Executive Dysfunction in Depression: A Systematic Review
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Abstract
Among the alterations observed in depression, volumetric reduction of the prefrontal cortex is commonly reported, which affects executive functions (EF), though this relationship has not been systematically evaluated. To address this gap, we conducted a systematic review using the PRISMA protocol to assess the presence of executive dysfunction (ED) in individuals with depression. We searched PubMed, Embase, and SciELO using a search strategy that combined the terms “Depression” and “Executive Dysfunction,” with no publication date or language restrictions. Eligible studies included longitudinal or cross-sectional analytical articles that evaluated EF using standardized or validated scales and tests, involving patients without comorbidities matched to controls. Literature reviews, studies involving patients with psychiatric comorbidities, and non-human models were excluded. The search yielded 672 articles from PubMed, 51 from Embase, and 4 from SciELO (total n = 727), of which 22 were selected for full-text review. Six studies included patients with comorbidities, leading to the inclusion of 16 studies. Most studies found impaired EF in depression, with EF performance appearing to be inversely proportional to symptom-induced stress levels. Evidence suggests that ED may reduce the likelihood of remission, though psychotherapeutic interventions can help mitigate these executive impairments. Additionally, ED appears to persist even after symptom remission, with more pronounced effects in older adults. Overall, these findings highlight the need for further investigation into ED in depression, as ED may serve as a potential biological marker for the disorder.
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References
American Psychiatric Association-APA (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th ed.). Washington: American Psychiatric Association Publishing. 1051 p.
Aromataris, E., & Munn, Z. (2017). JBI systematic reviews. Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute. https://doi.org/10.46658/JBIMES-20-02.
Ávila, R., & Bottino, C. M. C. (2006) Atualização sobre alterações cognitivas em idosos com síndrome depressiva. Brazilian Journal of Psychiatry [online]. v. 28, n. 4 [Accessed on 13th June 2022], pp. 316–320. https://doi.org/10.1590/S1516-44462006005000010.
Alexopoulos G. S. (2001). “The depression-executive dysfunction syndrome of late life”: a specific target for D3 agonists?. The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry, 9(1), 22–29. https://doi.org/10.1097/00019442-200102000-00004.
Alexopoulos, G. S., Raue, P. J., Kiosses, D. N., Mackin, R. S., Kanellopoulos, D., McCulloch, C., & Areán, P. A. (2011). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Archives of general psychiatry, 68(1), 33–41. https://doi.org/10.1001/archgenpsychiatry.2010.177.
Burdwood, E. N., Infantolino, Z. P., Crocker, L. D., Spielberg, J. M., Banich, M. T., Miller, G. A., & Heller, W. (2016). Resting-state functional connectivity differentiates anxious apprehension and anxious arousal. Psychophysiology, 53(10), 1451–1459. https://doi.org/10.1111/psyp.12696.
Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet (London, England), 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1.
Contreras-Osorio, F. et al. (2022) Effects of Physical Exercise on Executive Function in Adults with Depression: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, v. 19, n. 22, p. 15270, 1 Jan. https://doi.org/10.3390/ijerph192215270.
COVID-19 Mental Disorders Collaborators (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the Covid-19 pandemic. Lancet (London, England), 398(10312), 1700–1712. https://doi.org/10.1016/S0140-6736(21)02143-7.
Cristancho, P., Arora, J., Nishino, T., Berger, J., Carter, A., Blumberger, D., Miller, P., Snyder, A., Barch, D., & Lenze, E. J. (2023). A pilot randomized sham controlled trial of bilateral iTBS for depression and executive function in older adults. International journal of geriatric psychiatry, 38(1), e5851. https://doi.org/10.1002/gps.5851.
Davidson, R. J., & McEwen, B. S. (2012). Social influences on neuroplasticity: stress and interventions to promote well-being. Nature neuroscience, 15(5), 689–695. https://doi.org/10.1038/nn.3093.
Dias, N. M., Gomes, C. M. A., Reppold, C. T., Fioravanti-Bastos, A. C. M., Pires, E. U., Carreiro, L. R. R., & Seabra, A. G. (2015) Investigação da estrutura e composição das funções executivas: análise de modelos teóricos. Psicologia: Teoria e Prática, 17(2), 140–152. https://doi.org/10.15348/1980-6906/psicologia.v17n2p140-152.
Elkana O. (2024). Navigating the “frontal lobe paradox”: integrating Real-Life Tasks (RLTs) approach into neuropsychological evaluations. Frontiers in psychology, 15, 1394483. https://doi.org/10.3389/fpsyg.2024.1394483.
Feijs, H. M. E., van Aken, L., van der Veld, W. M., van der Heijden, P. T., & Egger, J. I. M. (2024). No relations between executive functions and dimensional models of psychopathology or is time the missing link?. PloS one, 19(3), e0288386. https://doi.org/10.1371/journal.pone.0288386.
Fiorentino, N., Gleichgerrcht, E., Roca, M., Cetkovich, M., Manes, F., & Torralva, T. (2013). The INECO Frontal Screening tool differentiates behavioral variant - frontotemporal dementia (bv-FTD) from major depression. Dementia & Neuropsychologia, 7(1), 33–39. https://doi.org/10.1590/S1980-57642013DN70100006.
Friedman, N. P., & Miyake, A. (2017). Unity and diversity of executive functions: Individual differences as a window on cognitive structure. Cortex: a journal devoted to the study of the nervous system and behavior, 86, 186–204. https://doi.org/10.1016/j.cortex.2016.04.023.
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., Schünemann, H. J., & GRADE Working Group (2008). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed.), 336(7650), 924–926. https://doi.org/10.1136/bmj.39489.470347.AD.
Hyman, S. E. (2008). A glimmer of light for neuropsychiatric disorders. Nature, 455(7215), 890–893. https://doi.org/10.1038/nature07454.
Khan, S. A., Ryali, V., Bhat, P. S., Prakash, J., Srivastava, K., & Khanam, S. (2015). The hippocampus and executive functions in depression. Industrial psychiatry journal, 24(1), 18–22. https://doi.org/10.4103/0972-6748.160920.
Koene, J., Zyto, S., van der Stel, J., van Lang, N., Ammeraal, M., Kupka, R. W., & van Weeghel, J. (2022). The relations between executive functions and occupational functioning in individuals with bipolar disorder: a scoping review. International journal of bipolar disorders, 10(1), 8. https://doi.org/10.1186/s40345-022-00255-7.
Light, S. N., Bieliauskas, L. A., & Zubieta, J. K. (2017). “Top-Down” Mu-Opioid System Function in Humans: Mu-Opioid Receptors in Ventrolateral Prefrontal Cortex Mediate the Relationship Between Hedonic Tone and Executive Function in Major Depressive Disorder. The Journal of neuropsychiatry and clinical neurosciences, 29(4), 357–364. https://doi.org/10.1176/appi.neuropsych.16090171.
Lima et al. (2022) Impairment of executive functions due to sleep alterations: An integrative review on the use of P300. Frontiers in neuroscience, 16, 906492. https://doi.org/10.3389/fnins.2022.906492.
Mac-Giollabhui, N., Swistun, D., Murray, S., Moriarity, D. P., Kautz, M. M., Ellman, L. M., …, & Alloy, L. B. (2019). Executive dysfunction in depression in adolescence: the role of inflammation and higher body mass. Psychological medicine, 50(4), 683–691. https://doi.org/10.1017/S0033291719000564.
Malhi GS (2018). Depression. Lancet, Nov 24, 392, (10161), p. 2299–2312. https://doi.org/10.1016/S0140-6736(18)31948-2.
Martin et al. (2000) Pharmacotherapy of early-onset depression. Update and new directions. Child Adolesc Psychiatry and Clinical Neurosciences, 9(1), p. 135–157.
McLennan et al. (2010) The depression-executive dysfunction (DED) syndrome and response to antidepressants: a meta-analytic review. International journal of geriatric psychiatry, 25(10), 933–944. https://doi.org/10.1002/gps.2431.
Menon V. (2011). Large-scale brain networks and psychopathology: a unifying triple network model. Trends in cognitive sciences, 15(10), 483–506. https://doi.org/10.1016/j.tics.2011.08.003.
Moher, D. et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine vol. 6(7), e1000097, 2009. https://doi.org/10.1371/journal.pmed.1000097.
Nakano et al. (2008) Executive dysfunction in medicated, remitted state of major depression. Journal of affective disorders, 111(1), 46–51. https://doi.org/10.1016/j.jad.2008.01.027.
Nunes, D., Monteiro, L., & Lopes, E. (2014). INECO frontal screening: um instrumento para avaliar as funções executivas na depressão. Psicologia Clínica, 26(2), 177–196. Available from : https://www.scielo.br/j/pc/a/VmPQ4WSmNdRHj5cbwP8QPYf/.
Osório, R., de Lózar, B. G., Ramos, I., & Agüera, L. (2009). Executive function in patients with late onset depression. Actas espanolas de psiquiatria, 37(4), 196–199.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery, 88, 105906. https://doi.org/10.1136/bmj.n71.
Porto, P., Hermolin, M., & Ventura, P. (2002). Alterações neuropsicológicas associadas à depressão. Revista Brasileira de Terapia Comportamental e Cognitiva, 4(1), 63–70. https://doi.org/10.31505/rbtcc.v4i1.123.
Rajtar-Zembaty, A., Sałakowski, A., Rajtar-Zembaty, J., & Starowicz-Filip, A. (2017). Executive dysfunction in late-life depression. Dysfunkcje wykonawcze w depresji wieku podeszłego. Psychiatria polska, 51(4), 705–718. https://doi.org/10.12740/PP/OnlineFirst/63765.
Roca et al. (2019) Suicidal risk and executive functions in major depressive disorder: a study protocol. BMC Psychiatry. 2019 Aug 16, 19(1), 253. https://doi.org/10.1186/s12888-019-2233-1.
Rozenthal et al. (2004) Aspectos neuropsicológicos da depressão. Revista de Psiquiatria do Rio Grande do Sul [online]. 2004, v. 26, n. 2 [Acessado 10 Agosto 2022], pp. 204-212. https://doi.org/10.1590/S0101-81082004000200010.
Santos, C. M. da C., Pimenta, C. A. de M., & Nobre, M. R. C. (2007). The PICO strategy for the research question construction and evidence search. Revista Latino-americana De Enfermagem, 15(3), 508–511. https://doi.org/10.1590/S0104-11692007000300023.
Salehinejad, M. A., Ghanavati, E., Rashid, M. H. A., & Nitsche, M. A. (2021). Hot and cold executive functions in the brain: A prefrontal-cingular network. Brain and neuroscience advances, 5, 23982128211007769. https://doi.org/10.1177/23982128211007769.
Singh et al. (2023) Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British journal of sports medicine, bjsports-2022-106195. Advance online publication. https://doi.org/10.1136/bjsports-2022-106195.
Snyder, H. R., Miyake, A., & Hankin, B. L. (2015). Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches. Frontiers in psychology, 6, 328. https://doi.org/10.3389/fpsyg.2015.00328.
Sterne, J. A. C., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., Henry, D., Altman, D. G., Ansari, M. T., Boutron, I., Carpenter, J. R., Chan, A. W., Churchill, R., Deeks, J. J., Hróbjartsson, A., Kirkham, J., Jüni, P., Loke, Y. K., Pigott, T. D., Ramsay, C. R., … Higgins, J. P. (2016). ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Clinical research ed.), 355, i4919. https://doi.org/10.1136/bmj.i4919.
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., … Higgins, J. P. T. (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed.), 366, l4898. https://doi.org/10.1136/bmj.l4898.
Tobore T. O. (2023). On the beauty of sadness: it’s okay to say, I am sad, thank you. Communicative & integrative biology, 16(1), 2211424. https://doi.org/10.1080/19420889.2023.2211424.
Tunvirachaisakul et al.(2018) Predictors of treatment outcome in depression in later life: A systematic review and meta-analysis. Journal of affective disorders, 227, 164–182. https://doi.org/10.1016/j.jad.2017.10.008.
Warren et al. (2021) The Structure of Executive Dysfunction in Depression and Anxiety. Journal of affective disorders, 279, 208–216. 2021. https://doi.org/10.1016/j.jad.2020.09.132.
Zhang, F. F., Peng, W., Sweeney, J. A., Jia, Z. Y., & Gong, Q. Y. (2018). Brain structure alterations in depression: Psychoradiological evidence. CNS neuroscience & therapeutics, 24(11), 994–1003. https://doi.org/10.1111/cns.12835.
Zhang et al. (2022) Associations between executive function impairment and biochemical abnormalities in depressed adolescents with non-suicidal self-injury. Journal of Affective Disorders, v. 298, p. 492–499, Feb. 2022. https://doi.org/10.1016/j.jad.2021.10.132.