Discussing cognitive symptoms with your patients

Temporal challenges facing adequate assessment

With the duration of a psychiatrist appointment standing at between 10 and 60 minutes per patient,* the effective diagnosis and management of depression can be a challenge.1

Identifying the patient’s emotional manifestations, in addition to any cognitive symptoms can be time-consuming. Another confounding factor is the patient’s difficulty in accurately describing the feelings and challenges which their condition provokes. As a result, adequate assessment of mood and cognition may be difficult in clinical practice.

Useful questions to ask during a consultation
Currently, there is little consensus to examine cognitive function as a routine aspect of depression assessment. Therefore, the following questions from the 5-item Perceived Deficit Questionnaire for depression (PDQ-5-D) may help to provide an insight into your patients’ cognitive performance:2

During the past four weeks, how often did you:

  • Have trouble getting things organised?
  • Have trouble concentrating on things like watching a television programme or reading a book?
  • Forget the date unless you looked it up?
  • Forget what you talked about after a telephone conversation?
  • Feel like your mind went totally blank?

The above questions do not include all cognitive deficits, nor do they exclude cognitive problems, even if negative answers are provided. They may however aid the identification of cognitive symptoms, which could then be further assessed. Details of the variety of both clinician-rated and patient-rated assessments of cognition can found in Assessing cognition in depression.

Identifying a patient’s cognitive symptoms can help reassure them that they are not part of a separate condition

Following a complete assessment, it is important that patients are made fully aware of their symptoms, and how these could be impacting on their lives. Identifying that their cognitive difficulties and their depression are linked can help to reassure patients that their cognitive impairment is not the result of a separate condition.

Importance of assessing cognition during follow-up

During follow-up appointments, assessments of cognition are an important consideration in the evaluation of progress and treatment success.2 This includes recovering patients, as cognitive symptoms have been shown to present for an average of 44% of the time during periods of remission.3 Systematic follow-up is also associated with positive outcomes in collaborative care for depression.4

Above all, it is important to define recovery from depression as the absence of all symptoms (emotional, physical and cognitive) and functional impairments associated with the condition.5

 

*Depending on local practice

References
  1. Cruz M et al. Appointment length, psychiatrists’ communication behavious and medication management appointment adherence. Psychiatric services 2013; 64(9): 886-892.
  2. Culpepper L. Cognition in MDD: Implications for Primary Care. In: Cognitive Dysfunction in Major Depressive Disorder. Ed: McIntyre R, Cha D, 2015.
  3. Conradi HJ et al. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med 2011; 41: 1165-117.
  4. Craven MA et al. Better practices in collaborative mental health care: an analysis of the evidence base. Can J Psychiatry 2006; 51(6 Suppl 1):7S-72S.
  5. Greer TL et al. Defining and Measuring Functional Recovery from Depression. CNS Drugs 2010; 24(4): 267-284.
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