Neuropsychological Assessments of Cognitive Impairment in Major Depressive Disorder: A Systematic Review and Meta-Analysis with Meta-Regression.

INTRODUCTION: Cognitive dysfunction or deficits are common in patients with major depressive disorder (MDD). The current study systematically reviews and meta-analyzes multiple domains of cognitive impairment in patients with MDD. METHODS: PubMed/MEDLINE, PsycINFO, Cochrane Library, Embase, Web of Science, and Google Scholar were searched from inception through May 17, 2023, with no language limits. Studies with the following inclusion criteria were included: (1) patients with a diagnosis of MDD using standardized diagnostic criteria; (2) healthy controls (i.e., those without MDD); (3) neuropsychological assessments of cognitive impairment using Cambridge Neuropsychological Test Automated Battery (CANTAB); and (4) reports of sufficient data to quantify standardized effect sizes. Hedges' g standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were used to quantify effect sizes of cognitive impairments in MDD. SMDs were estimated using a fixed- or random-effects models. RESULTS: Overall, 33 studies consisting of 2,596 subjects (n = 1,337 for patients with MDD and n = 1,259 for healthy controls) were included. Patients with MDD, when compared to healthy controls, had moderate cognitive deficits (SMD, -0.39 [95% CI, -0.47 to -0.31]). In our subgroup analyses, patients with treatment-resistant depression (SMD, -0.56 [95% CI, -0.78 to -0.34]) and older adults with MDD (SMD, -0.51 [95% CI, -0.66 to -0.36]) had greater cognitive deficits than healthy controls. The effect size was small among unmedicated patients with MDD (SMD, -0.19 [95% CI, -0.37 to -0.00]), and we did not find any statistical difference among children. Cognitive deficits were consistently found in all domains, except the reaction time. No publication bias was reported. CONCLUSION: Because cognitive impairment in MDD can persist in remission or increase the risk of major neurodegenerative disorders, remediation of cognitive impairment in addition to alleviation of depressive symptoms should be an important goal when treating patients with MDD.

Sleep, Positive Affect, and Circulating Interleukin-6 in Women With Temporomandibular Joint Disorder.

OBJECTIVE: Systemic inflammation is commonly observed in idiopathic chronic pain conditions, including temporomandibular joint disorder (TMD). Trait positive affect (PA) is associated with lower inflammation in healthy controls, but those effects may be threatened by poor sleep. The associations between PA with proinflammatory cytokine activity and potential moderation by sleep in chronic pain are not known. We thus investigated the association between PA and circulating interleukin-6 (IL-6) and moderation of that association by sleep in a sample of women with TMD and sleep difficulties. METHODS: Participants (n = 110) completed the insomnia severity index and provided blood samples at five intervals throughout an evoked pain testing session. They then completed a 14-day diary assessing sleep and affect, along with wrist actigraphy. RESULTS: There was not a significant main effect of PA on resting or pain-evoked IL-6 (b = 0.04, p = .33). Diary total sleep time (b = -0.002, p = .008), sleep efficiency (b = -0.01, p = .005), sleep onset latency (b = 0.006, p = .010), and wake after sleep onset (b = 0.003, p = .033) interacted with PA to predict IL-6, such that PA inversely predicted IL-6 at higher levels of total sleep time and sleep efficiency and at lower levels of sleep onset latency and wake after sleep onset. Surprisingly, when sleep was poor, PA predicted greater IL-6. CONCLUSIONS: The potential salutary effects of PA on resting IL-6 erode when sleep is poor, underscoring the importance of considering sleep in conceptual and intervention models of TMD.

Relationships between drinking quantity and frequency and behavioral and hippocampal BOLD responses during working memory performance involving allocentric spatial navigation in college students.

BACKGROUND: Quantity and frequency of drinking may be used to effectively quantify the severity of alcohol-use. Drinking-severity has been related to neurocognitive impairments in such domains as spatial working memory (SWM). Youth drinking has been associated with altered neurofunctional underpinnings of SWM. The current study examined the relationship between drinking-severity and SWM processing. METHODS: One-hundred-and-seventy college drinkers reported the maximum number of drinks in a 24 -h period in the last six-months (quantity) and average number of drinking weeks in the last six-months (frequency). All participants performed a virtual Morris Water Task during fMRI which included trials where the target platform was visible or hidden. RESULTS: Greater quantity was associated with reduced SWM-related activity in the dorsolateral prefrontal cortex (F(1, 167) = 4.15, p = .04). Greater frequency was associated with reduced SWM-related activity in the hippocampus (F(1, 167) = 4.34, p = 0.039). Greater quantity was associated with longer search times (r = 0.21, p = .005) and greater platforms found (r = 0.19, p = .01) in VISIBLE trials. We did not find a relationship between drinking quantity or frequency and gender on SWM-related activity, although men found more platforms in both HIDDEN (F(1, 168) = 11.7, p = 0.0008) and VISIBLE (F(1, 168) = 23.0, p < .0001) trials compared to women. CONCLUSIONS: Altered SWM-related hippocampal function relating to alcohol use in young adults raises questions regarding the impact on young adult health and the nature of the findings. Future studies should examine whether these differences may lead to cognitive deficits later in life.

Relations between adaptive and maladaptive pain cognitions and within-day pain exacerbations in individuals with fibromyalgia.

The objectives of this study were to assess within-person hypotheses regarding temporal cognition-pain associations: (1) do morning pain flares predict changes in two afternoon adaptive and maladaptive pain-related cognitions, and (2) do these changes in afternoon cognitions predict changes in end-of-day pain reports, which in turn, carry over to predict next morning pain in individuals with fibromyalgia. Two hundred twenty individuals with fibromyalgia completed electronic assessments of pain intensity, pain catastrophizing, and pain coping efficacy three times a day for three weeks. Multilevel structural equation modeling established that afternoon catastrophizing and coping efficacy were parallel mediators linking late morning with end-of-day pain reports (controlling for afternoon pain), in line with prediction. Catastrophizing was a stronger mediator than coping efficacy. Moreover, afternoon cognitions and end-of-day pain reports served as sequential mediators of the relation between same-day and next-day morning pain. These findings align with assertions of cognitive-behavioral theories of pain that pain flares predict changes in pain both adaptive and maladaptive cognitions, which in turn, predict further changes in pain.

Methodology and preliminary results from the neurobiology of late-life depression study.

BACKGROUND: We sought to investigate the relationship between neuroticism and depression in an elderly cohort. In this paper, we describe the methods of an National Institute of Mental Health-NIMH-supported study and present findings among the cohort enrolled to date. METHODS: We used the NEO Personality Inventory to assess neuroticism, and we employed several cognitive neuroscience-based measures to examine emotional control. RESULTS: Compared with a group of 27 non-depressed older control subjects, 33 older depressed subjects scored higher on measures of state and trait anxiety and neuroticism. On our experimental neuroscience-based measures, depressed subjects endorsed more negative words compared with controls on an emotional characterization test. In addition, we found a significant group-by-congruency effect on an emotional interference test where subjects were asked to identify the face's emotional expression while ignoring the words "fear" or "happy" labeled across the face. CONCLUSION: Thus, in this preliminary work, we found significant differences in measures of neuroticism and emotional controls among older adults with and without depression.

The within-day relation between lonely episodes and subsequent clinical pain in individuals with fibromyalgia: Mediating role of pain cognitions.

OBJECTIVE: This daily diary study of individuals with fibromyalgia (FM) examined whether morning increases in loneliness relate to worsened evening bodily pain through afternoon negative pain cognitions. METHODS: 220 participants with FM completed electronic diaries 4 times a day for 21days to assess loneliness, negative pain cognitions, bodily pain, and social enjoyment. Multilevel structural equation modeling was used to examine within-person relations of morning increases in loneliness, afternoon negative pain cognitions, and evening pain, controlling for morning pain. RESULTS: On mornings when individuals experienced higher than their usual levels of loneliness, they experienced higher levels of afternoon maladaptive pain cognitions, which in turn predicted increases in evening pain above the level of morning pain. Afternoon maladaptive pain cognitions fully mediated the relations between morning loneliness and evening pain. CONCLUSIONS: Lonely episodes are associated with subsequent increases in negative patterns of thinking about pain, which in turn predict subsequent increases in bodily pain within a day. Because pain cognitions mediate the loneliness-pain link, FM interventions may benefit from addressing individuals' vulnerability to maladaptive cognitions following lonely episodes.

Positive affect and pain: mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia.

Fibromyalgia (FM) is a chronic pain condition often resulting in functional impairments. Nonrestorative sleep is a prominent symptom of FM that is related to disability, but the day-to-day mechanisms relating the prior night's sleep quality to next-day reports of disability have not been examined. This study examined the within-day relations among early-morning reports of sleep quality last night, late-morning reports of pain and positive and negative affect, and end-of-day reports of activity interference. Specifically, we tested whether pain, positive affect, and negative affect mediated the association between sleep quality and subsequent activity interference. Data were drawn from electronic diary reports collected from 220 patients with FM for 21 consecutive days. The direct and mediated effects at the within-person level were estimated with multilevel structural equation modeling. Results showed that pain and positive affect mediated the relation between sleep quality and activity interference. Early-morning reports of poor sleep quality last night predicted elevated levels of pain and lower levels of positive affect at late-morning, which, in turn, predicted elevated end-of-day activity interference. Of note, positive affect was a stronger mediator than pain and negative affect was not a significant mediator. In summary, the findings identify 2 parallel mechanisms, pain and positive affect, through which the prior night's sleep quality predicts disability the next day in patients with FM. Furthermore, results highlight the potential utility of boosting positive affect after a poor night's sleep as one means of preserving daily function in FM.

Daily social enjoyment interrupts the cycle of same-day and next-day fatigue in women with fibromyalgia.

BACKGROUND: Fatigue is a debilitating symptom of fibromyalgia (FM) that has limited treatment options. Some evidence, however, has linked positive social engagement with reduced within-day fatigue. PURPOSE: This study elaborated longitudinal within-day and across-day relations between FM fatigue and social enjoyment. METHODS: One hundred seventy-six women with FM completed 21-day automated diaries assessing morning and end-of-day fatigue, and both afternoon social enjoyment and stress within two social domains: non-spousal and spousal. RESULTS: In the non-spousal domain, analysis supported a mediational path from lower morning fatigue to higher afternoon social enjoyment, which predicted lower end-of-day fatigue, and subsequently, lower next-morning fatigue. Enjoyment exerted a greater impact on within-day fatigue than did stress. Patterns in the spousal domain were similar, but the mediated path was nonsignificant. CONCLUSIONS: Positive social engagement offers relief from FM fatigue that carries over across days and may provide an additional target to enhance the effectiveness of current interventions.

Association between interactive voice response adherence and subject retention in a randomized controlled trial.

INTRODUCTION: Interactive voice response (IVR) technology uses the telephone to collect patient reports. This study examined whether IVR adherence during a year-long clinical trial was related to subject retention in the trial. METHODS: As part of a randomized, double-blind, placebo-controlled study of daily multivitamin supplementation for recurrent aphthous stomatitis, 160 study participants were asked to make 1 weekly IVR call for the one-year study duration. RESULTS: The 114 subjects who completed the study made 90.5% of their expected number of IVR calls, as compared to 55.7% of expected calls made by the 46 subjects who withdrew prematurely (p<0.001). Subjects who successfully completed the study were also more likely to initiate their IVR calls as compared to subjects who withdrew from the study (p<0.001). A multivariable model incorporating different adherence variables was able to successfully predict retention status of more than 80% of subjects. IVR adherence during the first few weeks of study participation was strongly predictive of subsequent retention and successful completion of this one-year study. DISCUSSION: Subjects who withdrew prematurely had more missing data than study completers, even after accounting for period of study participation, potentially introducing bias into IVR results. Sub-optimal adherence to weekly IVR might provide an early signal of subsequent premature withdrawal in clinical trials. IVR adherence could be used as a screening tool during a trial period, to identify subjects most likely to stay on long clinical trials. CONCLUSION: IVR adherence may be useful in anticipating retention in long-term clinical studies.

Beliefs about racism and health among African American women with diabetes: a qualitative study.

Exposure to racism has been linked to poor health outcomes. Little is known about the impact of racism on diabetes outcomes. This study explored African American women's beliefs about how racism interacts with their diabetes self-management and control. Four focus groups were conducted with a convenience sample of 28 adult African American women with type 2 diabetes who were recruited from a larger quantitative study on racism and diabetes. The focus group discussions were transcribed verbatim and analyzed by the authors. Women reported that exposure to racism was a common phenomenon, and their beliefs did in fact link racism to poor health. Specifically, women reported that exposure to racism caused physiological arousal including cardiovascular and metabolic perturbations. There was consensus that physiological arousal was generally detrimental to health. Women also described limited, and in some cases maladaptive, strategies to cope with racist events, including eating unhealthy food choices and portions. There was consensus that the subjective nature of perceiving racism and accompanying social prohibitions often made it impossible to address racism directly. Many women described anger in such situations and the tendency to internalize anger and other negative emotions, only to find that the negative emotions would be reactivated repeatedly with exposure to novel racial stressors, even long after the original racist event remitted. African American women in this study believed that racism affects their diabetes self-management and control. Health beliefs can exert powerful effects on health behaviors and may provide an opportunity for health promotion interventions in diabetes.