What is the overlap between subjective and objective cognitive impairments in MDD?

BACKGROUND: Cognitive impairments, such as memory deficits and execu­tive impairment, are common among patients with major depressive disor­der (MDD) and can be captured with objective or subjective assessments. The aim of this post-hoc analysis of the CONNECT study was to assess the degree of overlap between subjective and objective cognitive impairment among MDD patients, and to evaluate associated clinical characteristics.

METHODS: The study was conducted from April 2012 to February 2014 and enrolled a total of 602 patients with MDD who reported subjective cognitive impairment. Efficacy was assessed using a battery of objective tests of cog­nitive function representing multiple domains: Digit Symbol Substitution Test performance, Trail Making Test A, Trail Making Test B, Congruent and Incongruent Stroop Test, Groton Maze Learning Test, Detection Task, Identification Task, and One-Back Task. The Cognitive and Physical Functioning Questionnaire (CPFQ) was used to capture patient-reported assessments of cognitive function.

RESULTS: Although 48% of patients with MDD met our conservative criteria for subjectively defined marked cognitive impairment, 64% of patients with MDD met our conservative criteria for objectively defined cognitive impair­ment. Therefore, the proportion of patients defined as having impaired cog­nition was somewhat similar regardless of methodology. Overall, 80% of patients with MDD in this study reported either subjective or objective cog­nitive impairment per subjective and objective scales. However, the propor­tion of patients meeting criteria for both subjectively and objectively defined cognitive impairment was only 31%. This could be explained by the fact that the CPFQ total score was only modestly—although significantly—correlated with all but one of the objective tests..

CONCLUSIONS: This post-hoc study shows that approxi­mately 80% of patients with MDD participating in an anti­depressant trial reported either subjective or objective cognitive impairment.

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