The impact and challenges of cognitive impairments - Interview with Kamilla Miskowiak

EPA 2017 Florence, Prof Kamilla Miskowiak: the impact and challenges of cognitive impairments

An interview with Kamilla Miskowiak, of the University Hospital, Copenhagen, Denmark

What impact do cognitive symptoms have on a patient’s ability to function and return to work?

Cognitive impairments are a key problem for many people with mood disorders. They often persist into periods of remission even when a person is relatively well. Such deficits are a real obstacle and make it difficult for people to function at work. They can create stress and lead to poor decision making and are associated with increased risk of relapse.

There are also social aspects to cognitive dysfunction. If people cannot attend to a conversation, or remember what others have said, they are not able to engage in social life in the way that they did before.

 

What are the most significant challenges in treating mood disorders?

It is not just a case of feeling well but also of doing well, if you want to be well.

Cognitive dysfunction is not sufficiently targeted by current treatments. And this is a challenge since such problems are an obstacle for patients. It is also the case that there has been no consensus on when and how to assess cognition. We need more research on screening tools and guidance on how to use them. We also need randomised trials of targeting treatment on cognitive impairment.

Lately, there has been a shift in focus from simply improving mood symptoms -- so that patients fall below a certain cut-off score -- to a paradigm in which the target is functional recovery. This includes quality of life and capacity to work. For patients this is not just a case of feeling well but also of doing well, if they want to be well.

Can anything be done to smooth the return to work for people who are in recovery from MDD?

There are two steps: the first is to assess cognitive functioning in patients – to establish that they really are ready to perform the tasks required. There might be a neuropsychological report that identifies strengths and weaknesses. And then we can capitalise on the strengths and adjust work demands to accommodate weaknesses. That should improve the success rate in return to work, which is far better than keeping patients off work. People want to be productive and contribute.

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