Cognitive Performance in Non-Psychotic Non-Suicidal Unipolar Depressed Patients

Marco Moniz


Background: Cognitive impairment is central in depression and executive dysfunctions in patients with depression are frequent. However, little attention has been paid to the specificities of executive changes in patients with unipolar depression, though these modifications may have serious implications for psychosocial functions and treatment of these patients.
Goals: To compare neuropsychological performance, regarding executive functions, of two adult groups: non-psychotic non-suicide attempters with unipolar depression and healthy individuals.
Methods: This is a cross-sectional study with data collected in an outpatient clinic of mental health service of a general hospital. We
compared a group of non-psychotic non-suicidal unipolar depressed patients to a group of individuals without depression. Depressed subjects were controlled for prior suicidal attempts, and their neuropsychological profile was assessed using a range of measures of attention, verbal fluency, memory, psychomotor speed, and executive functioning (planning, decision making, set shifting, response inhibition, and inhibitory control).
Results: The group with depression (n=23) was significantly outperformed by the group of healthy individuals (n=23) in all measures. Also, differences in the executive functions of planning, decision making, set shifting, and inhibitory control were confirmed. We were unable to identify differences between non-suicidal individuals with depression and individuals without depression in terms of response inhibition, as has been the case in previous studies with samples with suicidal unipolar depressive patients.
Discussion: These results reinforce the hypothesis that there are specific alterations in patients with depression and highlight the need to develop specific cognitive rehabilitation programs for this population.


Unipolar depression, Executive dysfunction, Attention, Verbal fluency, Psychomotor speed.

Full Text:

View article


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

Arbuthnott, K., & Frank, J. (2000). Trail Making Test, Part B as a Measure of Executive Control: Validation Using a Set-Switching Paradigm. Journal of Clinical and Experimental Neuropsychology, 22, 518–528.;1-0;FT518.

Bashir, M., Khade, A., Kosaraju, S., Kumar, C. V., & Rani, U. (2013). Comparative Study of Psychomotor Performance in Depression Patients with Healthy Volunteers. Research and Reviews: A Journal of Medical Science and Technology, 2, 15–18.

Beats, B. C., Sahakian, B. J., & Levy, R. (1996). Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed. Psychological Medicine, 26, 591–603.

Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 7-15.

Bezdjian, S., Baker, L. A., Lozano, D. I., & Raine, A. (2009). Assessing inattention and impulsivity in children during the Go/NoGo task. British Journal of Developmental Psychology, 27, 365-383.

Canavarro, M. C. (2007). Inventário de sintomas psicopatológicos (BSI): Uma revisão crítica dos estudos realizados em Portugal. In M. R., C. Machado, M. M. Gonçalves, & L. S. Almeida (Eds.), Avaliação psicológica: Instrumentos validados para a população portuguesa (pp. 305-330). Coimbra, Portugal: Quarteto Editora.

Carrillo-de-la-Peña, M. T., & García-Larrea, L. (2007). Right frontal event related EEG coherence (ERCoh) differentiates good from bad performers of the Wisconsin Card Sorting Test (WCST). Neurophysiologie Clinique/Clinical Neurophysiology, 37, 63-75.

Cavaco, S., Gonçalves, A., Pinto, C., Almeida, E., Gomes, F., Moreira, I., … Teixeira-Pinto, A. (2013a). Trail making test: Regression-based norms for the Portuguese population. Archives of Clinical Neuropsychology, 28, 189-198.

Cavaco, S., Gon.alves, A., Pinto, C., Almeida, E., Gomes, F., Moreira, I., … Teixeira-Pinto, A. (2013b). Semantic fluency and phonemic fluency: Regression-based norms for the Portuguese population. Archives of Clinical Neuropsychology, 28, 262-271.

Cavaco, S., Pinto, C., Gonçalves, A., Gomes, F., Pereira, A., & Malaquias, C. (2008a). Trail making test: Dados normativos dos 21 aos 65 anos. Psychologica, 49, 222-238.

Cavaco, S., Pinto, C., Gon.alves, A., Gomes, F., Pereira, A., & Malaquias, C. (2008b). Auditory verbal learning test: Dados normativos dos 21 aos 65 anos (norms for 21–65 years old). Psychologica, 49, 208-221.

Cella, M., Dymond, S., & Cooper, A. (2010). Impaired flexible decision-making in major depressive disorder. Journal of Affective Disorders, 124, 207–210.

Christianson, M. K., & Leathem, J. M. (2004). Development and standardisation of the computerised finger tapping test: Comparison with other finger tapping instruments. New Zealand Journal of Psychology, 33, 44-49.

Degl’Innocenti, A, Agren, H., & B.ckman, L. (1998). Executive deficits in major depression. Acta Psychiatrica Scandinavica, 97, 182–188.

Elliott, R., Sahakian, B. J., McKay, A. P., Herrod, J. J., Robbins, T. W., & Paykel, E. S. (1996). Neuropsychological impairments in unipolar depression: The influence of perceived failure on subsequent performance. Psychological Medicine, 26, 975–989.

Gohier, B., Ferracci, L., Surguladze, S. a, Lawrence, E., El Hage, W., Kefi, M. Z., … Le Gall, D. (2009). Cognitive inhibition and working memory in unipolar depression. Journal of Affective Disorders, 116, 100–105.

Harvey, P. O., Le Bastard, G., Pochon, J. B., Levy, R., Allilaire, J. F., Dubois, B., & Fossati, P. (2004). Executive functions and updating of the contents of working memory in unipolar depression. Journal of Psychiatric Research, 38, 567–576.

Hubel, K. A., Yund, E. W., Herron, T. J., & Woods, D. L. (2013a). Computerized measures of finger tapping: Reliability, malingering and traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 35, 745-758.

Hubel, K. A., Yund, E. W., Herron, T. J., & Woods, D. L. (2013b). Computerized measures of finger tapping: Effects of hand dominance, age, and sex. Perceptual & Motor Skills: Motor Skills & Ergonomics, 116, 1-24.

Hueng, T.-T., Lee, I. H., Guog, Y.-J., Chen, K. C., Chen, S. S., Chuang, S. P., … Yang, Y. K. (2011). Is a patient-administered depression rating scale valid for detecting cognitive deficits in patients with major depressive disorder? Psychiatry and Clinical Neurosciences, 65, 70–76.

Hyler, S. E. (1994). Personality diagnostic questionnaire. New York, NY: New York State Psychiatric Institute.

Kaller, C. P., Unterrainer, J. M., Rahm, B., & Halsband, U. (2004). The impact of problem structure on planning: Insights from the Tower of London task. Cognitive Brain Research, 20, 462–472.

Kertzman, S., Reznik, I., Hornik-Lurie, T., Weizman, A., Kotler, M., & Amital, D. (2010). Stroop performance in major depression: Selective attention impairment or psychomotor slowness? Journal of Affective Disorders, 122, 167–173.

Kindlon, D., Mezzacappa, E., & Earls, F. (1995). Psychometric properties of impulsivity measures: Temporal stability, validity and factor structure. Journal of Child Psychology and Psychiatry, 36, 645–661.

Lam, R. W., Kennedy, S. H., McIntyre, R. S., & Khullar, A. (2014). Cognitive Dysfunction in Major Depressive Disorder: Effects on Psychosocial Functioning and Implications for Treatment. The Canadian Journal of Psychiatry, 59, 649–654.

Lampe, I. K., Sitskoorn, M. M., & Heeren, T. J. (2004). Effects of recurrent major depressive disorder on behavior and cognitive function in female depressed patients. Psychiatry Research, 125, 73–79.

McKinlay, A., & McLellan, T. (2011). Does mode of presentation affect performance on the Tower of London task?. Clinical Psychologist, 15, 63–68.

Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41, 49-100. cogp.1999.0734

Moniz, M., De Jesus, S. N., Gonçalves, E., Pacheco, A., & Viseu, J. (2016c). Decision-making in adult unipolar depressed patients and healthy subjects: Significant differences in net score and in non-traditional alternative measures. Neuropsychological Trends, 19, 7-15.

Moniz, M., De Jesus, S. N., Gonçalves, E., Viseu, J., Baptista, A. S., & Pacheco, A. (2016d). Computerized Victoria Stroop test in adult unipolar depressed patients and healthy subjects: Influence of age and gender. Psychology, 7, 1-5.

Moniz, M., De Jesus, S. N., Gonçalves, E., Viseu, J., Pacheco, A., & Moreira, S. (2016e). Portuguese version of simple Go/No-Go task: Influence of age in attention and response inhibition reaction time. Psychology, 7, 254-257.

Moniz, M., De Jesus, S. N., Pacheco, A., Gonçalves, E., & Viseu, J. (2016f). Computerized finger tapping task in adult unipolar depressed patients and healthy subjects: Influence of age, gender, education, and hand dominance. Review of European Studies, 8, 1-10.

Moniz, M., de Jesus, S. N., Pacheco, A., Gonçalves, E., Viseu, J., Brás, M., … Batista, S. (2017). The influence of planning and response inhibition on cognitive functioning of nonpsychotic unipolar depressed suicide attempters. Europe’s Journal of Psychology. 13, 717-732.

Moniz, M., De Jesus, S. N., Viseu, J., Gonçalves, E., Moreira, S., & Pacheco, A. (2016a). Executive dysfunction in nonpsychotic unipolar depressed patients: Assessement by the Wisconsin (Berg) Card Sorting Test. International Journal of Psychological Studies, 8, 112-118.

Moniz, M., De Jesus, S. N., Viseu, J., Gonçalves, E., Pacheco, A., & Baptista, A. S. (2016b). Planning dysfunction in nonpsychotic unipolar depressed patients: Assessement by a computerized version of the Tower of London task. International Journal of Psychological Studies, 8, 119-124.

Moritz, S., Birkner, C., Kloss, M., Jahn, H., Hand, I., Haasen, C., & Krausz, M. (2002). Executive functioning in obsessive-compulsive disorder, unipolar depression, and schizophrenia. Archives of Clinical Neuropsychology, 17, 477–483.

Mueller, S. T., & Piper, B. J. (2014). The Psychology Experiment Building Language (PEBL) and PEBL test battery. Journal of Neuroscience Methods, 222, 250-259.

Newman, S. D., Greco, J. a, & Lee, D. (2009). An fMRI study of the Tower of London: A look at problem structure differences. Brain Research, 1286, 123–132.

Piper, B. J., Mueller, S. T., Geerken, A. R., Dixon, K. L., Kroliczak, G., Olsen, R. H. J., & Miller, J. K. (2015). Reliability and validity of neurobehavioral function on the Psychology Experimental Building Language test battery in young adults. PeerJ, 3, e1460.

Roca, M., Vives, M., Lopez-Navarro, E., Garcia-Campayo, J., & Gili, M. (2015). Cognitive impairments and depression: a critical review. Actas Esp Psiquiatr, 43, 187–193.

Rogers, M. a, Kasai, K., Koji, M., Fukuda, R., Iwanami, A., Nakagome, K., … Kato, N. (2004). Executive and prefrontal dysfunction in unipolar depression: A review of neuropsychological and imaging evidence. Neuroscience Research, 50, 1–11.

Rohling, M. L., Green, P., Allen, L. M., & Iverson, G. L. (2002). Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests. Archives of Clinical Neuropsychology, 17, 205–222.

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., … Dunbar, G. C. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12, 232-241.

Sohlberg, M. M., & Mateer, C. A. (2001). Cognitive Rehabilitation: An Integrative Neuropsychological Approach. New York, NY: The Guilford Press.

Sousa, M. P., Lopes, J. S., & Vieira, R. (1979). Comparação entre a Escala de Hamilton e o questionário de Beck na quantificacão das depressões. Jornal do Médico, 103, 561-571.

Stordal, K. I., Lundervold, A. J., Egeland, J., Mykletun, A., Asbjørnsen, A., Landrø, N. I., … Lund, A. (2004). Impairment across executive functions in recurrent major depression. Nordic Journal of Psychiatry, 58, 41–47.

Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A Compendium of neuropsychological tests: Administration, norms, and commentary (3rd ed.). Oxford, UK: Oxford University Press.

Swann, A. C., Katz, M. M., Bowden, C. L., Berman, N. G., & Stokes, P. E. (1999). Psychomotor performance and monoamine function in bipolar and unipolar affective disorders. Biological Psychiatry, 45, 979–988.

Troyer, A. K., Leach, L., & Strauss, E. (2006). Aging and response inhibition: Normative data for the Victoria Stroop Test. Aging, Neuropsychology, and Cognition, 13, 20-35.

Wagner, S., Doering, B., Helmreich, I., Lieb, K., & Tadić, A. (2012). A meta-analysis of executive dysfunctions in unipolar major depressive disorder without psychotic symptoms and their changes during antidepressant treatment. Acta Psychiatrica Scandinavica, 125, 281–292.



  • There are currently no refbacks.