Cognitive symptoms in major depressive disorder: associations with clinical and functional outcomes in a 6-month, non-interventional, prospective study in China
Authors Wang G, Si TM, Li L, Fang Y, Wang CX, Wang LN, Tan KHX, Ettrup A, Eriksen HLF, Luo S, Ge L
Received 21 November 2018
Accepted for publication 3 May 2019
Published 1 July 2019 Volume 2019:15 Pages 1723—1736
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Prof. Dr. Roumen Kirov
Peer reviewer comments 2
Editor who approved publication: Professor Jun Chen
Gang Wang,1 Tian-Mei Si,2 Lingjiang Li3,4 Yiru Fang,5 Chun-Xue Wang,6 Li-Na Wang,7 Kristin Hui Xian Tan,8 Anders Ettrup,9 Hanne-Lise Falgreen Eriksen,9 Si Luo,10 Lan Ge10
1Beijing An Ding Hospital, Capital Medical University, China National Clinical Research Center for Mental Disorders, Beijing, People’s Republic of China; 2Peking University Sixth Hospital & Peking University Institute of Mental Health, Beijing, 100191, People’s Republic of China; 3Key Laboratory of Mental Health, Ministry of Health (Peking University) &National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China; 4The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China; 5Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 6Beijing Tian Tan Hospital, Department of Neuropsychiatry and Behavioral Neurology, Capital Medical University, National Clinical Research Center for Neurological Disease, Beijing, People’s Republic of China; 7Tianjin Anding Hospital, Tianjin, People’s Republic of China; 8Lundbeck Singapore Pte Ltd, Singapore; 9H. Lundbeck A/S, Valby, Denmark; 10Lundbeck China, Beijing, People’s Republic of China
Objective: Cognitive symptoms in major depressive disorder (MDD) are common and may negatively impact clinical and functional outcomes. The Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study aimed to assess the prevalence and course of cognitive symptoms, and their associations with clinical and functional outcomes during 6 months of antidepressant treatment, in a real-world setting among Chinese patients with MDD.
Patients and methods: Outpatients (n=598) aged 18–65 years with MDD and a total score ≥17 on the Hamilton Depression Rating Scale – 17 Items (HAM-D17) were observed over 6 months after initiating new antidepressant monotherapy, with follow-up visits at months 1, 2, and 6. Cognitive symptoms were assessed using the Perceived Deficits Questionnaire – Depression (PDQ-D) and cognitive performance using the Digit Symbol Substitution Test (DSST).
Results: At baseline, 76.9% of patients had indications of cognitive symptoms (PDQ-D total score ≥21); at month 6, this was reduced, but still present in 32.4%. Across the 6-month study period, patients improved across cognitive, clinical and functional assessments. High levels of cognitive symptoms (PDQ-D) consistently predicted worse clinical outcomes, ie, lower odds for remission and increased odds for relapse, as well as worse patient-reported functional outcomes and lower quality of life. In contrast, cognitive performance (DSST) predicted performance-based functioning but only a few patient-reported functional outcomes (absenteeism and quality of life), and no clinical outcomes. PDQ-D and DSST scores were uncorrelated at baseline.
Conclusion: The study highlights the importance of assessing and targeting cognitive symptoms for increasing patients’ chances of recovery and restoring functioning in the treatment of MDD. The results further highlight the relevance of complementary assessment methods to fully capture aspects of cognitive symptoms in patients with depression.
Keywords: MDD, antidepressants, cognitive performance, real-world evidence, PDQ-D, DSST
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