Executive Dysfunction in Depressive Disorders
This chapter reviews the current knowledge of the association between depression and executive functions (EFs). It defines various depressive disorders and describes their proposed neural substrates. Executive dysfunction in depressive disorders is discussed and how it changes across different stages of development including childhood/adolescence, adulthood, and senescence. For children and adolescents with major depressive disorder (MDD), there are inconsistent findings reported on deficits in EFs. Research demonstrates that EF impairments in depressive disorders are more common in adulthood, specifically for verbal fluency and inhibition, with no deficits observed in shifting. Moreover, depression-related executive dysfunction is more pronounced during advanced age. The importance of distinguishing between early- and late-onset depression in aging is emphasized, considering that both have distinct cognitive/neurological profiles and different treatment trajectories. In abnormal aging, major cognitive deficits in patients with late-life depression (LLD) have been shown to relate particularly to fronto-subcortical circuit dysfunction. Finally, the overlapping neural circuitries of depression and EFs are discussed, particularly the dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC). Depressed individuals tend to have hypoactivation of the DLPFC, reduced gray matter and demyelination, as well as blunted activation in the ACC, contributing to a decline in EFs and an increased severity of depressive symptoms.
KeywordsDepression Dysexecutive syndrome Prefrontal cortex Cingulate cortex Depressive disorder Late-life depression Aging Early-onset depression Executive function Orbitofrontal
We would like to express our gratitude to Valeria L. Torres for her comments and editing of this manuscript.
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