Cognitive Impairment in Depressed Older Adults: Implications for Prognosis and Treatment

Late-life depression is often accompanied by cognitive impairment. In some cases, the syndromes of depression and cognitive impairment may be related to the same underlying disorder (eg, vascular dementia, hypothyroidism), whereas in other cases, they may be relatively independent and simply coexist. Cognitive deficits in late-life depression span multiple domains; however, deficits in executive functions may be particularly important as their presence predicts poor clinical outcomes. Cognitive impairment, when mild, does not appear to progress to dementia in most cases, but variability in the course of elders with depression and cognitive impairment suggests the need for careful follow-up, particularly in cases where executive dysfunction is suspected. The Expert Consensus Guideline recommends antidepressant drug therapy combined with a psychosocial intervention as the treatment of choice for geriatric depression. New treatments including computerized cognitive remediation and problem-solving therapy may be particularly effective in treating both affective and cognitive symptoms.