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Change in Cognitive Function over the Course of Major Depressive Disorder: A Systematic Review and Meta-analysis

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Abstract

Major depressive disorder (MDD) is associated with significant cognitive deficits during the acute and remitted stages. The aim of this systematic review and meta-analysis was to examine the course of cognitive function whilst considering demographic, treatment, or clinical features of MDD that could moderate the extent of cognitive change. Databases were searched to identify studies that reported on cognitive function in MDD with a ≥12-week test–retest interval. Relevant studies were pooled using random effects modelling to generate an inverse-variance, weighted, mean effect size estimate (Hedges’ g) of cognitive change for each cognitive variable and for an overall composite cognitive domain. Of 6898 records, 99 eligible studies were identified from which 69 were meta-analysed, consisting of 4639 MDD patients (agemean = 40.25 years, female% = 64.62%) across 44 cognitive variables. In over 95% of cognitive variables, improvements were either of non-significant, negligible, or of a small magnitude, and when compared to matched healthy controls, the possibility of practice effects could not be precluded. Depressive symptom improvement and the number of previous depressive episodes moderated the extent of cognitive change, demonstrating state- and scar-like features for one-quarter of the cognitive domains. Further longitudinal studies are required to elucidate the MDD cognitive trajectory from initial onset. Findings nonetheless suggest that following pharmacological and non-pharmacological treatment, cognitive change in MDD is typically small, but the capacity for change may be less with episode recurrence. Targeting cognition early in the course of illness may facilitate better prognosis and support a more complete functional recovery.

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Data Availability

The datasets analysed during the current study are available at https://osf.io/8srcj/?view_only=6bb8e7404e714ebeb81c23c747f4b34a. Additional data generated during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank Leah Doyle, BSc. Psychology student, who assisted in the completion of title and abstract screening. Furthermore, we would like to extend a thank you to the authors that corresponded to our request for additional information or descriptive data in order to facilitate study inclusion in the meta-analysis.

Funding

The completion of this research project was supported by funding from Dublin City University School of Psychology as part of the Staff Research Funding for Undergraduate Summer Internships (UGSI) 2021 Scheme awarded to EA (as PI) and JW (as undergraduate student).

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Authors and Affiliations

  1. School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland

    Elayne Ahern & Jessica White

  2. Department of Psychology, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland

    Elayne Ahern

  3. School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland

    Jessica White

  4. Department of Applied Social Sciences, Technological University of the Shannon Midwest, Limerick, Ireland

    Eadaoin Slattery

Authors
  1. Elayne Ahern
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  2. Jessica White
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  3. Eadaoin Slattery
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Contributions

EA: conceptualisation, methodology, investigation, data management (screening and extraction), formal analysis, visualisation, writing — original draft, writing — review and editing, supervision, project administration, funding acquisition; JW: data management (screening and extraction), visualisation, writing — original draft, writing — review and editing, funding acquisition; ES: data management (screening), writing — review and editing.

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Correspondence to Elayne Ahern.

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Competing Interests

EA received funding from the Irish Research Council under the Government of Ireland Postgraduate Scholarship Programme (GOIPG/2018/1729) for research on online psychological treatments in major depressive disorder to promote functional recovery, including online neurocognitive remediation therapy which exclusively targets cognition (2018–2020). No other potential conflicts of interest are reported by the authors.

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Ahern, E., White, J. & Slattery, E. Change in Cognitive Function over the Course of Major Depressive Disorder: A Systematic Review and Meta-analysis. Neuropsychol Rev (2024). https://doi.org/10.1007/s11065-023-09629-9

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