Cognitive Functioning I

Abstract

Depression is a highly prevalent psychiatric disorder in older adults. It is associated with poor outcomes and comorbidities, including cognitive impairment that can persist following symptomatic treatment, and may be a risk factor for dementia in some individuals. The literature on cognitive function-ing in late-life depression suggests that a remote history of depression and first-time late-onset depression might both increase the likelihood of persistent cognitive impairment. A conceptual model based on findings that depression is associated with both chronic elevation of adrenal glucocorticoid production and cere-brovascular disease may assist in understanding the heterogeneity in cognitive outcomes associated with late-life depression. Because depres-sion can injure neurons and lower brain or cognitive reserve, regular assessment of cognitive functioning in older adults with mood disorders is recommended. L ate-life depression (LLD) is a heterogeneous disorder that can be broadly defined as depres-sion in individuals age 60 and older. It is associated with several public health concerns, including increased mortality rates, physical disability, functional decline, increased health care utilization, and increased suicide rate. 1-3 Epidemiological data suggest that between 11% and 30% of older adults experience clinically signifi-cant depressive symptoms. 4,5 These rates are higher in clinical settings and nursing homes. 6 Some but not all stud-ies have found distinctive clinically relevant features associated with depression that occurs for the first time in late-onset versus earlier-onset, recurrent depression.