Moving Beyond Mood: Is it Time to Recommend Cognitive Training for Depression in Older Adults?

Abstract

Major depression is often associated with neuropsychological deficits, most commonly in the areas of executive functioning (e.g. set-shifting, problem-solving, decision-making), information processing speed, new learning and memory. These cognitive deficits may be even more pronounced in older adults with depression and particularly in those with cardiovascular risk factors, where cognitive impairment is linked with multiple pathophysiologies including white matter lesions and alterations in key grey matter brain structures. In this group, underlying neurodegenerative pathology is also an important consideration. Of concern, cognitive deficits are predictive of treatment responsiveness and may persist despite depressive symptom resolution. However, most traditional treatments for depression (i.e. antidepressants and psychological therapies) do not focus on cognition. By contrast, cognitive training is a novel non-pharmacological therapy that may be used to directly target cognition and psychosocial functioning, by promoting neural plasticity. In this chapter, we review the evidence for cognitive training in depression with additional reference to work in healthy samples and those with neuropsychiatric and neurodegenerative disease. Studies using both computer-based and strategy-based training approaches are discussed. To date, there is a lack of well-controlled studies utilising cognitive training for people with depression. Nonetheless, 13 studies employing computer-based cognitive training programs reveal promising results, particularly for improving memory and mood. Further randomised controlled trials in those with depression are now required, to examine the potential magnitude of cognitive improvement and to determine which individual, clinical and treatment-related factors may influence treatment efficacy.