Does cognition predict treatment response and remission in psychotherapy for late-life depression?

Am J Geriatr Psychiatry. 2015 Feb;23(2):215-9. doi: 10.1016/j.jagp.2014.09.003. Epub 2014 Sep 21.

Abstract

Objectives: To identify cognitive predictors of geriatric depression treatment outcome.

Method: Older participants completed baseline measures of memory and executive function, health, and baseline and post-treatment Hamilton Depression Scales (HAM-D) in a 12-week trial comparing psychotherapies (problem-solving vs. supportive; N = 46). We examined cognitive predictors to identify treatment responders (i.e., HAM-D scores reduced by ≥50%) and remitters (i.e., post-treatment HAM-D score ≤10).

Results: Empirically derived decision trees identified poorer performance on switching (i.e., Trails B), with a cut-score of ≥82 predicting psychotherapy responders. No other cognitive or health variables predicted psychotherapy outcomes in the decision trees.

Conclusions: Psychotherapies that support or improve the executive skill of switching may augment treatment response for older patients exhibiting executive dysfunction in depression. If replicated, Trails B has potential as a brief cognitive tool for clinical decision-making in geriatric depression.

Keywords: Intervention; cognitive predictors; depressed; older adults; psychological treatments; treatment outcome.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cognition*
  • Decision Trees
  • Depression / psychology*
  • Depression / therapy*
  • Executive Function
  • Female
  • Humans
  • Male
  • Memory
  • Neuropsychological Tests
  • Predictive Value of Tests*
  • Psychotherapy*
  • Remission Induction*
  • Sensitivity and Specificity
  • Treatment Outcome