The Role of Cognitive Dysfunction in Late-Life Depression

Depression is one of the most common psychiatric concerns in older adults. Because of the intersection of biological, emotional, social, and cognitive factors that are at play in depression, symptoms are often heterogeneous in presence and severity. In combination with the expected changes in cognitive abilities as one ages, late-life depression can be additive to these changes. The higher risks of neurodegenerative processes and vascular events in later life can cause, magnify, or accelerate cognitive decline. As such, individuals with late-life depression often present with a complex array of problems that can impact cognition and functioning, and thus complicate the implementation of traditional psychotherapies. Although treatment methods have been adapted to target late-life depression, they are often modifications of treatment approaches for depression in other age groups, rather than developments to directly address unique late-life depression presentations. This dissertation will investigate and discuss aspects of our understanding of the role of cognitive functioning in late-life depression, with the overarching goal of narrowing the focus of research and clinical practice to targeting shortcomings and improve late-life depression treatment. The three main aims of the dissertation are broadly, (1) identify how the scientific literature accounts for cognitive functioning in late-life depression psychotherapy research, (2) determine whether cognitive functioning predicts late-life depression psychotherapy treatment response, and (3) understand the barriers and facilitators to practical implementation of an adapted psychotherapy for late-life depression.