AAGP: Sertraline May Not Reduce Cognitive Deficits in Elderly Patients with Depression and Cognitive Impairment

By Bonnie Darves, Doctor’s Guide

 March 4, 2003

HONOLULU, HA -- Elderly patients with cognitive impairment (CI) and depression (DEP-MCI) who are treated with sertraline may experience little improvement in cognitive function, according to a new study presented here March 3^rd at the Annual Meeting of the American Association for Geriatric Psychiatry.

Researchers at Columbia University in New York, say their study may have implications for future treatment because comorbid depression and CI are common in the elderly population, but there is scant data on whether treatment with antidepressants leads to a reversal of cognitive deficits.

Lead researcher Davangere Devanand, MD, and colleagues sought to evaluate the effectiveness of sertraline in reducing CI in patients who have depression and cognitive impairment without dementia.

They evaluated 39 patients mean age of 72 who received up to 200 mg/day of sertraline for up to 12 weeks. To meet inclusion criteria, patients had to have mean Hamilton Rating Scale for Depression (HAM-D) scores of 8 or greater, and Mini-Mental State Examination scores of at least 17. Patients with dementia were excluded. Mean age at first diagnosis of depression was 63.9 years, and mean duration of memory complaints was 33.5 months.

Of the 26 patients who remained in the trial, 17 responded and nine were deemed to be non-responders, based on lack of significant improvement in either HAM-D scores or Clinical Global Impression scores. Age and education had no significant effect on treatment response, Dr. Devanand said. Patients who dropped out of the study did so within the first 3 weeks -- primarily because of side effects such as gastrointestinal complaints, anxiety and somatic problems.

"What we saw was that few patients showed dramatic improvement in CI pre- and post-trial, and total recall didn't [change] at all [over the course of treatment]," he said. "That really was striking -- that even after treatment for depression, people didn't do better on cognitive improvement. These preliminary results show that [comorbid] patients treated for depression will still get dementia."

The results were disheartening, Dr. Devanand added, because researchers have hoped that improvements in attention and motor speed that antidepressants produce might carry over into general function improvement in cognitively impaired patients.

Although study limitations were few, he admitted that his team had difficulty finding an adequate number of patients with depression and CI who met other inclusion criteria. "There were fewer [patients] than we expected," he said.