This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (158)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Psychiatry, Other  • Alert me on articles by topic

George S. Alexopoulos, MD; Barnett S. Meyers, MD; Robert C. Young, MD; Balu Kalayam, MD; Tatsuyuki Kakuma, PhD; Michelle Gabrielle, MSW; Jo Anne Sirey, PhD; James Hull, PhD

Arch Gen Psychiatry. 2000;57:285-290.

Background  This study investigated the relationship of executive and memory impairment to relapse, recurrence, and course of residual depressive symptoms and signs after remission of geriatric major depression.

Methods  Fifty-eight elderly subjects remitted from major depression received continuation nortriptyline treatment (plasma levels 60-150 ng/mL) for 16 weeks and then were randomly assigned to either nortriptyline maintenance therapy or placebo for up to 2 years. Diagnosis was made using the Research Diagnostic Criteria and the DSM-IV criteria after an interview using the Schedule for Affective Disorders and Schizophrenia. Executive dysfunction and memory were assessed with the Dementia Rating Scale, disablity and social support were rated with the Philadelphia Multiphasic Instrument, and medical burden was assessed with the Cumulative Illness Rating Scale.

Results  Abnormal initiation and perseveration scores, but not memory impairment, were associated with relapse and recurrence of geriatric depression and with fluctuations of depressive symptoms in the whole group and in subjects who never met criteria for relapse or recurrence during the follow-up period. Memory impairment, disability, medical burden, social support, and history of previous episodes did not significantly influence the outcome of depression in this sample.

Conclusions  Executive dysfunction was found to be associated with relapse and recurrence of geriatric major depression and with residual depressive symptoms. These observations, if confirmed, will aid clinicians in identifying patients in need of vigilant follow-up. The findings of this study provide the rationale for investigation of the role of specific prefrontal pathways in predisposing or perpetuating depressive syndromes or symptoms in elderly patients.

From the Department of Psychiatry, Cornell University, White Plains, NY.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Sleep Disturbance and Depression Recurrence in Community-Dwelling Older Adults: A Prospective Study
Cho et al.
Am. J. Psychiatry 2008;165:1543-1550.
ABSTRACT | FULL TEXT  

Depressive State- and Disease-Related Alterations in Neural Responses to Affective and Executive Challenges in Geriatric Depression
Wang et al.
Am. J. Psychiatry 2008;165:863-871.
ABSTRACT | FULL TEXT  

Outcomes and Predictors of Late-Life Depression Trajectories in Older Primary Care Patients
Cui et al.
AJGP 2008;16:406-415.
ABSTRACT | FULL TEXT  

Electroconvulsive Therapy for Depression
Lisanby
NEJM 2007;357:1939-1945.
FULL TEXT  

Does Depression Precede or Follow Executive Dysfunction? Outcomes in Older Primary Care Patients
Cui et al.
Am. J. Psychiatry 2007;164:1221-1228.
ABSTRACT | FULL TEXT  

Optimizing the Use of Data Generated by Geriatric Depression Treatment Studies During a Time of Diminishing Resources
Meyers
AJGP 2007;15:545-552.
FULL TEXT  

Response Inhibition Predicts Poor Antidepressant Treatment Response in Very Old Depressed Patients
Sneed et al.
AJGP 2007;15:553-563.
ABSTRACT | FULL TEXT  

Effect of antidepressant therapy on executive function after stroke
Narushima et al.
Br. J. Psychiatry 2007;190:260-265.
ABSTRACT | FULL TEXT  

The Prognosis of Major and Minor Depression in Older Medical Inpatients.
Cole et al.
AJGP 2006;14:966-975.
ABSTRACT | FULL TEXT  

Cognitive Predictors of Response to Treatment for Depression in Multiple Sclerosis
Julian and Mohr
J. Neuropsychiatry Clin. Neurosi. 2006;18:356-363.
ABSTRACT | FULL TEXT  

Cognitive Impairment and Depression Outcomes in the IMPACT Study.
Steffens et al.
AJGP 2006;14:401-409.
ABSTRACT | FULL TEXT  

Maintenance treatment of major depression in old age.
Reynolds et al.
NEJM 2006;354:1130-1138.
ABSTRACT | FULL TEXT  

Depressive Symptom Deterioration in a Large Primary Care-Based Elderly Cohort
Katon et al.
AJGP 2006;14:246-254.
ABSTRACT | FULL TEXT  

Cerebrovascular Risk Factors, Executive Dysfunction, and Depression in Older Primary Care Patients
Sanders et al.
AJGP 2006;14:145-152.
ABSTRACT | FULL TEXT  

Increased Hippocampal Plaques and Tangles in Patients With Alzheimer Disease With a Lifetime History of Major Depression
Rapp et al.
Arch Gen Psychiatry 2006;63:161-167.
ABSTRACT | FULL TEXT  

Predictors of Partial Remission in Older Patients Treated for Major Depression: The Role of Comorbid Dysthymia
Hybels et al.
AJGP 2005;13:713-721.
ABSTRACT | FULL TEXT  

Does Executive Dysfunction Affect Treatment Outcome in Late-Life Mood and Anxiety Disorders?
Mohlman
J Geriatr Psychiatry Neurol 2005;18:97-108.
ABSTRACT  

Electroconvulsive Therapy: A Selected Review
Greenberg and Kellner
AJGP 2005;13:268-281.
ABSTRACT | FULL TEXT  

Effects of Previous Major Depressive Illness on Cognition in Alzheimer Disease Patients
Cannon-Spoor et al.
AJGP 2005;13:312-318.
ABSTRACT | FULL TEXT  

Neuropsychological Differences Between Late-Onset and Recurrent Geriatric Major Depression
Rapp et al.
Am. J. Psychiatry 2005;162:691-698.
ABSTRACT | FULL TEXT  

Cerebrovascular Disease and Late-Life Depression
Kales et al.
AJGP 2005;13:88-98.
ABSTRACT | FULL TEXT  

Randomized, Double-Blind, Placebo-Controlled Trial of Fluoxetine Treatment for Elderly Patients With Dysthymic Disorder
Devanand et al.
AJGP 2005;13:59-68.
ABSTRACT | FULL TEXT  

The Impact of Medical Comorbidity on Acute Treatment in Major Depressive Disorder
Iosifescu et al.
Focus 2005;3:69-75.
ABSTRACT | FULL TEXT  

The Course of Depression in Elderly Patients
Mueller et al.
Focus 2005;3:76-82.
ABSTRACT | FULL TEXT  

The Clock Drawing Test as a Measure of Executive Dysfunction in Elderly Depressed Patients
Woo et al.
J Geriatr Psychiatry Neurol 2004;17:190-194.
ABSTRACT  

Executive Deficits in Elderly Patients With Major Unipolar Depression
Baudic et al.
J Geriatr Psychiatry Neurol 2004;17:195-201.
ABSTRACT  

An Open Treatment Trial of Venlafaxine for Elderly Patients With Dysthymic Disorder
Devanand et al.
J Geriatr Psychiatry Neurol 2004;17:219-224.
ABSTRACT  

On the "Infallibility" of Psychopathology and Its Implications for Action
Alexopoulos
Am. J. Psychiatry 2004;161:2151-2154.
FULL TEXT  

A Longitudinal Study of Hippocampal Volume, Cortisol Levels, and Cognition in Older Depressed Subjects
O'Brien et al.
Am. J. Psychiatry 2004;161:2081-2090.
ABSTRACT | FULL TEXT  

Localizing Gray Matter Deficits in Late-Onset Depression Using Computational Cortical Pattern Matching Methods
Ballmaier et al.
Am. J. Psychiatry 2004;161:2091-2099.
ABSTRACT | FULL TEXT  

Comorbid Medical Illness and Relapse of Major Depressive Disorder in the Continuation Phase of Treatment
Iosifescu et al.
Psychosomatics 2004;45:419-425.
ABSTRACT | FULL TEXT  

Executive Functioning, Illness Course, and Relapse/Recurrence in Continuation and Maintenance Treatment of Late-Life Depression: Is There a Relationship?
Butters et al.
AJGP 2004;12:387-394.
ABSTRACT | FULL TEXT  

Late-Life Depression and Microstructural Abnormalities in Dorsolateral Prefrontal Cortex White Matter
Taylor et al.
Am. J. Psychiatry 2004;161:1293-1296.
ABSTRACT | FULL TEXT  

Effect of Medical Comorbidity on Response to Fluoxetine Augmentation or Dose Increase in Outpatients With Treatment-Resistant Depression
Perlis et al.
Psychosomatics 2004;45:224-229.
ABSTRACT | FULL TEXT  

Clinical and Biological Interactions in Affective and Cognitive Geriatric Syndromes
Alexopoulos
Focus 2004;2:236-238.
FULL TEXT  

Prognostic value of frontal functional neuroimaging in late-onset severe major depression
NAVARRO et al.
Br. J. Psychiatry 2004;184:306-311.
ABSTRACT | FULL TEXT  

The Course of Depression in Elderly Patients
Mueller et al.
AJGP 2004;12:22-29.
ABSTRACT | FULL TEXT  

Longitudinal Association of Initiation/Perseveration and Severity of Geriatric Depression
Murphy and Alexopoulos
AJGP 2004;12:50-56.
ABSTRACT | FULL TEXT  

The Impact of Medical Comorbidity on Acute Treatment in Major Depressive Disorder
Iosifescu et al.
Am. J. Psychiatry 2003;160:2122-2127.
ABSTRACT | FULL TEXT  

Does Antidepressant Therapy Improve Cognition in Elderly Depressed Patients?
Doraiswamy et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:M1137-1144.
ABSTRACT | FULL TEXT  

Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Late Life
Charney et al.
Arch Gen Psychiatry 2003;60:664-672.
ABSTRACT | FULL TEXT  

Apathy and Executive Function in Depressed Elderly
Marin et al.
J Geriatr Psychiatry Neurol 2003;16:112-116.
ABSTRACT  

Clinical and Biological Interactions in Affective and Cognitive Geriatric Syndromes
Alexopoulos
Am. J. Psychiatry 2003;160:811-814.
FULL TEXT  

Advances in Psychotherapy for Mental Illness in Late Life
Arean
AJGP 2003;11:4-6.
FULL TEXT  

Problem-Solving Therapy Versus Supportive Therapy in Geriatric Major Depression With Executive Dysfunction
Alexopoulos et al.
AJGP 2003;11:46-52.
ABSTRACT | FULL TEXT  

Frontostriatal and Limbic Dysfunction in Late-Life Depression
Alexopoulos
AJGP 2002;10:687-695.
ABSTRACT | FULL TEXT  

Frontal White Matter Microstructure and Treatment Response of Late-Life Depression: A Preliminary Study
Alexopoulos et al.
Am. J. Psychiatry 2002;159:1929-1932.
ABSTRACT | FULL TEXT  

Treatment and Course of Geriatric Depression: Questions Raised by an Evolving Clinical Science
Meyers
AJGP 2002;10:497-502.
FULL TEXT  

Ischemic Basis for Deep White Matter Hyperintensities in Major Depression: A Neuropathological Study
Thomas et al.
Arch Gen Psychiatry 2002;59:785-792.
ABSTRACT | FULL TEXT  

Brain Morphometric Abnormalities in Geriatric Depression: Long-Term Neurobiological Effects of Illness Duration
Bell-McGinty et al.
Am. J. Psychiatry 2002;159:1424-1427.
ABSTRACT | FULL TEXT  

Cell adhesion molecule expression in the dorsolateral prefrontal cortex and anterior cingulate cortex in major depression in the elderly
THOMAS et al.
Br. J. Psychiatry 2002;181:129-134.
ABSTRACT | FULL TEXT  

Executive Dysfunction in Geriatric Depression
Lockwood et al.
Am. J. Psychiatry 2002;159:1119-1126.
ABSTRACT | FULL TEXT  

Adverse Life Events in Elderly Patients With Major Depression or Dysthymic Disorder and in Healthy-Control Subjects
Devanand et al.
AJGP 2002;10:265-274.
ABSTRACT | FULL TEXT  

Relationship Between Clinical Variables and Symptomatic Anxiety in Late-Life Depression
Flint and Rifat
AJGP 2002;10:292-296.
ABSTRACT | FULL TEXT  

Provisional Diagnostic Criteria for Depression of Alzheimer Disease: Rationale and Background
Olin et al.
AJGP 2002;10:129-141.
ABSTRACT | FULL TEXT  

A 75-Year-Old Man With Depression
Kroenke
JAMA 2002;287:1568-1576.
FULL TEXT  

Clinical Presentation of the ""Depression-Executive Dysfunction Syndrome"" of Late Life
Alexopoulos et al.
AJGP 2002;10:98-106.
ABSTRACT | FULL TEXT  

Multinuclear Magnetic Resonance Spectroscopy Studies of Brain Purines in Major Depression
Renshaw et al.
Am. J. Psychiatry 2001;158:2048-2055.
ABSTRACT | FULL TEXT  

Executive Dysfunction and Disability in Elderly Patients With Major Depression
Kiosses et al.
AJGP 2001;9:269-274.
ABSTRACT | FULL TEXT  

Hippocampal and Anterior Cingulate Activation Deficits in Patients With Geriatric Depression
de Asis et al.
Am. J. Psychiatry 2001;158:1321-1323.
ABSTRACT | FULL TEXT  

New Concepts for Prevention and Treatment of Late-Life Depression
Alexopoulos
Am. J. Psychiatry 2001;158:835-838.
FULL TEXT  

"The Depression-Executive Dysfunction Syndrome of Late Life": A Specific Target for D3 Agonists?
Alexopoulos
AJGP 2001;9:22-29.
FULL TEXT