pts: gold standard diagnosis; no selective reporting	No significant association between MADRS score and ADT performance (p=0.58)
Sexton et al.¹⁹19 Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097 http://dx.doi.org/10.1371/journal.pmed.1...	HDRS-17 4.2 ± 4.8 GDS-15 3.8 ± 3.5	Digit Span: Letter Fluency; TMT B	Cross-sectional (Bivariate correlation)	3 Points: gold standard diagnosis; participants clinical data; no selective reporting	After controlling for age and gender, there were no significant associations between composite executive score and depression severity. (p>0.50)
Sheline et al.²⁰20 Sair HI, Welsh-Bohmer KA, Wagner HR, Steffens DC. Ascending digits task as a measure of executive function in geriatric depression. J Neuropsychiatry Clin Neurosci. 2006;18(1):117-20. http://dx.doi.org/10.1176/appi.neuropsych.18.1.117 http://dx.doi.org/10.1176/appi.neuropsyc...	MADRS 26.17 ± 4.5	Verbal Fluency; TMT-B; Strop; DRS-IP; WCST	Cross-sectional (Partial correlation analysis)	3 Pts: gold standard diagnosis; no selective reporting; comprehensive assessment	Significant association between MADRS and executive function composite score (r=-0.21; p<0.05).

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