fMRI Activation During Executive Function Predicts Response to Cognitive Behavioral Therapy in Older, Depressed Adults
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Objectives To test our hypothesis that pre-treatment executive function and brain regional activation during executive function would discriminate between responders and non-responders to cognitive behavioral therapy (CBT) in elderly depressed outpatients.Design Clinical cohort study.Setting University-affiliated hospital.Participants Sixty outpatients (age 59 years and older) completed 12 weeks of CBT between July 2010 and December 2011. Forty-four completed fMRI procedures.Measurements The main outcome consisted of a conversion from a clinical diagnosis (Mini-International Neuropsychiatric Interview) of depression to no clinical diagnosis of depression or a significant improvement in diagnostic criteria. Brain activation measured by functional magnetic resonance imaging during the Wisconsin Card Sorting task (WCST) was the primary predictor variable.Results 67% of patients had a positive response to CBT. Decreased activation in the left inferior frontal triangle and right superior frontal gyrus as well as increased activity in the right middle frontal gyrus and left superior frontal gyrus predicted a positive response to CBT. Demographic and neurocognitive measures of WCST performance were not significant predictors of a positive CBT outcome, whereas the measure of WCST-induced activity in the prefrontal cortex was a significant predictor.Conclusions These data are among the first to suggest that measures of prefrontal brain activation during executive functioning predict response to CBT in older adults. Further exploration of the specific underlying processes that these prefrontal cortical regions are engaging that contributes to better CBT outcomes is warranted in larger, randomized studies.
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Previous research has demonstrated the potential of cognitive behavioral therapy (CBT) in enhancing EFD.
“Previous research has demonstrated the potential of CBT in enhancing EFD.6”
From Can Intermittent Theta-Burst Stimulation of Dorsolateral Prefrontal Cortex Relieve Executive Dysfunction in Patients With Late-Life Depression? (2024) · cites this paper as [6]
The Discussion suggests that CBT’s structure may compensate for executive-function impairments, but presents this as a possible explanation, not a demonstrated treatment effect. The Results report that baseline brain activation during an executive-function task predicted response to CBT; they do not show that CBT enhanced executive functioning or reduced executive-function deficits. No page number is available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn 45 older adults with major depression, greater dorsolateral prefrontal and other cognitive control network activity during an in-scanner executive test predicted better response to cognitive behavioral therapy.
“Gallagher-Thompson et al. 29 found that increased activity in the DLPFC and other CCN regions during an executive functioning test (Wisconsin Card Sorting Test) completed in the scanner predicted a better CBT response in 45 older adults with major depression.”
From State of the Science of Neural Systems in Late‐Life Depression: Impact on Clinical Presentation and Treatment Outcome (2018) · cites this paper as [29]
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- Authors
- Thompson, D. G., Kesler, S. R., Sudheimer, K., Mehta, K. M., Thompson, L. W., Marquett, R. M., Holland, J. M., Reiser, R., Rasgon, N., Schatzberg, A., & O'Hara, R. M.
- Affiliations
- Stanford Medicine (US)
- Mental Illness Research, Education and Clinical Centers (US)
- Palo Alto University (US)
- ORCID
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 23
- Issue
- 1
- Pages
- 13-22
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC8040025
- OpenAlex
- W1963873005
- Cited by
- 74
- References
- 46
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 2 · 2023: 3 · 2021: 26 · 2020: 4 · 2019: 4 · 2018: 7 · 2017: 9 · 2016: 3 · 2015: 8 · 2014: 3
- FWCI
- 10.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIMH Exploratory/Developmental Research Grant Program (R21 MH091625-01)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- cognitive behavioral therapy, treatment response prediction, executive function, older adults, depression, prefrontal cortex activation, Wisconsin Card Sorting Test, superior frontal gyrus, middle frontal gyrus, brain-behavior relationship
- MeSH terms
- Aged, Brain Mapping, Depressive Disorder, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Cognitive Behavioral Therapy, Treatment Outcome, Prefrontal Cortex, Executive Function
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