Education did not interact with major depression on performance of memory tests in acute southern Brazilian in patients

Camozzato, Analuiza; Fleck, Marcelo Pio de Almeida; Delgado, Vera; Chaves, Marcia Lorena Fagundes

doi:10.1590/S1980-57642008DN10100005

Abstract

The relationship of cognitive function to depression in older adults has become a topic of extensive clinical interest and research.

Objective:

To analyze association between cognitive/memory performance, Major Depression, and education in 206 inpatients from the Psychiatry and Internal Medicine Departments.

Methods:

Patients were evaluated by the Mini Mental State Examination, a battery of memory tests, and the MontgomeryÅsberg Depression Rating Scale. Depression patients comprised 45 severe and 42 mild/moderate, according to the Montgomery-Asberg scale. The effect of psychoactive drugs was recorded (30% drug-free). Education was measured in years. Cognitive/memory tests assessed five domains: general mental functioning, attention, sustained attention/working memory, learning memory (verbal), and remote memory. An index for memory impairment was created (positivity: 50% of tests below cutoff).

Results:

The chief effect on worse performance was Major Depression for the domains (age and education adjusted) of attention, learning, remote memory, and general functioning. For the domain "sustained attention and working memory", only severely depressed patients differed from the medical controls (p=.008). Education showed an independent effect on test performances. No interaction between depression and educational status was observed. We also observed an independent effect of psychoactive drugs on some cognitive/ memory domains. Logistic Regression showed Major Depression as the main risk for cognitive impairment.

Conclusions:

These data demonstrated association of Major Depression with impaired cognitive performance independent of educational attainment or psychiatric medications.

Key words:
depression; neuropsychological tests; memory; cognition; education; Brazil.

Resumo

A relação entre função cognitiva com depressão em adultos mais velhos tem se tornado um tópico de grande interesse clínico e investigativo.

Objetivo:

Analisar a associação entre desempenho cognitivo/ memória, depressão maior e educação em 206 pacientes das unidades de Psiquiatria e Medicina Interna.

Métodos:

Pacientes foram avaliados pelo Mini Exame do Estado Mental, uma bateria de testes de memória e escala de depressão de Montgomery-Åsberg. Pacientes deprimidos eram 45 graves e 42 leve/moderados de acordo com a escala Montgomery-Asberg. O efeito de drogas psicoativas foi registrado (30% não usavam medicações). Educação foi registrada em anos completos de escola. Testes cognitivos/memória avaliaram cinco domínios: função mental geral, atenção, atenção sustentada/memória operante, aprendizado (verbal), e memória remota. Um índice para comprometimento de memória foi criado (positividade: 50% dos testes abaixo do ponto de corte).

Resultados:

O principal efeito para pior desempenho nos domínio de atenção, aprendizado, memória remota e função geral foi depressão maior (ajustado idade e educação). Para o domínio atenção sustentada e memória operante apenas os pacientes gravemente deprimidos diferiram dos controles clínicos (p=0,008).

Palavras-chave:
depressão; testes neuropsicológicos; memória; cognição; educação; Brasil.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Emery VO, Oxman TE. Update on the dementia spectrumof depression. Am J Psychiatry 1992;149:305-317.
²
Folstein M, McHugh P. Dementia syndrome of depression.In: Katzman R, Terry R, Bick K, editors. Alzheimer's disease: senile dementia and related disorders. New York: Raven Press, 1978:87-93.
³
Jorm AF. Cognitive deficit in the depressed elderly: A reviewof some basic and resolved issues. Aust N Z J Psychiatry 1986; 20:11-22.
⁴
Abrams R, Taylor MA. Cognitive dysfunction in melancholia. Psychol Med 1987;17:351-62.
⁵
Rund B, Landro N. Information processing: a new modelfor understanding cognitive disturbances in psychiatric patients. Acta Psychiatr Scand 1990;81:309-16.
⁶
Sternberg D, Jarvik M. Memory function in depression. Arch Gen Psychiatry 1976;33:211-24.
⁷
Stromgren LS. The influence of depression on memory. Acta Psychiatr Scand 1977;56:101-29.
⁸
Blaney PH.Affect and memory. Psychol Bull 1986;99:229-46.
⁹
Ceitlin LH, Santos BJ, Parisotto L, Zanatta MS, Chaves ML.Elaboration of word lists in Portuguese with emotional content and their influence on memory function in normal subjects. Int J Methods Psychiatr Res 1995;5:195-203.
¹⁰
Deptula D, Singh R, Pomara N. Aging, emotional states andmemory. Am J Psychiatry 1993;150:429-34.
¹¹
Jorm AF, Henderson AS. Memory bias in depression implications for risk factors studies relying on self-reports of exposure. Int J Methods Psychiatr Res 1992;2:31-38.
¹²
Beck A. Cognitive therapy and emotional disorders. NewYork: International Universities Press; 1976.
¹³
Costello C. Depression: loss of reinforcement or loss reinforces effectiveness? Behav Ther 1972;3:240-247.
¹⁴
Eelen P, Van Den Bergh O. Cognitive-behavioral models ofdepression. Acta Psychiatr Belg 1986;86:748-59.
¹⁵
Karasu TB. Toward a clinical model of psychotherapy fordepression: Systematic comparison of three psychotherapies. Am J Psychiatry 1990;147:133-147.
¹⁶
Austin MP, Mitchell P, Goodwin GM. Cognitive deficits indepression: possible implications for functional neuro-neuropathology. Br J Psychiatry 2001;178: 200-206.
¹⁷
Veiel HO. A preliminary profile of neuropsychologicaldeficits associated with major depression. J Clin Exp Neuropsychol 1997;19:587-603.
¹⁸
Ardila A, Ostrosky F, Mendoza V. Learning to read is muchmore than learning to read: a neuropsychologically-based learning to read method. J Int Neuropsychol Soc 2000;6:789-801.
¹⁹
Rosselli M, Ardila A. The impact of culture and educationon non-verbal neuropsychological measurements: A critical review. Brain Cogn 2003; 52:326-333.
²⁰
Ardila A, Rosselli M, Rosas P. Neuropsychological assessment of illiterates. Visuospatial and memory abilities. Brain Cogn 1989;11:147-166.
²¹
Nitrini R, Caramelli P, Herrera Junior E, et al. Performanceof illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004; 10:634-638.
22. Nitrini R, Caramelli P, Herrera Jr. E, Charchat-Fichman H,Porto CS. Performance in Luria's fist-edge-palm test according to educational level. Cogn Behav Neurol. 2005;18:211-214.
²³
Brucki SM, Rocha MS. Category fluency test: effects of age,gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004;37:1771-1777.
²⁴
Wenestam CG. A critique of research on cognition and cognitive processes. Br J Educ Psychol 1993;63:34-45.
²⁵
Ardila A. Cultural values underlying psychometric cognitivetesting. Neuropsychol Rev 2005;15:185-195.
²⁶
Harding TW, Climent CE, Diop M, et al. The WHO collaborative study on strategies for extending mental health care, II: the development of new research methods. Am J Psychiatry 1983; 140:1474-1480.
²⁷
Mari JJ,Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of São Paulo. Br J Psychiatry 1986;148:23-26.
²⁸
Montgomery S, Åsberg M. A new depression scale designedto be sensitive to change. Br J Psychiatry 1979;134:382-389.
²⁹
Dratcu L, Costa Ribeiro L, Calil H. Depression Assessmentin Brazil: The first application of the Montgomery-Asberg Depression Rating Scale. Br J Psychiatry 1987;150:797-800.
³⁰
Folstein M, Folstein S, McHugh P. »," ®,(r) §,§ , ¹,¹ ²,² ³,³ ß,ß Þ,Þ þ,þ ×,× Ú,Ú ú,ú Û,Û û,û Ù,Ù ù,ù ¨,¨ Ü,Ü ü,ü Ý,Ý ý,ý ¥,¥ ÿ,ÿ ¶,¶ Mini Mental State »," ®,(r) §,§ , ¹,¹ ²,² ³,³ ß,ß Þ,Þ þ,þ ×,× Ú,Ú ú,ú Û,Û û,û Ù,Ù ù,ù ¨,¨ Ü,Ü ü,ü Ý,Ý ý,ý ¥,¥ ÿ,ÿ ¶,¶ : Apractical method for grading the cognitive states of patients for the clinician. J Psychiatric Res 1975;12:189-198.
³¹
Chaves MLF and Izquierdo I. Differential diagnosis betweendementia and depression: a study of efficiency increment. Acta Neurologica Scand 1992;85:378-382.
³²
Wechsler D. Manual of memory scale. New York: Psychological Corporation; 1973.
³³
Chaves MLF, Izquierdo I. Previous exposure to a novel experience enhances the performance in two simple memory tests in humans. Braz J Med Biol Res 1986;19:211-219.
³⁴
Squire L. Memory and brain. New York: Oxford; 1987.
³⁵
Hill SK, Keshavan MS, Thase ME, Sweeney JA. Neuropsychological dysfunction in antipsychotic-naive firstepisode unipolar psychotic depression. Am J Psychiatry 2004;161:996-1003.
³⁶
Austin MP, Mitchell P, Wilhelm K, et al. Cognitive functionin depression: a distinct pattern of frontal impairment in melancholia? Psychol Med 1999;29:73-85.
³⁷
Schmitt JA, Kruizinga MJ, Riedel WJ. Non-serotonergicpharmacological profiles and associated cognitive effects of serotonin reuptake inhibitors. J Psychopharmacol 2001;15:173-179.
³⁸
Cornell DG, Suarez R, Berent S. Psychomotor retardation inmelancholic and non-melancholic depression: cognitive and motor components. J Abnormal Psychol 1984;932:150-157.
³⁹
Brown RG, Scott LC, Bench CJ, et al. Cognitive function indepression: its relationship to the presence and severity of intellectual decline. Psychol Med 1994;24:829-847.
⁴⁰
Ilsley JE, Moffoot AP, O'Carroll RE. An analysis of memorydysfunction in major depression. J Affect Disord 1995;35:1-9.
⁴¹
Palmer BW, Boone KB, Lesser IM, et al. Neuropsychologicaldeficits among older depressed patients with precominantly psychological or vegetative symptoms. J Affect Disord 1996;41:17-24.
⁴²
Purcell R, Maruff P, Kyrios M, et al. Neuropsychologicalfunction in young patients with unipolar malor depression. Psychol Med 1997;27:1277-1285.
⁴³
Cohen R, Weingartner H, Smalberg S, et al. Effort and cognition in depression. Arch Gen Psychiatry 1982;39:593-598.
⁴⁴
Wolfe J, Granholm E, Butters N, et al.Verbal memory deficitsassociated with major affective disorders: a comparison of unipolar and bipolar patients. J Affect Disord 1987; 13:83-92.
⁴⁵
Austin MP, Ross M, Murray C, O'Carrol RE, Ebmeier KP,Goodwin GM. Cognitive function in major depression. J Affect Disord 1992;25:21-30.
⁴⁶
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
⁴⁷
Maier W, Philipp M, Heuser I, et al. Improving depressionseverity assessment - I. Reliability, internal validity and sensitivity to change of three observer depression scales. J Psychiatry Res 1988;22:3-12.
⁴⁸
Peyre F, Martinez R, Calache M, et al. New validation of theMontgomery and Asberg Depression Scale (MADRS) on a sample of 147 hospitalized depressed patients. Ann Med Psychol 1989;147:762-767.
⁴⁹
Maier W, Philipp M. Comparative analysis of observerdepression scales. Acta Psychiatr Scand 1985;72:239-245.
⁵⁰
Schmand B, Smit JH, Geerlings MI. The effects of intelligence and education on the development of dementia. A test of the brain reserve hypothesis. Psychol Med 1997;27:1337-1344.

Publication Dates

Publication in this collection
Jan-Mar 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Emery VO, Oxman TE. Update on the dementia spectrumof depression. Am J Psychiatry 1992;149:305-317.

[2] ²
Folstein M, McHugh P. Dementia syndrome of depression.In: Katzman R, Terry R, Bick K, editors. Alzheimer's disease: senile dementia and related disorders. New York: Raven Press, 1978:87-93.

[3] ³
Jorm AF. Cognitive deficit in the depressed elderly: A reviewof some basic and resolved issues. Aust N Z J Psychiatry 1986; 20:11-22.

[4] ⁴
Abrams R, Taylor MA. Cognitive dysfunction in melancholia. Psychol Med 1987;17:351-62.

[5] ⁵
Rund B, Landro N. Information processing: a new modelfor understanding cognitive disturbances in psychiatric patients. Acta Psychiatr Scand 1990;81:309-16.

[6] ⁶
Sternberg D, Jarvik M. Memory function in depression. Arch Gen Psychiatry 1976;33:211-24.

[7] ⁷
Stromgren LS. The influence of depression on memory. Acta Psychiatr Scand 1977;56:101-29.

[8] ⁸
Blaney PH.Affect and memory. Psychol Bull 1986;99:229-46.

[9] ⁹
Ceitlin LH, Santos BJ, Parisotto L, Zanatta MS, Chaves ML.Elaboration of word lists in Portuguese with emotional content and their influence on memory function in normal subjects. Int J Methods Psychiatr Res 1995;5:195-203.

[10] ¹⁰
Deptula D, Singh R, Pomara N. Aging, emotional states andmemory. Am J Psychiatry 1993;150:429-34.

[11] ¹¹
Jorm AF, Henderson AS. Memory bias in depression implications for risk factors studies relying on self-reports of exposure. Int J Methods Psychiatr Res 1992;2:31-38.

[12] ¹²
Beck A. Cognitive therapy and emotional disorders. NewYork: International Universities Press; 1976.

[13] ¹³
Costello C. Depression: loss of reinforcement or loss reinforces effectiveness? Behav Ther 1972;3:240-247.

[14] ¹⁴
Eelen P, Van Den Bergh O. Cognitive-behavioral models ofdepression. Acta Psychiatr Belg 1986;86:748-59.

[15] ¹⁵
Karasu TB. Toward a clinical model of psychotherapy fordepression: Systematic comparison of three psychotherapies. Am J Psychiatry 1990;147:133-147.

[16] ¹⁶
Austin MP, Mitchell P, Goodwin GM. Cognitive deficits indepression: possible implications for functional neuro-neuropathology. Br J Psychiatry 2001;178: 200-206.

[17] ¹⁷
Veiel HO. A preliminary profile of neuropsychologicaldeficits associated with major depression. J Clin Exp Neuropsychol 1997;19:587-603.

[18] ¹⁸
Ardila A, Ostrosky F, Mendoza V. Learning to read is muchmore than learning to read: a neuropsychologically-based learning to read method. J Int Neuropsychol Soc 2000;6:789-801.

[19] ¹⁹
Rosselli M, Ardila A. The impact of culture and educationon non-verbal neuropsychological measurements: A critical review. Brain Cogn 2003; 52:326-333.

[20] ²⁰
Ardila A, Rosselli M, Rosas P. Neuropsychological assessment of illiterates. Visuospatial and memory abilities. Brain Cogn 1989;11:147-166.

[21] ²¹
Nitrini R, Caramelli P, Herrera Junior E, et al. Performanceof illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004; 10:634-638.

[22] 22. Nitrini R, Caramelli P, Herrera Jr. E, Charchat-Fichman H,Porto CS. Performance in Luria's fist-edge-palm test according to educational level. Cogn Behav Neurol. 2005;18:211-214.

[23] ²³
Brucki SM, Rocha MS. Category fluency test: effects of age,gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004;37:1771-1777.

[24] ²⁴
Wenestam CG. A critique of research on cognition and cognitive processes. Br J Educ Psychol 1993;63:34-45.

[25] ²⁵
Ardila A. Cultural values underlying psychometric cognitivetesting. Neuropsychol Rev 2005;15:185-195.

[26] ²⁶
Harding TW, Climent CE, Diop M, et al. The WHO collaborative study on strategies for extending mental health care, II: the development of new research methods. Am J Psychiatry 1983; 140:1474-1480.

[27] ²⁷
Mari JJ,Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of São Paulo. Br J Psychiatry 1986;148:23-26.

[28] ²⁸
Montgomery S, Åsberg M. A new depression scale designedto be sensitive to change. Br J Psychiatry 1979;134:382-389.

[29] ²⁹
Dratcu L, Costa Ribeiro L, Calil H. Depression Assessmentin Brazil: The first application of the Montgomery-Asberg Depression Rating Scale. Br J Psychiatry 1987;150:797-800.

[30] ³⁰
Folstein M, Folstein S, McHugh P. »," ®,(r) §,§ , ¹,¹ ²,² ³,³ ß,ß Þ,Þ þ,þ ×,× Ú,Ú ú,ú Û,Û û,û Ù,Ù ù,ù ¨,¨ Ü,Ü ü,ü Ý,Ý ý,ý ¥,¥ ÿ,ÿ ¶,¶ Mini Mental State »," ®,(r) §,§ , ¹,¹ ²,² ³,³ ß,ß Þ,Þ þ,þ ×,× Ú,Ú ú,ú Û,Û û,û Ù,Ù ù,ù ¨,¨ Ü,Ü ü,ü Ý,Ý ý,ý ¥,¥ ÿ,ÿ ¶,¶ : Apractical method for grading the cognitive states of patients for the clinician. J Psychiatric Res 1975;12:189-198.

[31] ³¹
Chaves MLF and Izquierdo I. Differential diagnosis betweendementia and depression: a study of efficiency increment. Acta Neurologica Scand 1992;85:378-382.

[32] ³²
Wechsler D. Manual of memory scale. New York: Psychological Corporation; 1973.

[33] ³³
Chaves MLF, Izquierdo I. Previous exposure to a novel experience enhances the performance in two simple memory tests in humans. Braz J Med Biol Res 1986;19:211-219.

[34] ³⁴
Squire L. Memory and brain. New York: Oxford; 1987.

[35] ³⁵
Hill SK, Keshavan MS, Thase ME, Sweeney JA. Neuropsychological dysfunction in antipsychotic-naive firstepisode unipolar psychotic depression. Am J Psychiatry 2004;161:996-1003.

[36] ³⁶
Austin MP, Mitchell P, Wilhelm K, et al. Cognitive functionin depression: a distinct pattern of frontal impairment in melancholia? Psychol Med 1999;29:73-85.

[37] ³⁷
Schmitt JA, Kruizinga MJ, Riedel WJ. Non-serotonergicpharmacological profiles and associated cognitive effects of serotonin reuptake inhibitors. J Psychopharmacol 2001;15:173-179.

[38] ³⁸
Cornell DG, Suarez R, Berent S. Psychomotor retardation inmelancholic and non-melancholic depression: cognitive and motor components. J Abnormal Psychol 1984;932:150-157.

[39] ³⁹
Brown RG, Scott LC, Bench CJ, et al. Cognitive function indepression: its relationship to the presence and severity of intellectual decline. Psychol Med 1994;24:829-847.

[40] ⁴⁰
Ilsley JE, Moffoot AP, O'Carroll RE. An analysis of memorydysfunction in major depression. J Affect Disord 1995;35:1-9.

[41] ⁴¹
Palmer BW, Boone KB, Lesser IM, et al. Neuropsychologicaldeficits among older depressed patients with precominantly psychological or vegetative symptoms. J Affect Disord 1996;41:17-24.

[42] ⁴²
Purcell R, Maruff P, Kyrios M, et al. Neuropsychologicalfunction in young patients with unipolar malor depression. Psychol Med 1997;27:1277-1285.

[43] ⁴³
Cohen R, Weingartner H, Smalberg S, et al. Effort and cognition in depression. Arch Gen Psychiatry 1982;39:593-598.

[44] ⁴⁴
Wolfe J, Granholm E, Butters N, et al.Verbal memory deficitsassociated with major affective disorders: a comparison of unipolar and bipolar patients. J Affect Disord 1987; 13:83-92.

[45] ⁴⁵
Austin MP, Ross M, Murray C, O'Carrol RE, Ebmeier KP,Goodwin GM. Cognitive function in major depression. J Affect Disord 1992;25:21-30.

[46] ⁴⁶
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.

[47] ⁴⁷
Maier W, Philipp M, Heuser I, et al. Improving depressionseverity assessment - I. Reliability, internal validity and sensitivity to change of three observer depression scales. J Psychiatry Res 1988;22:3-12.

[48] ⁴⁸
Peyre F, Martinez R, Calache M, et al. New validation of theMontgomery and Asberg Depression Scale (MADRS) on a sample of 147 hospitalized depressed patients. Ann Med Psychol 1989;147:762-767.

[49] ⁴⁹
Maier W, Philipp M. Comparative analysis of observerdepression scales. Acta Psychiatr Scand 1985;72:239-245.

[50] ⁵⁰
Schmand B, Smit JH, Geerlings MI. The effects of intelligence and education on the development of dementia. A test of the brain reserve hypothesis. Psychol Med 1997;27:1337-1344.

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