Persistent Cognitive Impairment in Depression: The Role of Psychopathology and Altered Hypothalamic-Pituitary-Adrenocortical (HPA) System Regulation
Abstract
Background Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system and cognitive impairment are consistent findings in depression. This study examines the associations between HPA system regulation, cognitive functioning, and psychopathology in depressed inpatients on admission and at discharge.Methods The HPA system dysregulation was evaluated with the dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test. Cognitive assessment included speed of information processing, divided and selective attention, as well as short-term and working memory. Psychopathology was evaluated with the Hamilton Rating Scale for Depression (HAMD). Data from 75 depressed inpatients are reported, 51 (68%) of them achieved remission.Results Despite a significant reduction of depressive symptoms between admission and discharge, a high rate of patients remained cognitively impaired. Selective attention improved significantly in remitters and nonremitters, while speed of information processing increased only in remitters. The cortisol response to the DEX/CRH test decreased significantly only in remitters, which was uncorrelated with cognitive performance. In nonremitters, severity of depression was significantly correlated with information processing time while improvement in short-term memory was negatively associated with the cortisol response at discharge.Conclusions Our data support the assumption that psychopathological symptoms and the HPA system dysregulation can be dissociated in their impact on cognitive functioning in depressed patients.
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Many studies show no change in divided attention with SSRI treatment.
“Many studies, albeit largely observational or with a mix of medications used, show no change in sustained attention25,99, selective attention100, or divided attention5,101, despite improvements in mood symptoms.”
From Paying attention to attention in depression (2019) · cites this paper as [101]
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- Authors
- Reppermund, S., Zihl, J., Lucae, S., Horstmann, S., Kloiber, S., Holsboer, F., & Ising, M.
- Affiliations
- Max Planck Society (DE)
- Corresponding author
- Reppermund, Simone
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 62
- Issue
- 5
- Pages
- 400-406
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2050554629
- Cited by
- 147
- References
- 52
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 13 · 2019: 10 · 2018: 15 · 2017: 6 · 2016: 7 · 2015: 8 · 2014: 3 · 2013: 10 · 2012: 10
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Max Planck Institute for Plasma Physics (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- persistent cognitive impairment, depression, hypothalamic-pituitary-adrenal axis, HPA axis dysregulation, dexamethasone/corticotropin-releasing hormone test, cortisol response, psychopathology, selective attention, processing speed, working memory, short-term memory, remission, hospitalized patients
- MeSH terms
- Adult, Analysis of Variance, Cognition Disorders, Corticotropin-Releasing Hormone, Depression, Dexamethasone, Female, Humans, Hypothalamo-Hypophyseal System, Male, Middle Aged, Neuropsychological Tests, Pituitary-Adrenal System, Psychopathology, Severity of Illness Index, Chi-Square Distribution
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