Norms for depressed patients for the California verbal learning test: associations with depression severity and self-report of cognitive difficulties.

This study provides norms for depressed subjects for a widely used test of verbal memory, the California Verbal Learning Test (CVLT). Subjects were 156 outpatients with major depression tested during a drug washout period. Mean CVLT memory scores for these patients were generally between one-half and one standard deviation below age- and sex-corrected norms for nondepressed populations. Severity of depression in the patients was not associated with memory performance, but was associated with self-report of cognitive difficulties. A table of age-, sex-, and education-specific norms for the CVLT is provided.     

Verbal learning and memory in older adults with minor and major depression

Late-life minor depression (miD) is a prevalent but poorly understood illness. Verbal learning and memory profiles have commonly been used to characterize neuropsychiatric disorders. This study compared the performance of 27 older adults with miD on the California Verbal Learning Test (CVLT) with 26 age-matched individuals with Major Depressive Disorder (MDD) and 36 non-depressed controls. Results revealed that the miD group performed comparably with controls and significantly better than the MDD group on several CVLT indices. Moreover, cluster analysis revealed three distinct groups, consistent with theoretical representations of "normal," "subcortical," and "cortical" verbal learning and memory profiles. The majority of the miD group showed "normal" profiles (74%), whereas most individuals with MDD displayed "subcortical" profiles (54%). The findings suggest that depression in the elderly is a heterogeneous entity and that the CVLT may be a useful tool for characterizing learning and memory in late-onset depressive disorders.     

Relative memory deficits in recurrent versus first-episode major depression on a word-list learning task.

Although memory deficits are associated with major depressive disorder, few studies have identified which patient characteristics predict impairment. Because recurrent depression appears related to more severe cerebral dysfunction, the present study tested whether recurrent depressed individuals have worse memory function than first-episode depressed individuals. Two groups of young-adult, nonpsychotic, depressed inpatients (20 single episode [SE] and 46 recurrent episode [RE]) were administered the California Verbal Learning Test within a broader battery of neuropsychological tests. The groups were equivalent in age, education, estimated IQ, severity of depression, and demographic composition. The RE group demonstrated memory deficits relative to both the SE group and published norms, but no other significant difference was found across the battery. Data indicate that abnormal memory performance is associated with recurrent depression, whereas memory deficits are not prominent in first-episode depressed individuals.     

Cognitive functioning in a population-based sample of young adults with a history of non-psychotic unipolar depressive disorders without psychiatric comorbidity

BACKGROUND: There is evidence for cognitive dysfunction in unipolar depression among middle-aged and elderly patients, but cognitive functioning among depressed young adults has scarcely been systematically investigated. The aims of the present study were to examine cognitive functioning among depressed young adults identified from the general population and to determine whether cognitive deficits vary as a function of different disorder characteristics, such as severity and age at onset. METHODS: Performance in verbal and visual short-term memory, verbal long-term memory and learning, attention, processing speed, and executive functioning was compared between a population-based sample of 21-35-year-olds with a lifetime history of non-psychotic unipolar depressive disorders without psychiatric comorbidity (n=68) and healthy controls derived from the same population (n=70). RESULTS: Depressed young adults were not found to be impaired in any of the assessed cognitive functions, except for some suggestion of mildly compromised verbal learning. Nevertheless, younger age at depression onset was associated with more impaired executive functioning. LIMITATIONS: The results may slightly underestimate of the true association between depression and cognitive impairments in the young adult population due to possible dropout of participants. Additionally, the problem of multiple testing was not entirely corrected. CONCLUSION: The findings from this study indicate that a lifetime history of non-psychotic unipolar depressive disorders among young adults without psychiatric comorbidity may be associated only with minimal cognitive deficits, even when some residual depressive symptoms are prevalent. However, early-onset depression may represent a more severe form of the disorder, associated with more cognitive dysfunction.     

Psychopathological dimensions of depression: a factor study of the 17-item Hamilton depression rating scale in unipolar depressed outpatients

BACKGROUND: Agreement on the factor structure of the Hamilton Depression Rating Scale (HDRS) has not been consistent among studies, and some investigators argued that the scale's factor structure is not reliable. This study aimed at shedding more light on this debated issue. METHODS: We studied 186 adults with unipolar depression (Major Depressive Disorder, n=80; Dysthymic Disorder, n=71; Depressive Disorder Not Otherwise Specified, n=25; Adjustment Disorder, n=10). They had no comorbid DSM-IV axis I or axis II disorders, and had received no treatment with antidepressant drugs in the previous 2 months. The factor structure of the scale was studied using the principal factor method, followed by oblique rotation. Factor scores were computed for each subject using the regression method. RESULTS: Using the scree-test criterion for factor extraction, we obtained a four-factor solution, explaining 43.8% of total variance. The four factors extracted were identified as (1) somatic anxiety/somatization factor; (2) a psychic anxiety dimension; (3) a pure depressive dimension; and (4) anorexia factor. Patients with Major Depressive Disorder scored significantly higher than patients with other diagnoses on the pure depressive dimension. LIMITATIONS: These results need to be replicated in different cultures, using analogous factoring techniques. CONCLUSIONS: Though not exhibiting factorial invariance in the stricter sense of the term, the 17-item HDRS did exhibit a relatively reliable factor structure. Our analysis provides further evidence that the scale is multidimensional. However, as long as the multidimensional character of the scale is taken into account the scale should be able to play a useful role in clinical research.     

Psychopathology in prenatally DES-exposed females: current and lifetime adjustment

This report concerns the long-term effects of prenatal exposure to diethylstilbestrol (DES) on overall psychologic functioning in females. Thirty DES-exposed women aged 17-30 years and 30 control women with a history of abnormal Pap smear findings were interviewed with the SADS-L and completed the SCL-90-R and the PRI-Q. Both DES and PAP women showed elevated symptoms on the SCL-90-R in comparison to published norms and were similar to women with cancer, but their rates of psychiatric disorders (SADS-L/RDC) at the time of the evaluation did not differ from community norms. However, both groups met criteria for Major Depressive Disorder (lifetime) significantly above expectancy, and the DES women reported slightly more episodes than the control group. The DES women also had significantly more problems than the PAP control group in social relations with spouses and other significant persons.     

Influence of age and executive functioning on verbal memory of inpatients with depression

BACKGROUND: Despite many studies demonstrating memory and executive impairments in young and old depressed patients, the relationships between age, executive functioning and memory have not been evaluated in depression. The aim of this study was to investigate if older patients were more vulnerable than younger patients to the impact of depression on memory and if the differences between young and old depressed could be related to executive functioning. METHODS: Forty-nine inpatients, with unipolar and bipolar depression, ranging in age from 19 to 72 years were compared with 70 controls on a verbal memory task. Age cut-off of 45 years was used as a categorical variable to divide subjects into subgroups. A subset of patients (n=41) was also evaluated with the modified version of the Wisconsin Card Sorting Test and separated into a non-dysexecutive group and a group of patients with mild-executive impairment. RESULTS: Depressed patients exhibited memory deficits with a pattern of memory failure -- impaired free recall and normal cued recall and recognition -- interpreted as a retrieval problem. Both age and executive function influenced memory performance in depression, however neither group x age interaction nor age x executive status interaction were significant. Multiple regression analysis showed that free recall scores were related to age and psychomotor retardation in depressed patients. CONCLUSION: Age and executive functioning have different influences on the memory performance of depressed patients. Our findings support an 'executive memory decline hypothesis' in young as well as old depressed patients. The memory deficits in depression may be associated with both trait and state factors and raise questions about the long-term cognitive functioning of patients with recurrent affective disorders.     

Effects of severe depression on TOMM performance among disability-seeking outpatients.

The purpose of this study is to examine the effects of severe depression on the Test of Memory Malingering (TOMM). The present study examined whether 20 participants with high levels of depression, as measured by the Beck Depression Inventory 2nd Edition (BDI-II) and with current diagnoses of Major Depressive Disorder, would perform significantly worse on the TOMM than a control group. The results showed that the depressed and control groups did not have significant mean group differences on TOMM performance. Of the 20 depressed participants, only 2 on Trial 2 and 1 on the Retention Trial scored below the cutoff of 45, while none of the control participants performed in this range. The potential ameliorating effects of medications on the performance of the depressed group are discussed. The results indicate that the TOMM can be used with even severely depressed participants with only slight caution.     

Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review

A comprehensive, empirically based review of the published studies addressing neuropsychological performance in adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) was conducted to identify patterns of performance deficits. Findings from 33 published studies were submitted to a meta-analytic procedure producing sample-size-weighted mean effect sizes across test measures. Results suggest that neuropsychological deficits are expressed in adults with ADHD across multiple domains of functioning, with notable impairments in attention, behavioral inhibition, and memory, whereas normal performance is noted in simple reaction time. Theoretical and developmental considerations are discussed, including the role of behavioral inhibition and working memory impairment. Future directions for research based on these findings are highlighted, including further exploration of specific impairments and an emphasis on particular tests and testing conditions.     

Bipolar I and bipolar II disorder: cognition and emotion processing

BACKGROUND: Cognitive impairment may be part of the endophenotype of bipolar disorder (BP), but little is known about patterns and severity of impairment in BP subgroups and their relation to depression. The same applies to deficits in emotion processing known to be present in BP. METHOD: To explore the relationship between depression and impairment in cognition and emotion processing and the differences between BP subgroups, we assessed 36 (25 BP I and 11 BP II) patients using a cognitive battery and a facial emotion recognition task. RESULTS: BP patients were impaired compared to published norms on memory, naming and executive measures (Binomial Single Proportion tests, p<0.05). Cognitive performance was largely unrelated to depression ratings. Surprise recognition was the only emotion processing impairment in BP patients compared to controls (patients' recognition score 75% v. controls' 89%, p=0.024). Patients with higher depression ratings were more impaired in recognizing expressions of anger (t23=2.21, p=0.037). BP II patients were more impaired than BP I patients in IQ, memory and executive measures (Mann-Whitney tests, p<0.05). Depression severity or exposure to medication or electroconvulsive therapy (ECT) did not explain these differences. CONCLUSIONS: We confirm cognitive impairment and an isolated facial emotion processing deficit in BP patients and suggest that these deficits are largely unrelated to depressive symptoms. Our study also provides evidence that cognitive deficits are more severe and pervasive in BP II patients, suggesting that recurrent depressive episodes, rather than mania, may have a more detrimental and lasting effect on cognition.     

Ecological validity of neuropsychological tests: focus on the California Verbal Learning Test and the Wisconsin Card Sorting Test.

To date, few studies have assessed the ecological validity of current measures of memory and executive functioning, particularly the California Verbal Learning Test (CVLT) and the Wisconsin Card Sorting Test (WCST). A battery of tests, including the CVLT and the WCST, was administered to 28 severely head-injured adults who were 1 year or more postinjury. Hierarchical linear regression was performed to assess the relationship between these cognitive tests and work functioning while statistically controlling for physical disability, emotional distress, and memory compensation strategies utilized by the participants. Results suggest that the CVLT was best at predicting performance on the job; however, the CVLT and the WCST were about equally predictive of the type of position held by a participant. Hence, this study demonstrates the ecological validity of measures of memory and executive functioning for predicting work-related skills.     

Visual-spatial learning and memory in schizotypal personality disorder: continued evidence for the importance of working memory in the schizophrenia spectrum.

Verbal episodic memory deficits, a well-established feature of the schizophrenia spectrum, have also been found in individuals with schizotypal personality disorder (SPD), although visual-spatial episodic memory has proven harder to examine. To address this, we administered the Visual Object Learning Test (VOLT), a measure of visual-spatial learning and memory, as well as the California Verbal Learning Test (CVLT) and a verbal working memory test, to 50 individuals with SPD, 19 with other personality disorders (OPD), and 17 healthy volunteers. Compared to both other groups, individuals with SPD learned verbal and visual-spatial information at a reduced rate and recalled fewer words and objects after a long delay. Verbal working memory performance eliminated diagnostic differences in these episodic memory domains. These findings suggest that it is possible to detect both auditory and visual processing episodic memory abnormalities in the spectrum and that these deficits are uniformly a function of verbal working memory impairments.     

Neuropsychological functioning in patients with borderline personality disorder

Although results have been variable, studies suggest that individuals with borderline personality disorder (BPD) exhibit cognitive deficits suggestive of frontal- and temporal-lobe dysfunction. Patients diagnosed with BPD (n = 18) using two structured interviews, and who were carefully screened for neurological and substance-use disorders, were compared to depressed patients (n = 18) and a nonpsychiatric control group (n = 18) on a series of neuropsychological tasks. The role of emotion on cognitive functioning was assessed by including emotional stimuli and interference on several of the tasks. Little support was found for the neurobehavioral hypothesis of BPD. The BPD group performance did not differ from the normal group on most tasks of executive functioning or memory, and the introduction of emotional stimuli did not impair performance. The depressed group performed less effectively than the other groups. Reasons for variable findings and factors affecting the cognitive functioning of patients with BPD are discussed. There may be considerable heterogeneity in the cognitive functioning of BPD patients, with those exhibiting significant cognitive deficits comprising only a subgroup.     

Interference control, working memory, concept shifting, and verbal fluency in adults with attention-deficit/hyperactivity disorder (ADHD)

In this study, the authors aimed to examine 4 domains of executive functioning in adults with attention-deficit/hyperactivity disorder (ADHD)--namely interference control, concept shifting, verbal fluency, and verbal working memory. Four groups of participants were included: (a) adults diagnosed with ADHD (ADHD-super(-); n = 20), (b) adults diagnosed with both ADHD and 1 or more comorbid disorder(s) (ADHD-super(+); n = 22), (c) adults referred for ADHD because of ADHD symptomatology but not diagnosed as such (non-ADHD; n = 34), and (d) healthy controls (n = 136). ADHD-related deficits (independent of comorbidity) were revealed for concept shifting and verbal working memory. In addition, the ADHD-super(+) and non-ADHD groups displayed deficits in terms of general processing speed. Given that these deficits were not found in the ADHD-super(-) group, the authors contend that these deficits are likely attributable to comorbidity rather than ADHD itself. Contrary to the authors' expectations, these findings do not correspond with the cognitive subtype hypothesis.     

Nocturnal indicators of increased cardiovascular risk in depressed adolescent girls

Depression is an independent risk factor for cardiovascular disease in adults, and recent literature suggests preclinical signs of cardiovascular risk are also present in depressed adolescents. No study has examined the effect of clinical depression on cardiovascular factors during sleep. This study examined the relationship between clinical depression and nocturnal indicators of cardiovascular risk in depressed adolescent girls from the general community (13–18 years old; 11 clinically depressed, eight healthy control). Continuous beat‐to‐beat finger arterial blood pressure and heart rate were monitored via Portapres and electrocardiogram, respectively. Cardiovascular data were averaged over each hour for the first 6 h of sleep, as well as in 2‐min epochs of stable sleep that were then averaged within sleep stages. Data were also averaged across 2‐min epochs of pre‐sleep wakefulness and the first 5 min of continuous non‐rapid eye movement sleep to investigate the blood pressure dipping response over the sleep‐onset period. Compared with controls, depressed adolescents displayed a similar but significantly elevated blood pressure profile across sleep. Depressed adolescents had significantly higher systolic and diastolic blood pressure and mean arterial pressures across the entire night (P < 0.01), as well as during all sleep stages (P < 0.001). Depressed adolescents also had higher blood pressure across the sleep‐onset period, but the groups did not differ in the rate of decline across the period. Higher blood pressure during sleep in depressed adolescent females suggests that depression has a significant association with cardiovascular functioning during sleep in adolescent females, which may increase risk for future cardiovascular pathology.     

Executive function and attention deficit hyperactivity disorder: stimulant medication and better executive function performance in children.

BACKGROUND: Executive function deficits have been reported repeatedly in children with Attention Deficit Hyperactivity Disorder (ADHD). Stimulant medication has been shown to be effective in improving cognitive performance on most executive function tasks, but neuropsychological tests of executive function in this population have yielded inconsistent results. Methodological limitations may explain these inconsistencies. This study aimed to measure executive function in medicated and non-medicated children with ADHD by using a computerized battery, the Cambridge Neuropsychological Test Automated Battery (CANTAB), which is sensitive to executive function deficits in older patients with frontostriatal neurological impairments. METHODS: Executive function was assessed in 30 children with ADHD: 15 were stimulant medication naive and 15 were treated with stimulant medication. These two groups were compared to 15 age, sex and IQ matched controls. RESULTS: The unmedicated children with ADHD displayed specific cognitive impairments on executive function tasks of spatial short-term memory, spatial working memory, set-shifting ability and planning ability. Impairments were also seen on spatial recognition memory and delayed matching to sample, while pattern recognition memory remained intact. The medicated children with ADHD were not impaired on any of the above executive function tasks except for deficits in spatial recognition memory. CONCLUSIONS: ADHD is associated with deficits in executive function. Stimulant medication is associated with better executive function performance. Prospective follow-up studies are required to examine these effects.     

Structure-function associations in hippocampus in bipolar disorder

Hippocampus volume decreases and verbal memory deficits have been reported in bipolar disorder (BD) as independent observations. We investigated potential associations between these deficits in subjects with BD. Hippocampus volumes were measured on magnetic resonance images of 31 subjects with BD and 32 healthy comparison (HC) subjects. The California Verbal Learning Test-Second Edition (CVLT) assessed verbal memory function in these subjects. Compared to the HC group, the BD group showed both significantly smaller hippocampus volumes and impaired performance on CVLT tests of immediate, short delay and long delay cued and free recall. Further, smaller hippocampus volume correlated with impaired performance in BD. Post hoc analyses revealed a trend towards improved memory in BD subjects taking antidepressant medications. These results support associations between morphological changes in hippocampus structure in BD and verbal memory impairment. They provide preliminary evidence pharmacotherapy may reverse hippocampus-related memory deficits.     

Intergenerational influences on early alcohol use: independence from the problem behavior pathway

Conduct problems are a general risk factor for adolescent alcohol use. However, their role in relation to alcohol-specific risk pathways of intergenerational transmission of alcohol use is not well understood. Further, the roles of alcohol-specific contextual influences on children's early alcohol use have been little examined. In a 20-year prospective, multimethod study of 83 fathers and their 125 children, we considered the predictors of child alcohol use by age 13 years. The predictors included fathers' adolescent antisocial behavior and alcohol use, both parents' adult alcohol use, norms about and encouragement of child use, parental monitoring, child-reported exposure to intoxicated adults, and parent-reported child externalizing behaviors. Path models supported an association between fathers' adolescent alcohol use and children's use (β = 0.17) that was not better explained by concurrent indicators of fathers' and children's general problem behavior. Fathers' and mothers' adult alcohol use uniquely predicted child use, and exposure to intoxicated adults partially mediated the latter path. Other family risk mechanisms were not supported. However, parental alcohol use and child alcohol use were linked in expected ways with family contextual conditions known to set the stage for alcohol use problems later in adolescence.     

An investigation of visuospatial memory impairment in children with attention deficit hyperactivity disorder (ADHD), combined type

BACKGROUND: Memory impairment is not considered a core cognitive feature of attention deficit hyperactivity disorder, combined type (ADHD-CT), although it is associated with impairments in attentional and executive functions. This study investigates visuospatial memory impairment, in particular encoding and retrieval aspects, in children with ADHD-CT who are stimulant-medication naive and medicated with stimulant medication. METHOD: A cross-sectional study of visuospatial memory in 6- to 12-year-old children with stimulant-medication-naive ADHD-CT (n = 62) and medicated ADHD-CT (n = 58) compared to an age- and gender-matched healthy control group (n = 39) was completed. RESULTS: Both medication-naive and medicated ADHD-CT groups demonstrated subtle yet significant impairment in visuospatial memory. The memory impairment was delay-independent, which, along with other factors, suggest dysfunction of the encoding rather than retrieval phase of visuospatial memory. CONCLUSIONS: Careful study of large ADHD-CT samples does detect deficits in a visuospatial memory task, but these reflect attentional deficits rather than being specifically due to dysfunction of the medial temporal lobe explicit memory system. Children with ADHD-CT may benefit from cognitive and behavioural strategies focused on improving encoding of relevant information rather than retrieval strategies.     

Effects of borderline personality disorder features and a family history of alcohol or drug dependence on P300 in adolescents.

Decrements in P300 amplitude have been associated with familial risk for alcoholism as well as several other psychiatric disorders characterized by disinhibited behavior. The present study examined the P300 in relation to Borderline Personality Disorder (BPD) features in adolescents with a paternal history of alcohol or drug dependence. One hundred and seventy-five males and females, aged 14-20, were assigned to groups based on BPD features (BPD+ vs. BPD-), family history of substance dependence (negative FH-, alcohol FHA, drug FHD) and gender. BPD features were assessed using the Structured Clinical Interview for the DSM-III-R questionnaire. P300 ERPs were recorded while each subject performed the Stroop color-word compatibility test. Repeated measures analyses, which included Conduct Disorder and Depression symptoms as covariates, indicated a significant reduction in P300 amplitude in the BPD+ group. There were no significant effects of FH or gender on P300 amplitude. These results document the presence of neurophysiological abnormalities associated with BPD features in an adolescent sample. This effect appeared to be independent of a family history of alcohol or substance dependence. These findings suggest that BPD symptoms during adolescence are relevant to the examination of the physiological antecedents of those forms of adult psychopathology characterized by behavioral disinhibition, including alcohol and drug dependence.