Executive functions and updating of the contents of working memory in unipolar depression.

BACKGROUND Depression is characterized by cognitive impairments, including executive dysfunctions. These executive deficits could reflect impairments of more basic executive processes, such as updating, set shifting and inhibition. While shifting and inhibition impairments are often reported, studies on depression have been somewhat obscure about specific deficits of the updating process. The main goal of that study was to assess the updating process in young in-patients with depression. METHODS We used a verbal n-back task to assess updating process. Load and mental manipulation within working memory (WM) were incremented by using three different levels of complexity (1,2,3-back). Neuropsychological tests and an attentional task (0-back) were also administered to subjects. Twenty-two individuals meeting DSM-IV criteria for Major Unipolar Depression and 22 healthy control subjects, matched on age, verbal IQ and education, were included in the study. RESULTS Subjects with depression showed significant deficits at the n-back task compared to control subjects. They were normal in tasks assessing the short-term maintenance in WM and attention. This suggests that depressed patients exhibit impairment in the updating process. Depressed patients also showed set shifting and inhibition deficits. Only the n-back task was correlated with the number of hospitalizations and the longitudinal course of the illness. CONCLUSIONS Our results suggest that young depressed in-patients have widespread executive dysfunctions, including updating, shifting and inhibition processes. We also found a correlation between a longitudinal measure of depression severity and an updating task performance. We suggest that using multiple executive tasks gives the opportunity to distinguish the specific influence of various executive processes on clinical dimensions in depression.