Neurocognitive dysfunction in antidepressant-free, non-elderly patients with unipolar depression: Alerting and covert orienting of visuospatial attention

Background: Cognition is impaired across various domains in young and middle-age adults with unipolar depression. Performance appears in general worse in effortful tasks requiring executive function and attention. Probing specific cognitive operations in depressed patients, such as alerting and covert orienting of visuospatial attention, can better define and characterize the pathophysiology. Methods: Nine antidepressant-free, clinically depressed patients and fourteen age-matched healthy subjects performed a Posner task with components of phasic alerting and covert orienting of visuospatial attention. Reaction times were analyzed by repeated-measures ANOVA with DIAGNOSIS as the between-group measure. Visual field (FIELD), stimulus onset asynchrony (SOA), and orienting CUE condition were within-subject, repeated measures. Results: ANOVA showed intact attentional orienting in both groups. There were no FIELD differences across groups nor main effects of DIAGNOSIS. Interactions of DIAGNOSIS with SOA and DIAGNOSIS with CUE condition identified a phasic alerting deficit in the depressed patients. There were no significant effects of time-on-task, suggesting adequate vigilance or sustained attention in both groups. Plotting depressed versus control subjects' reaction time for each task condition (Brinley plot) showed linearity with a slope of 1.6 (i.e., patients were 1.6-fold slower) and a correlation coefficient of 0.98 (accounting for 96% of the overall variance). Limitations: This study contains a small sample with potential for Type II error. The study addressed depression at the syndrome level. Depressed patients selected on particular symptom dimensions (e.g., anxiety, psychomotor retardation, etc.) could reveal abnormalities in hemisphere asymmetries that were not observed here. Conclusions: These data highlight that global slowing is a major cognitive deficit in depression and arises across levels of difficulty. Putative specific deficits in depression need adjustment for the large effects of global slowing which can mimic selective impairments in more effortful task conditions.