Dissociating the Effect of Treatment-Resistance on Neuropsychological Performance in Patients with Major Depressive Disorder Open Access

Moreines, Jared (2010)

Permanent URL: https://etd.library.emory.edu/concern/etds/w9505086g?locale=en
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Abstract

Dissociating the Effect of Treatment-Resistance on Neuropsychological Performance in Patients with Major Depressive Disorder

By Jared L. Moreines

Abstract

Deficits in cognitive functioning are common in depression and may vary according to a patient's course of illness. Differences in resting functional magnetic resonance imaging (rfMRI) Functional Connectivity (FC) of brain regions involved in mood and cognition have been shown to be associated with cognitive ability and depressive state. In the present study, healthy controls and individuals with depression who were either treatment-naïve or severely treatment-resistant underwent rfMRI scanning and neuropsychological testing on subtests from the Cambridge Neuropsychological Test Automated Battery and standard and emotional versions of the Stroop Task, all previously shown to be deficient in individuals with depression. Comparisons between all patients and controls revealed differences in measures of processing speed, bias for negative information, and executive functioning. Comparisons between the treatment-naïve and treatment-resistant groups revealed differences in processing speed of directed response to emotional words. Due to an issue in the rfMRI data, it could not be analyzed for this thesis. However, the results of neuropsychological testing suggest select differences in the neurocognitive profiles of treatment-naïve versus treatment-resistant depression related to processing speed. Limitations of the current study include inability to dissociate past and current medication effects from treatment-resistance, small sample size, and no correction for multiple comparisons.

Table of Contents

Table of Contents

Introduction

Major Depression and Treatment Resistance……………………………………..1

Neuropsychological Functioning in Depression…………………………………..2

Functional Neuroimaging in Depression and Neuropsychology………….5

Present Study Intentions………………………………………………………….........10

Methods Subjects………………………………………………………………………................…..12

Neuropsychological Testing Procedure………………………………………….....16

Neurocognitive Battery…………………………………………………………............17

Table 1. Description of Neurocognitive Tests and Expected

Results……..............................................................29

Imaging Protocol…………..……………………………………………...........………..32

Results

Demographic and Clinical Data………………………………………………….......36

Table 2. Group Demographic Data………………………………………...37

Table 3. Patient Clinical Data……………………………………………......37

Neuropsychological Data………………………………………………………...........38

Table 4. Regular and Emotional Stroop Task Group Data………40

Table 5. Cambridge Neuropsychological Test Automated

Battery Group Data by Subtest……………………………42-45

Imaging Results…………………………………………………………………..............51

Figure 1. Results from T-Test (HC vs. MDD) of Whole Brain

rfMRI FC for Elliot ROI………………………………………….…51

Figure 2. Comparison of Maps Resulting from Seeds in

Affected and Unaffected Slices…………………………….…52

Discussion

Summary and Evaluation of Findings………………………………………….....53

Limitations and Recommendations for Future Studies………….……....61

Conclusion……………………………………………………………………………........….63 References……………………………………………………………………………...............…..64

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