Cognitive dysfunction in depression. Is it well detected

Introduction Major depression cognitive impairments lasts in remission periods, have an impact on treatment outcome and hamper psychosocial functioning. Thus, its accurate detection and specific treatment has become a crucial step. Objectives In order to assess objective cognitive functioning (OCF), a neuropsychological battery was administered. For subjective cognitive functioning (SCF), cognitive perception was evaluated by clinicians and patients. Aims To determine the concordance between OCF and SCF. Methods One hundred and two patients were grouped according to Hamilton Depressive Rating Scale (HDRS−17): 18 remitters (RE   18). OCF was computed combining T-scores of digit symbol substitution test (WAIS-IV) with two RAVLT subtests (learning and memory). SCF was assessed with a CGI adaptation for cognitive disturbances severity. Results The OFC was 41.21(8.49) for all patients and 45.54(6.8), 41.93(6.8) and 38.7 (9.7) for RE, PR, and AD, respectively. Psychiatrist and patients’ SCF had a poor agreement (α=0.518), with Cronbach's alpha for RE, PR and AD of −0.607, 0.518 and 0.404. Concordance between OCF and SCF was calculated for all patients (psychiatrist, r  = −0.317, P  = 0.002; patient, r  = −0.310, P  = 0.002), for RE ( r  = −0.535, P  = 0.022; r  = 0.395, P  = 0.105) for PR ( r  = −0.013, P  = 0.94; r  = −0.328, P  = 0.045) and for AD ( r  = −0.252, P  = 0.122; r  = −0.333, P  = 0.033). Patients rated their SFC as more impaired than did clinicians. Conclusions Concordance between clinicians and patients regarding SCF is very poor, worsening in AD group and being null in remission. This study also points out that CF is best detected by patients in acute episodes and by psychiatrists when patients are in clinical remission.