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Cognitive Behavioral Performance of Untreated Depressed Patients with Mild Depressive Symptoms
For more information about PLOS Subject Areas, click here. Damage of the brain mental processes and behavior study evaluated the working memory performance of 18 patients experiencing their first onset of mild depression without treatment and 18 healthy matched controls. The results demonstrated that working memory impairment in patients with mild depression occurred when memorizing the position of a picture but not when memorizing the pictures themselves.
There was no significant difference between the two groups in the emotional impact on the working memory, indicating damage of the brain mental processes and behavior the attenuation of spatial working memory was not affected by negative emotion; however, cognitive control selectively affected spatial working memory, damage of the brain mental processes and behavior. In addition, the accuracy of spatial working memory in the depressed patients was not significantly reduced, but the reaction time was significantly extended compared with the healthy controls.
This finding indicated that there was no damage to memory encoding and function maintenance in the patients but rather only impaired memory retrieval, suggesting that the extent of damage to the working memory system and cognitive control abilities was associated with the corresponding depressive symptoms.
The development of mild to severe depressive symptoms may be damage of the brain mental processes and behavior by spatial working memory damage from the impaired memory retrieval function extending damage of the brain mental processes and behavior memory encoding and memory retention impairments. In addition, the impaired cognitive control began with an inadequate capacity to automatically process internal negative emotions and further extended to impairment of the ability to regulate and suppress external emotions.
The results of damage of the brain mental processes and behavior mood-congruent study showed that the memory of patients with mild symptoms of depression was associated with a mood-congruent memory effect, demonstrating that mood-congruent memory was a typical feature of depression, regardless of the severity of depression.
This study provided important information for understanding the development of cognitive dysfunction. Citation: Li M, Zhong N, Lu S, Wang G, Feng L, Hu B Cognitive Behavioral Performance of Untreated Depressed Patients with Mild Depressive Symptoms. PLoS ONE 11 1 : e Received: April 21, ; Accepted: December 16, ; Published: January 5, Copyright: © Li et al.
This is an open access article distributed under the terms of the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. htmlauthors who received the funding: ML NZ SL ; Open Research Fund of Beijing Key Lab of Magnetic Resonance Imaging and Brain Informatics CGZC03, authors who received the funding: ML NZ SL ; and Beijing Outstanding Talent Training Foundation G, authors who received the funding: ML NZ SL.
The funders had no role in study design, data collection and analysis, damage of the brain mental processes and behavior, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist. Numerous studies have confirmed that patients with depression have emotional and cognitive deficits [ 1 — 4 ], with executive, language, and working memory dysfunctions [ 5 — 9 ], damage of the brain mental processes and behavior.
After completing memory tasks, patients with depression performed significantly worse than the normal population [ 5 ]. Working memory [ 10 ] provides temporary storage and a limited processing system for cognitive information. It comprises the cognitive bases of verbal understanding, reasoning, problem solving, and learning. Working memory is divided into spatial working memory and non-spatial working memory including words and objects based on memory objects, with spatial working memory more active in the right frontal hemisphere and non-spatial working memory more active in the left frontal hemisphere [ 11 ], damage of the brain mental processes and behavior.
A study has shown that the right hemisphere has more conductive to spatial working memory, and the left hemisphere is more conductive to non-spatial working memory [ 12 ]. Previous studies of working memory have primarily involved research on the executive function, cognitive control function, non-spatial working memory of words or objects, spatial working memory, relationship between emotional and spatial working memory, and mood-congruent memory.
An imaging study has demonstrated abnormal executive function and a template of visuospatial function in the working memory of patients with depression [ 13 ]. Studies have also demonstrated that the impaired working memory in patients with depression primarily showed deficits in executive function [ 1415 ].
These patients demonstrated a high error rate in the working memory task and an extended response time [ 16 ]. Schatzberg et al. have observed significant impairments in attention and verbal memory in patients with depression [ 17 ].
A word memory study by Fossati et al. showed that patients with depression performed normally in a cued-recall and a recognition memory task, but were impaired in free recall [ 18 ]. Harvey et al. have used an n-back working memory paradigm for verbal memory study.
The accuracy of the working memory of patients with severe depression was lower than that of healthy controls, and the response time of patients with severe depression was significantly longer than that of healthy controls [ 2 ].
Rose and Ebmeier used a symbolic n-back experimental paradigm and showed lower memory accuracy and a longer response time in patients with depression compared with healthy controls [ 19 ]. Some studies have suggested that the working memory of patients with depression declines as the task difficulty increased [ 236 ]. Many studies have focused on the relationship between emotion and cognition. Research has shown that negative emotion has different impacts on the words and spatial working memory in normal subjects [ 2021 ].
Lavric et al. used a word n-back working memory task and spatial n-back working memory task and showed that negative emotion had no impact on the results of the word memory task but did affect spatial working memory [ 20 ]. Li et al. have also demonstrated that negative emotion did not impact word memory damage of the brain mental processes and behavior but did impact spatial working memory, with a decline in spatial working damage of the brain mental processes and behavior retention capacity [ 22 ].
These results indicated that negative emotion selectively affects spatial working memory. This type of impact was explained as follows: Shackman believed that negative emotion and spatial working memory both have advantages in the right hemisphere of the brain.
This overlap of cortical functions allows them to mutually affect each other [ 21 ]. Weiland-Fiedler et al. believed that depression primarily damaged the right hemisphere of the brain, resulting in more influences on the right hemisphere, which is associated with spatial working memory [ 1 ]. believed that the emotional impact of memory might not result in competition in the cortical region but rather a competition of resources.
Spatial working memory required more attention resources compared with word memory, thereby resulting in functional damage to spatial working memory [ 20 ]. Hertel et al. have suggested that patients with depression experience a loss of cognitive control function, leading to decreased working memory capacity [ 23 ]. However, some studies have observed damage to both verbal and spatial working memory in patients with depression [ 24 ]. The differences among these studies may be caused by different memory material and the depression severity in the tested subjects.
Studies of mood-congruent memory [ 2526 ] have suggested that stimuli that are consistent with emotion are more easily remembered [ 27 ], that is, people with negative emotion could easily remember the negative information [ 28 ]. Storbeck and Clore induced different emotions in the subjects to study mood-congruent memory and found that subjects with an induced negative emotional status had a more accurate memory than subjects with an induced positive emotional status [ 29 ].
Patients with depression tended to remember more negative stimuli that were consistent with their mood compared with the healthy controls. In contrast, these patients rarely remembered the positive stimuli that were inconsistent with their mood [ 30 ].
The enhanced memory of mood-congruent negative stimuli and the reduced memory of positive stimuli that were inconsistent with the mood might represent the cognitive control ability of patients with depression [ 3132 ], damage of the brain mental processes and behavior.
Although the results of studies on mood-congruent memory and on the selective influence of negative emotion appear inconsistent, they are not contradictory. Negative emotions selectively affect spatial working memory, which explains the differences in memory accuracy and response times inter-group comparisons associated with different emotions between the patient and healthy control groups. Mood-congruent memory studies have observed differences in the memory accuracy of subjects experiencing negative or positive emotional states in intra-group comparisons.
Hence, using different perspectives, these two study types reveal memory effects among depressed patients. Although many studies have observed working memory damage in patients with depression, regardless of whether they are simple working memory studies in patients with depression or studies of the correlation between emotion and memory, there have been inconsistent findings and conclusions.
There are several possible explanations for these discrepancies. For example, word memory encoding is localized in the left prefrontal cortex, while the encoding of facial emotional memory involves the bilateral prefrontal cortex [ 33 ].
For patients with depression and attention deficit, the short display time of memory stimuli affects the memory encoding. This memory impairment may not be associated with a difference in the memory system but may mostly reflect the lack of attention resources [ 20 ]. However, the severity of depression e.
There is insufficient comparative analysis evidence for both spatial working memory and non-spatial working memory between patients with depression and healthy controls. Otherwise, most previous studies have focused on the working memory of patients with severe depression but have rarely reported on patients with mild depression who can live and work normally [ 2224 damage of the brain mental processes and behavior. In this study, we assessed patients with a first onset of untreated mild depression.
All subjects provided signed informed consent and this study was approved by the Ethics committee at Beijing Anding Hospital, Capital Medical University, China. Thirty-six subjects participated in this study, including 18 patients with depression i. The patients were recruited at their first visit to the outpatient clinic at Beijing Anding Hospital, Capital Medical University, Beijing, China, and the healthy volunteers were recruited through promotional posters.
All patients were diagnosed with depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-IV. Severity of depression was assessed using Clinical Global Impression- severity of illness CGI-SIin which the CGI-SI was scored by one doctor, and can divide the severity of depression into eight level a score from 0—7 : 3 is mild and 4 is moderate.
In addition, the 17 items of the Hamilton depression rating scale HAMD scored by another doctor, and the Quick inventory damage of the brain mental processes and behavior depressive symptomatology-self report QIDS-SR 16 were used to assess the depression. Only when the results assessed by the CGI-SI, HAMD and QIDS-SR 16 are consistent mild or moderatethe patients could be enrolled.
Subjects were given the payment after completion of the experiment. This study used three types of experimental pictures, including 60 samples each of positive, neutral, and negative pictures.
All pictures were obtained from the International Affective Picture System IAPSwith an average valence of 7. After picture processing using Picture Manager Software Adobe Photoshop 6. This study used a modified Sternberg working memory WM paradigm [ 34 ].
To examine the consistency of mood and memory, each WM encoding task prompted four pictures depicting a specific type of emotions i. These four pictures corresponded to four different positions upper left, upper right, lower left, and lower right. The WM encoding task used in the experiment included positive, damage of the brain mental processes and behavior, negative, and neutral pictures.
The probe stimulus, and WM encoding task picture types were identical. Probe stimuli were divided into two types: a picture probe presenting at the center of the screen and a picture position probe presenting at any location. Then, the WM encoding task was presented for 10 seconds. The subjects were instructed to memorize each picture and its corresponding position during 10 second periods, damage of the brain mental processes and behavior.
After the encoding task disappeared, a five-second WM maintenance was given; then, a probe picture was shown at the center of the screen, and the subjects were asked to judge whether the probe picture was previously shown.
Subjects were required to press the left button if the probe had been shown previously and the right button if the probe had not been previously shown. After the subjects pressed the button, the same probe picture was shown the picture position probe and the subject was asked if the picture had been shown at this particular position. SPSS We employed a mixed-model analysis of variance ANOVA with 2 group: depressed, control × 3 within-subject factor stimulus material: positive, neutral, negative repeated measures analysis on the accuracy and response time of the picture and position working memory, and we used the Bootstrapped two-way ANOVA bootstrap samples to verify; we included gender, age and education level as covariates.
Comparisons of between-group in age and years of education were performed using an independent-samples t-test; pair-wise inter-group comparisons were performed using independent-samples t-tests, and the Bootstrapped independent-samples t-tests bootstrap samples were used to verify; pair-wise intra-group comparisons on the three emotional picture types were performed using paired-samples t-tests, the Bonferroni method was applied to conduct multiple comparison corrections, and we also used the Bootstrapped paired-samples t-tests bootstrap samples analysis.
The comparison of gender distribution between the groups depressed patients and healthy volunteers was performed using a chi-squared test. In addition, we also analyzed the effect size.
Brain and Mental Health - Nucleus Health
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