Pain and major depressive disorder: Associations with cognitive impairment as measured by the THINC-integrated tool (THINC-it)

Scand J Pain. 2017 Apr:15:62-67. doi: 10.1016/j.sjpain.2016.12.004. Epub 2017 Jan 10.


Objectives: To examine the role of pain on cognitive function in adults with major depressive disorder (MDD).

Methods: Adults (18-65) with a Diagnostic and Statistical Manual - Fifth Edition (DSM-5)-defined diagnosis of MDD experiencing a current major depressive episode (MDE) were enrolled (nMDD=100). All subjects with MDD were matched in age, sex, and years of education to healthy controls (HC) (nHC=100) for comparison. Cognitive function was assessed using the recently validated THINC-integrated tool (THINC-it), which comprises variants of the choice reaction time (i.e., THINC-it: Spotter), One-Back (i.e., THINC-it: Symbol Check), Digit Symbol Substitution Test (i.e., THINC-it: Codebreaker), Trail Making Test - Part B (i.e., THINC-it: Trails), as well as the Perceived Deficits Questionnaire for Depression - 5-item (i.e., THINC-it: PDQ-5-D). A global index of objective cognitive function was computed using objective measures from the THINC-it, while self-rated cognitive deficits were measured using the PDQ-5-D. Pain was measured using a Visual Analogue Scale (VAS). Regression analyses evaluated the role of pain in predicting objective and subjective cognitive function.

Results: A significant between-group differences on the VAS was observed (p<0.001), with individuals with MDD reporting higher pain severity as evidenced by higher scores on the VAS than HC. Significant interaction effects were observed between self -rated cognitive deficits and pain ratings (p<0.001) on objective cognitive performance (after adjusting for MADRS total score), suggesting that pain moderates the association between self-rated and objective cognitive function.

Conclusions: Results indicated that pain is associated with increased self-rated and objective cognitive deficits in adults with MDD.

Implications: The study herein provides preliminary evidence demonstrating that adults with MDD reporting pain symptomatology and poorer subjective cognitive function is predictive of poorer objective cognitive performance. THINC-it is capable of detecting cognitive dysfunction amongst adults with MDD and pain.

Keywords: Cognition; Cognitive impairment; Major depressive disorder; Measurement based care; Pain.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cognition
  • Cognitive Dysfunction / diagnosis
  • Cognitive Dysfunction / etiology*
  • Depressive Disorder, Major / complications*
  • Depressive Disorder, Major / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Pain / complications*
  • Pain / psychology*
  • Prospective Studies
  • Young Adult