EPV595
Global cognitive functioning in TRD and non-TRD patients: longitudinal real-world evidence from the PROMPT study
V. T. H. Wahner 1,*, S. Jörgens 1 2, B. T. Baune 1 3 4 and PROMPT consortium
1Department of Psychiatry, University of Münster, Münster, 2Department Hamm 2, Hochschule Hamm-Lippstadt, Hamm, Germany, 3Department of Psychiatry, University of Melbourne, 4Florey Institute of Neuroscience and Mental Health, Parkville, Australia
Introduction: The exact role of cognitive functioning (CF) and impairment in treatment-resistant depression (TRD) is not well understood. In particular, the lack of longitudinal and comparative data with non-TRD patients represents a major gap in the current literature.
Objectives: This study sought to compare 12-week trajectories of global CF between TRD and non-TRD patients in a real-world setting.
Methods: This prospective observational study included 146 inpatients with major depressive disorder (MDD) who were assessed with a standardized cognitive test battery (BAC-A) and structured clinical interviews at baseline, week 8, and week 12. Fifty-four patients (mean age = 48.5±15.5; 48% female) met the criteria for TRD, defined as nonresponse to at least two antidepressant regimens during the current episode, and were compared with ninety-two non-TRD patients (mean age = 33.9±12.8; 50% female). Composite cognitive z-scores (age- and sex-adjusted) were analysed using linear mixed-effects models to examine the effects of group, time and their interaction. In a second step, the model was adjusted for symptom severity (MADRS scores), recurrence, years of education, current medication (benzodiazepines, antipsychotics) and psychiatric comorbidities (anxiety disorders, personality disorders).
Results: Global CF improved significantly over 12 weeks (β = 0.29, p < .001). The TRD group showed lower baseline CF (β = -0.45, p = .032). This group effect was no longer significant after adjustment for clinical covariates. Higher education predicted better CF (β = 0.12, p < .001), whereas antipsychotic use was associated with poorer CF (β = -0.74, p < .001). The non-significant group × time interaction indicated similar trajectories between groups. Random-effects variances (intercept = 1.05; slope = 0.00) suggested substantial between-subject variability at baseline and parallel improvement trajectories. Figure 1 depicts group mean trajectories of global CF over 12 weeks.
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Conclusions: Observed differences in global CF between TRD and non-TRD patients appear to reflect underlying clinical characteristics rather than treatment resistance per se. Future studies should investigate group differences at the domain level and account for substantial between-subject variability in their analyses.
Disclosure of Interest: V. Wahner: None Declared, S. Jörgens: None Declared, B. Baune Consultant of: BTB received speaker/consultation fees from: AstraZeneca, Lundbeck, Pfizer, Takeda, Servier, Bristol Myers Squibb, Otsuka, LivaNova, Boehringer-Ingelheim, Biogen and Janssen-Cilag.